Submitted: 31 July 2024
Accepted: 24 February 2025
Published online: 1 July, TAPS 2025, 10(3), 37-48
https://doi.org/10.29060/TAPS.2025-10-3/OA3473

Kevin Xuan Hong Tang¹, Koon Kee Teo¹ & Kye Mon Min Swe²

¹Department of Medicine, Faculty of Medicine, Newcastle University Medicine Malaysia (NUMed), Malaysia; ²Department of Research, Faculty of Medicine, Newcastle University Medicine Malaysia (NUMed), Malaysia

Abstract

Introduction: Every medical graduate is expected to fulfil the teaching responsibilities stated by the General Medical Council (GMC). It is beneficial to nurture both teaching motivation and skills early in the undergraduate program. This study aims to evaluate the outcomes of final-year medical students as near-peer teachers in a student-led near-peer teaching program and their fulfilment of the educational responsibilities stated by the GMC.

Methods: A cross-sectional study was conducted among the year 5 medical students who participated in the Peer Teaching Program. A structured post-participation 6-point Likert scale questionnaire with written consent was distributed to the near-peer teachers to assess their perspectives on skills enhancement, motivation, and career direction. Additionally, the Peer Tutor Assessment Instrument questionnaires were distributed to the near-peer students to evaluate the performance of the near-peer teachers in five areas: responsibility and respect, information processing, communication, critical analysis, and self-awareness.

Results: There were 28 near-peer teachers, and 49 near-peer students participated in the study.  The near-peer teachers score the highest in skills (5.36 ± 0.53), followed by motivation (5.16 ± 0.60) and career direction (4.79 ± 0.82). Three quarters of the near-peer teachers considered teaching to be their future primary career path after experiencing this teaching experience (4.36 ±1.34). Generally, the near-peer teachers were highly evaluated by the near-peer students across all domains (5.06 ± 0.51).

Conclusion: Overall, the near-peer teaching programme likely improved the final-year medical students in fulfilling the “Doctors as Teachers” responsibilities outlined by the GMC.

Keywords:           Near-peer Teaching, Medical Students, Undergraduate Medical Education, General Medical Council, Doctors as Teachers

Practice Highlights

• Near-peer teachers are likely improved in skills enhancement, motivation and career direction.
• Sex and students’ background are not associated with the perceived outcomes of near-peer teachers.

I. INTRODUCTION

One of the aspects of Good Medical Practice outlined by the General Medical Council (GMC) for all medical professionals is to “be willing to offer professional support to colleagues, including students, through teaching” (General Medical Council, 2023). The role of doctors as teachers has been widely recognised as they need to teach and educate juniors, students and even patients (General Medical Council, 2011, 2015, 2023). On average, junior doctors spend around 80 minutes per day teaching medical students (Busari et al., 2002). This task is daunting for every new medical graduate who has just begun their UK foundation programme. They need to assume this responsibility with minimal formal training and preparations (Pierce et al., 2024; Qureshi et al., 2013).

Therefore, it is beneficial to motivate medical graduates to teach and equip them with appropriate teaching skills as early as their undergraduate programme (General Medical Council, 2011; Knobloch et al., 2018). Near-peer teaching involves students one or more academic years ahead teaching their peers or junior students (De Menezes & Premnath, 2016; Ten Cate & Durning, 2007; Yu et al., 2011). This has long been thought of as a programme to be incorporated into the medical curriculum to optimise teaching qualities and to produce more competent and knowledgeable doctors in the future (Botelho et al., 2022; Burgess et al., 2014; Zheng & Wang, 2022). Generally, medical schools provide a safe space for medical students to practice, correct and improve their teaching and pedagogical skills (Hardie et al., 2022). Most medical students feel less daunted and more supported involved in teaching their near-peer students (Yu et al., 2011).

To address this gap of insufficient teaching opportunities, most medical schools provide near-peer teaching programmes for their medical student (Frearson & Gale, 2017). However, most of the near-peer teaching programmes are carried out formally with structured guidance and training (General Medical Council, 2011), be it in the form of the Peer Assisted Learning Scheme (PALS) student-selected components (SSC) (Furmedge et al., 2014; Hettle & Morgan, 2019; Ross & Cameron, 2007; Ten Cate & Durning, 2007) or Doctors as Teachers and Educators training course (Cook et al., 2010; General Medical Council, 2011). Little is known about the outcomes of the student-led, student-run, near-peer teaching (NPT) programme in medical schools.

In the academic year 2023/2024, the Newcastle University Medicine Malaysia (NUMed) final-year medical students were involved as near-pear teachers in an NPT programme. This study thus aims to evaluate the outcomes of participation of the final year medical students as near-peer teachers in the student-led near-peer teaching programme and to determine whether the soon-to-be medical graduates can fulfil the “Doctors as Teachers” responsibilities stated by the GMC.  

II. METHODS

The NPT Programme was a purely student-led, student-run 3-month teaching programme which provided additional focus on the learning outcomes of the third-year medical curriculum. This programme functioned as an adjunct to the formal curriculum and provided precious opportunities for final-year medical students to improve their teaching skills.

Before the academic year started, invitation email was sent out to recruit final-year medical students to participate voluntarily as the near-peer teachers and the year 3 medical students as the near-peer students. A total of 51 final-year medical students and 100 year 3 medical students signed up for this programme. The near-peer students were randomly assigned to groups of 5 to 6 each, and each group was guided by 3 near-peer teachers. Before the programme commenced, all near-peer teachers were required to attend a mandatory online training course conducted by the lecturers to enhance their presentation and teaching skills.

This programme comprised a total of twelve teaching sessions spanning twelve weeks, covering four sessions of Essential Clinical Placement teaching sessions, four sessions of Case-Based Discussion, one surgical teaching topic and case-based session, one Single Best Answer practice session, one Written Prescribing Exam (WRISKE) session and one Objective Structural Clinical Examination (OSCE) session. Most sessions were delivered virtually (Zoom) or physically, depending on students’ preferences, except for the OSCE session, which was always conducted physically. The teaching materials were prepared by the near-peer teachers beforehand and distributed to the students after each teaching session. The NPT programme coordinator supervised and provided necessary support to both near-peer teachers and near-peer students throughout the entire programme.

The near-peer teachers and near-peer students consented to participate in this study via written consent. A structured post-participation Likert 6-point scale “Peer Tutors Own Assessment” questionnaire with written consent, which was adopted from Liew et al. (2015), was sent to the near-peer teachers after this Near-Peer Teaching Programme via Google form to explore their perceived benefits in three components which are 1) Skills Enhancement, 2) Motivation and 3) Career Direction [Expectation]. This questionnaire (Appendix 1) contains 14 items, with responses scale from strongly disagree (1) to strongly agree (6). Cronbach’s alpha was 0.801, 0.714, and 0.814 for the domains of skills enhancement, motivation, and career direction.

Similarly, all the near-peer students who participated in this near-peer teaching programme were given the Peer Tutor Assessment questionnaire adopted from Liew et al. (2015), to fill in via Google form (Appendix 2). This questionnaire is to assess the acceptability of the teachings of the near-peer teachers. It contains 16 items that evaluate five domains: (1) Responsibility and Respect, (2) Information Processing, (3) Communication, (4) Critical Analysis, and (5) Self-Awareness. Subgroup analyses were conducted to evaluate whether sex and student background affect self-perceived outcomes of near-peer teachers using independent T-test. Each participant was given 3 weeks to complete the questionnaire. Several reminders were sent via email throughout these 3 weeks to each participant to encourage them to fill in the questionnaire. Both near-peer teachers and near-peer students’ data were checked for normality. The asymmetry fell between -1 and +1 and assumed relatively symmetrical and mesokurtic.

III. RESULTS

A total of 51 medical students in their final year signed up as near-peer teachers. Of these, 28 near-peer teachers completed the questionnaire (response rate 54.9%), while 49 out of 100 near-peer students who joined this NPT programme responded in this study (response rate 49.0%). Among those near-peer teachers who responded, there were 9 (32.1%) males and 19 (67.9%) females. More local students responded in this study than international students (75% vs 25%). The overall mean age ± SD of the near-peer teachers is 23.75 ±1.21 years old.  For the near-peer students, the overall mean age ± SD is 21.69 ± 0.74 years old. The number of international and local near-peer students who responded was similar. The data of the responses of both near-peer teachers and near-peer students that supports the findings of this study  is openly available at Figshare https://doi.org/10.6084/m9.figshare.26886517.v1 (Tang et al., 2024a) and https://doi.org/10.6084/m9.figshare.26886514.v1 (Tang et al., 2024b).

Table 1 showed peer review findings to ensure their voices were represented. To ensure the trustworthiness of the findings, actions were taken to address credibility, dependability, confirmability, transferability, and reflexitivity are outlined in Table 2. Figure 1 indicates the near-peer teachers view of the benefits of involving in the student-led near-peer teaching program.

Table 1. Demographic data of the near-peer teachers

Table 2. The mean score (± SD) for the self-evaluation of near-peer teachers in relation to (1) skills enhancement, (2) motivation and (3) career direction (expectation)

Figure 1. Near-peer teachers view of the benefits of involving in the student-led NPT program: Analysis of post-participation questions responses (n=28) in Likert 6-point scale in relation to (a) skills enhancement, (b) motivation and (c) career direction (expectation)

Based on the responses to the questionnaire, the near-pear teachers widely agreed that the NPT programme positively impacted them (5.11 ± 0.58), with the highest score in the domain of skills enhancement (5.36 ± 0.53), followed by motivation (5.16 ± 0.60) and career direction (4.79 ± 0.82). Most of the near-peer teachers considered this programme improved their skills in terms of teaching, organising, communicating and understanding educational principles (Table 2). 100% of them agreed that this NPT programme increased their confidence in speaking to groups and enhanced their planning and organising skills.  Furthermore, all 28 respondents (100%) reported being more motivated to revise their own clinical skills and focus more on their practical skills after teaching near-peer students to address the

knowledge gap. A significant proportion of near-peer teachers felt more encouraged to participate in more teaching programmes in the future (n=27, 96.43%) and more inclined to help fellow students next time (n=25, 89.28%).  It is noteworthy that 96.43% of near-peer teachers agreeing that this NPT programme helped in deciding their career direction and motivated them to undertake more trainings. Besides, three quarters of them would consider teaching as their major career pathway in the future, with a mean score of 4.36 ± 1.34. Lastly, all 28 respondents (100%) agreed that joining the NPT programme had enhanced their curriculum vitae (100%).

Table 3 shows the mean score of near-peer students’ evaluation of near-peer teachers in five domains after joining the near-peer teaching programme.

Table 3. The mean score (± SD) for the near-peer students’ evaluation of near-peer teachers after the NPT programme in relation to (1) responsibility and respect, (2) information processing, (3) communication, (4) critical analysis and (5) self-awareness

When asked to evaluate the teaching of their near-peer teachers, the near-peer students considered the near-peer teachers demonstrating positive outcomes in all five domains (5.06 ± 0.51). The near-peer teachers were thought to have a high degree of professionalism in terms of responsibility and respect (5.15 ± 0.57) and self-awareness (5.11 ± 0.62). The most outstanding attribute demonstrated was the ability to complete assigned tasks appropriately (5.27 ± 0.73). Besides, the near-peer teachers performed satisfactorily to process information (5.12± 0.66), communicate (5.01± 0.65) and analyse critically (4.93 ± 0.66). However, the near-peer teachers were identified to score slightly lower in making non-confusing comments and responses (4.92 ± 0.84) as well as giving a summary of the session (4.90 ± 0.82).

Variables	Independent T- test
	Mean difference (95% CI)	P-value
Sex (Male vs Female)
Skills	-0.101 (-0.549, 0.348)	0.649
Motivation	0.118 (-0.385, 0.621)	0.634
Career Direction (Expectation)	0.507 (-0.154, 1.169)	0.127
Students’ background (Local vs International)
Skills	-0.210 (-0.688, 0.268)	0.376
Motivation	-0.276 (-0.810, 0.258)	0.297
Career Direction (Expectation)	0.280 (-0.439, 1.034)	0.414

Table 4. Comparison of self-perceived outcomes of near-peer teachers between male and female, local and international students (Independent t-test)

The independent t-test were performed to find out the association between sex and perceived outcomes of the near-peer teachers. Our study revealed that it is statistically insignificant between male and female in the perceived benefits for skills (P = 0.649), motivation (P = 0.549) and career direction (P = 0.127).

Besides, there is no correlation between students’ background and the three measured outcomes. There is statistically insignificant between local and international students in term of skills (P = 0.376), motivation (P = 0.397) and career direction (P = 0.414).

IV. DISCUSSION

This study provides valuable insights into the background and characteristics of the final-year medical students who voluntarily participated in a student-led, student-run NPT programme. The outcomes of their participation concerning their perceived benefits in terms of skills, motivation, and expectations were investigated. Overall, the near-peer teachers reported that this NPT programme helped them tremendously to improve their skills in terms of learning and teaching, which might be driven by their primary motive for joining this programme. This finding was similar to previous studies, which showed skills enhancement in volunteer near-peer teachers (Buckley & Zamora, 2007; Liew et al., 2015). Our study further reaffirms the plausibility of a student-run NPT programme to enhance teaching and learning skills. However, due to the voluntary nature of participation in this near-peer teaching programme, the students who are likely most in need of skill enhancement may have been omitted from this programme, and they might be less equipped to teach after they graduate. Some studies recommended more incentives to be given to such students to encourage them to make use of the opportunities offered (Buckley & Zamora, 2007).

The motivation evaluated includes both self-actualising inner motivations to improve their clinical and practical skills and the external, tangible desire to help fellow students. The high motivation score suggests the reinforcement of a desirable attitude towards future educational and teaching responsibilities, which matches the GMC’s emphasis on the teaching role of doctors (General Medical Council, 2015). A couple of reasons may explain this: firstly, the near-peer teachers are final-year medical students, who will sit for their final examinations very soon and are desperately finding ways to improve their learning. The process of teaching, which requires extensive preparation, a comprehensive understanding of the content, dynamic synthesis, and anticipation of the questions that may be asked of them, forms an efficient learning strategy. Secondly, the near-peer teachers, inspired by the excellent teaching they once had, wish to impart good teaching to the near-peer students going through the same journey.

Although many near-peer teachers are more motivated to be involved in more teaching and even take up teaching training courses in the future, the influence is not apparent in the long-term career direction. This could be explained well by the brief intervention of this NPT programme that lasted 3 months. However, the lucrative income opportunities in other medical specialities and the limited exposure to medical education pathways in undergraduate medical schools are some factors that may sway them away from considering medical education as their primary career pathway (Puri et al., 2021; Sarikhani et al., 2021). Therefore, more effort should be directed to increase teaching opportunities and to raise awareness of medical education career options in the undergraduate medical school programme. This includes developing Student Selected Components focusing on medical education and giving opportunities to shadow clinical teaching staff (Liew et al., 2015; Wilson et al., 2008).

After participating in this study, the near-peer students evaluated the near-peer teachers highly in all the domains. This provides a strong indication of the recognition and acceptance of the teaching skills of the near-peer teachers. In addition, the ability of the near-peer teachers to demonstrate responsibility and respect throughout this programme shows their preparedness to work under the GMC with desirable attitudes and professionalism. Previous studies have also shown that near-peer teachers gain more subjectively and objectively than students (Liew et al., 2015; Ten Cate & Durning, 2007). This can be related to the underpinning of the psychological and social theories behind the dynamics between near-peer teachers and near-peer students (Loda et al., 2019). The theoretical model of cognitive and social congruence explains the positive evaluation of the near-peer teachers (Loda et al., 2019; Rollmann et al., 2023). The proximity of age between the near-peer teachers and the near-peer students enables them to share similar knowledge frameworks, language and social roles.  Besides, near-peer teachers are perceived to be more approachable and understanding of the needs and struggles of the near-peer students. This may be because the near-peer teachers have had similar experiences themselves. Therefore, near-peer teachers are better able to process difficult concepts and frameworks, emphasize the key points, and communicate the information using familiar and non-confusing language to ensure that near-peer students comprehend better (Loda et al., 2019; Loda et al., 2020). The perceived barrier to providing feedback to near-peer teachers is also lower compared to faculty-led staff, as the age difference between them is much smaller. This might suggest why near-peer teachers feel less offended by criticism and are more likely to accept and respond to criticism gracefully (Loda et al., 2019). Nevertheless, the near-peer students thought that some near-peer teachers experienced some difficulties in giving relevant input and summary of the sessions, thus necessitating more structured pedagogical training for near-peer teachers in this aspect. Mastering these teaching skills would allow the near-peer students to appreciate better the big picture and key takeaway points of each lesson (Khaw & Raw, 2016).

One of the focuses of this study is to analyse the sex-specific difference of the perceived outcomes of the near-peer teachers. Although there is an appropriate twice female near-peer teachers who responded to this study compared to male near-peer teachers, the results shows that the sex-specific difference in the perceived improvement in motivation, skills and career direction is not significant. There is no sex-specific difference in term of enthusiasm and motivation to involve in near-peer teaching (Messerer et al., 2021).  Throughout the whole process, they receive similar gender-equitable support and guidance without any discrimination.

V. LIMITATIONS AND RECOMMENDATIONS

As few studies have reported outcomes for a purely student-led student-run NPT programme, this study offers valuable insights concerning the perceived benefits for near-peer teachers. However, this study has several limitations. Firstly, given the relatively small sample size of the near-peer teachers and the subjective nature of the self-reported questionnaire, the results may benefit from further objective testing, such as correlation with examination results. Secondly, this study is only carried out in a single medical school, with a slight variation in the implementation of the NPT compared to other institutions. Verification of these results across various medical schools would strengthen these findings. This study thus calls for more structured student-led peer teaching programmes to be implemented in more medical schools and to be assessed longitudinally to evaluate the association between the student-led peer teaching programme and the outcomes of participation of the near-peer teachers. It may also be worthwhile to investigate and assess the perspective of near-pear teachers who demonstrated interest in medical education, as well as to evaluate the long-term outcomes in career direction for medical graduates who once participated in near-peer teaching programmes.

VI. CONCLUSION

In conclusion, this purely student-led, student-run near-peer teaching programme likely improved the final-year medical students in fulfilling the “Doctors as Teachers” responsibilities outlined by the GMC. Besides, the near-peer teachers also reported having positive outcomes in their skills and career direction.  Likewise, from the perspective of the near-peer students, the near-peer teachers demonstrated outstanding skills and professionalism in all five domains: responsibility and respect, information processing, communication, critical analysis and self-awareness. Possessing the skills and professionalism fulfils the expectations of GMC for healthcare professionals to provide the right care at the right time with the right skills for the good of patients.

Notes on Contributors

Kevin Xuan Hong Tang was a final year medical student who conceptualised and designed the study, reviwed the literature, conducted the data collection and analysis, prepared the figures and wrote the manuscript.

Koon Kee Teo was a final year medical student who reviewed the literature, collected and analysed the data, prepared the figures and helped in writing the manuscript.

Kye Mon Min Swe is an Associate Professor in Education Research in NUMed. She participated in conceptualising the study, performed statistical analysis and drafted, reviewed and edited the manuscript. All the authors have read and approved the final manusript.

Ethical Approval

 This study titled “Embracing Doctors as Teachers: Evaluating the Student-led Near-Peer Teaching at Transnational Campus” was approved by the Research Management Committee and the Newcastle University Ethics Committee (Approval number 45070/2023).

Data Availability

The data that support the findings of this study are openly available in Figshare repository, as below,

https://doi.org/10.6084/m9.figshare.26886517.v1 (Tang et al., 2024a) and

https://doi.org/10.6084/m9.figshare.26886514.v1 (Tang et al., 2024b).

Acknowledgement

The authors would like to thank the NUMed Medical Education Society for carrying out this programme. The authors are grateful for Professor Vishna Devi Nadarajah for her support and feedback in this research.

Funding

The authors declare that there is no funding received in this study.

Declaration of Interest

The authors declare that there is no conflict of interest.

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*Kye Mon Min Swe
1, Jalan Sarjana 1, Educity,
79200 Iskandar Puteri, Johor, Malaysia
Email: kye-mon.min-swe@newcastle.edu.my

Submitted: 13 June 2024
Accepted: 4 February 2025
Published online: 1 July, TAPS 2025, 10(3), 26-36
https://doi.org/10.29060/TAPS.2025-10-3/OA3439

Humairah Zainal¹, Xin Xiaohui¹, Julian Thumboo^1,2,3 & Fong Kok Yong^2,3

¹Health Services Research Unit, Singapore General Hospital, Singapore; ²Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, ³Duke-NUS Medical School, National University of Singapore, Singapore

Abstract

Introduction: As healthcare becomes increasingly digital, undergraduate medical students receive limited formal training in digital healthcare technologies (DHTs). Additionally, stakeholders’ perspectives on essential digital health competencies (DHCs) across generations remain underexplored. This comparative study aims to identify knowledge gaps, inform evolving expectations, and promote continuous learning by comparing medical students’ and senior clinicians’ views on essential DHCs in Singapore.

Methods: Individual semi-structured interviews were conducted with medical students, clinical educators, and clinical teachers. Clinical-year medical students from all three local medical schools were recruited using convenience and snowball sampling, while purposive sampling ensured diverse representation of clinicians across Singapore’s public healthcare organisations, focusing on those engaged in education-related activities. Data were collected from September 2020 to February 2023 until thematic saturation was achieved, and analysed using qualitative thematic analysis.

Results: Sixty-three participants took part, including 30 medical students, 12 clinical educators and 21 clinical teachers. All clinicians had more than 10 years of clinical experience and came from 24 different disciplines and 12 healthcare institutions. The findings showed unanimous support for integrating electronic health records in patient communication, and training in DHTs like telemedicine and point-of-care ultrasound. Discrepancies emerged; clinicians prioritised physical examination, while students viewed it as potentially replaceable by DHTs. Furthermore, while students valued healthcare-related smartphone applications in patient care, few clinicians shared this view, citing privacy and security concerns.

Conclusion: Evaluating stakeholders’ perspectives highlights evolving clinical skills and essential DHCs for medical students, potentially informing global DHC training programmes.

Keywords:           Technology, Medical Education, Curriculum, Clinical Competence, Digital Competence, Qualitative, Singapore

Practice Highlights

• An inter-generational perspective in medical education leverages the strengths of both medical students and senior clinicians, ensuring a balanced approach that keeps pace with technological advancements while maintaining the core principles of patient care.
• The digital health competencies deemed essential for future clinical practice are consistent across all stakeholders.
• The study highlights the emerging need for additional competencies among medical trainees so as to meet the evolving demands of healthcare delivery.
• Regularly comparing the perspectives of various stakeholders in the healthcare system enables educational institutions to adapt and refine their curricula continuously.

I. INTRODUCTION

Digital healthcare, which leverages advanced technologies to enhance, complement, or replace traditional healthcare services, is becoming increasingly common in clinical practice (Alkire (née Nasr) et al., 2020). Digital healthcare technologies (DHTs) such as electronic health records (EHR), telemedicine, and Artificial Intelligence (AI) have significantly improved data management, diagnostics, and patient care (Clay-Williams et al., 2023; Food and Drug Administration, 2019; Welcher et al., 2018;). However, many studies and reviews have highlighted a global lack of formal and systematic training in DHTs for undergraduate medical students (Aungst & Patel, 2020; Edirippulige et al., 2018; Tudor Car et al., 2021). While recommendations for integrating digital health education (DHE) exist, they often propose standalone courses focused on specific DHTs rather than embedding DHE into the core medical curriculum (Tudor Car et al., 2021; Zainal et al., 2023a; Zainal et al., 2023b).  Barriers to consistently incorporating DHE into medical curricula, as reported in countries such as Canada, Germany, the United Kingdom (U.K.), and the United States (U.S.) include limited faculty expertise, curriculum overload and fragmented implementation efforts (Gillissen et al., 2022; Hurley et al., 2011; Machleid et al., 2020; Sit el al., 2020; Sorg et al., 2022).

Furthermore, there is limited research exploring the perspectives of both medical students and senior clinicians on the relevant digital health competencies (DHCs) required for clinical care. DHCs encompass the knowledge, skills, and attitudes essential for assessing, diagnosing, and treating patients in the digital age. An inter-generational comparison of these perspectives is crucial for identifying gaps in the existing curricula and ensuring medical education aligns with the rapidly evolving healthcare landscape. Medical students can offer fresh insights into emerging tools and platforms while senior clinicians can contribute perspectives on clinical skills given their wealth of clinical experience.

Despite Singapore’s advanced digitalisation, challenges remain in standardising DHE across its three medical schools: Yong Loo Lin School of Medicine at National University of Singapore (NUS), Lee Kong Chian School of Medicine at Nanyang Technological University (NTU) and Duke-NUS Medical School (Duke-NUS) (Zainal et al., 2023a). Although these institutions boast state-of-the-art facilities, a disconnect persists between medical training and clinical practice due to various institutional and structural barriers (Zainal et al., 2023a). While efforts to integrate DHE, such as virtual reality courses, have been initiated, there are variations in content and duration across institutions, underscoring the lack of a standardised approach (Zainal et al., 2023a).

This study uses Singapore as a case study to explore the perceptions of medical students, clinical educators, and teachers regarding DHCs, with the aim of improving DHE integration into undergraduate medical curricula. Specifically, it compares the views of these stakeholders in identifying any digital competencies that may be relevant for clinical practice in an increasingly digital healthcare landscape. By focusing on Singapore, this study not only sheds light on gaps in the local curricula but also provides insights that can inform global efforts to strengthen DHE integration in medical education.

II. METHODS

A. Setting and Sample

A qualitative study was conducted using individual semi-structured interviews with medical students, clinical educators, and clinical teachers. Participants were identified by Principal Investigator (P.I.) FKY, based on their year of study and clinical roles respectively, ensuring relevant knowledge and experience.

The study employed a combination of convenience sampling and snowballing technique to recruit students from all three local medical schools. Clinical-year students (third to fifth years) were included due to their potential exposure to DHTs during clinical rotations, while pre-clinical students were excluded. Convenience sampling was initially used for ease of access, and snowballing technique was subsequently employed to expand participation and capture diverse perspectives.

To ensure diverse representation among clinicians, purposive sampling was applied across Singapore’s three public healthcare organisations. Clinical educators dedicating over 20 per cent of their time to education-related activities (e.g., teaching, curriculum planning, research, and administration) and clinical teachers contributing less than 20 per cent of their time to such roles were included. Clinicians not involved in educational roles were excluded from the study.

This study was classified as a quality improvement (QI) project on medical education curricula by the SingHealth Research Integrity, Compliance, and Ethics (RICE) committee. As such, it did not meet the criteria for human subject research and was granted an ethical waiver by SingHealth Institutional Review Board (Reference Number: 2020/2880). Nonetheless, this research adhered strictly to the ethical principles of the Declaration of Helsinki and institutional guidelines.

Data collection occurred from September 2020 to February 2023. Participants were invited by the P.I. via email detailing the study’s purpose, procedures, potential risks, and benefits, with consent obtained before the interviews. To address potential biases due to the P.I.’s professional relationships, interviews were conducted by a research fellow without prior connections to participants. Verbal consent was recorded at the start of each Zoom session, and participants were reminded of their right to withdraw, with pre-withdrawal data retained for comprehensive analysis.

To ensure anonymity, participants were assigned coded identifiers (‘MS’ for medical students, ‘CL’ for clinicians). Identifying information and audio recordings were securely stored and separated from the main dataset. Results were reported with care to avoid identifying individuals, and the data was exclusively used for curriculum development.

B. Data Collection

The interview guide followed Kallio et al.’s (2016) framework, including pre-requisites for semi-structured interviews, literature review, expert consultation, preliminary guide development, pilot testing with five participants, and finalisation. Questions addressed clinical competencies, their relevance to digital healthcare, and ways medical schools can better prepare students for digitalisation (Tables 1 and 2). Interviews included medical students and clinicians across specialties to ensure diverse perspectives.

The study involved 63 participants, with sample size guided by theoretical and practical considerations. Data collection continued until thematic saturation was reached, ensuring all relevant perspectives were captured. Practical constraints like time and resources influenced the participant number, but the focus remained on data richness and diversity for a comprehensive exploration of the research questions.

Sixty interviews were conducted via Zoom due to COVID-19 restrictions, with three in-person interviews held under local health guidelines. Each session lasted about 40 minutes and was audio-recorded. Transcriptions were generated using Otter AI and reviewed for accuracy by the P.I. and research fellow.

Table 2. Interview questions for clinical educators and teachers

C. Data Analysis

Thematic analysis followed Braun and Clarke’s six-step framework to explore curricular gaps (Braun & Clarke, 2006). Two researchers independently coded the data, resolving discrepancies through discussion to refine the codebook and ensure consistency. Credibility was enhanced by triangulating findings across participants from various medical schools and healthcare clusters, capturing diverse perspectives and minimising bias.

To contextualise the findings, comparisons were made with studies from other high-income countries undergoing similar healthcare digitalisation. Additionally, recent data from stakeholders, including medical school leaders, were analysed to understand the digital competencies needed for future clinical practice. Reporting adhered to the Standards for Reporting Qualitative Research (O’Brien et al. 2014).

III. RESULTS

Sixty-three participants took part in our study. Thirty of them were medical students who were undergoing clinical rotations in various disciplines, with 10 coming from each school. Twelve were clinical educators and 21 were clinical teachers. The clinicians were aged between 44 and 70 years. All had more than 10 years of clinical experience and came from 24 different disciplines and 12 healthcare institutions. A summary of their demographics is reported in Table 3 and illustrative excerpts are found in Table 4.

Table 3. Demographics of participants

Four major themes were derived from the data.

A. Limited and Inconsistent Exposure to DHTs

Students reported limited exposure to DHTs in core medical curricula, with training mainly through electives, select programmes, and student-driven initiatives. Exposure to health informatics and telemedicine was brief, with telemedicine training primarily prompted by the COVID-19 pandemic. Other DHTs like robotic surgery, virtual reality, and POCUS were inconsistently incorporated across medical schools. Some clinicians also reiterated the need for DHT exposure in public healthcare institutions, as doing so could inspire medical students to engage in innovation, research, and development in cutting-edge fields like robotics.

B. Unified Views among Clinicians and Students on Essential Competencies

Clinicians and students shared unified perspectives on incorporating key DHCs like EHR, telemedicine, and POCUS into medical curricula. These competencies are viewed as crucial for preparing students for contemporary clinical practice.

Participants emphasised the need to balance EHR use with effective patient interaction. M25, a third-year student, highlighted the importance of maintaining empathy and humanistic values, while CL27, a rheumatologist, stressed integrating EHR data into patient discussions to improve engagement and understanding of health conditions.

All groups also agreed on the importance of telemedicine training. Students expressed interest in learning how to identify conditions suitable for virtual consultations, build patient rapport, and conduct comprehensive assessments via tele-platforms. MS5 noted the challenges of teleconsultation, such as interpreting body language and addressing legal responsibilities. Clinicians like CL14 underscored the need to teach students how to select patients for teleconsultation and identify red flags effectively.

Additionally, both clinicians and students strongly supported incorporating POCUS into the curriculum. Students acknowledged its utility in bedside diagnostics, while clinicians like CL9 and CL18 highlighted its value in resource-limited settings and its role in enhancing diagnostic accuracy. They advocated for routine training in ultrasound, considering its increasing use in general practice and as a critical tool in diverse healthcare settings. These unified views suggest the need to prioritise these DHCs in medical education to meet the evolving demands of healthcare delivery.

C. Divergent Opinions on Traditional Clinical Skills

Discrepancies in opinions emerged regarding traditional clinical skills, particularly physical examination. Students often viewed diagnostic imaging and tests as superior to these skills, perceiving physical exams as less critical. For instance, M11, a Year 4 student, argued that ultrasonography provides more precise diagnoses, making physical examination less relevant.

Clinicians, however, emphasised preserving traditional skills like history-taking and physical examination, especially for resource-limited settings. CL3, an ophthalmologist, expressed concern that reliance on diagnostic tools has led to the erosion of these essential skills.

D. Emerging Technologies and Concerns

The perceived competencies for medical education varied between students and senior clinicians. Students valued wearables and healthcare apps for patient empowerment, personalised care, and strengthening doctor-patient trust. For instance, MS30, a fourth-year student, suggested that wearable data could help create personalised care plans and enhance clinical practice.

Clinicians, however, expressed concerns about the privacy and security of patient data in these apps. They emphasised the responsibility to protect patient information and were cautious about using apps that did not meet security standards. These differing opinions highlight the need for a DHE curriculum that addresses both student interests and clinician concerns.

In our sample selection, we included both clinical educators and clinical teachers to capture a range of perspectives on the integration of DHCs into medical education. However, our analysis did not reveal significant differences in the views expressed by these two groups. Both shared similar opinions on the importance of teaching DHCs such as EHR, telemedicine and POCUS. This alignment may be attributed to their shared roles in preparing medical students for clinical practice, regardless of their specific titles or responsibilities. As such, the findings reflect a unified perspective among clinicians involved in medical education, despite the initial distinction made in the sample selection.

Table 4. Illustrative quotes from interviews with participants

IV. DISCUSSION

This study contributes to the literature by comparing the views of medical students, clinical educators, and clinical teachers on essential competencies for medical school curricula. It highlights a consensus on the need for training in EHR, telemedicine, and POCUS, while also identifying emerging needs like interpreting data from healthcare devices and engaging patients with this data. Unlike previous studies that focused on either clinicians or students (Blacketer et al., 2021; Foadi et al., 2021; Gillissen et al., 2022; Hersh et al., 2017; Liu et al., 2022; Machleid et al., 2020; Pontefract & Wilson, 2019), this research explores inter-generational differences, revealing that younger trainees prioritise patient-centred care and digital health literacy. This emphasis on inclusivity and data literacy is crucial given the global challenge of inadequate health literacy, particularly among older populations (Sørensen et al., 2021; Wittink & Oosterhaven, 2018). Integrating these competencies into curricula can foster ongoing improvement in medical education.

In comparing the views of medical students and senior clinicians regarding DHCs, it is important to acknowledge that the latter group represents a diverse range of roles within the clinical environment. While this study focused specifically on clinicians involved in medical education, senior clinicians may also take on roles as clinical researchers, administrators, or leaders in healthcare innovation. These differing responsibilities could shape their perspectives on the DHCs that should be emphasised in medical curricula. The results of this study should be interpreted within the context of the clinical educators’ primary role in teaching medical students, which may prioritise practical and immediate clinical skills over broader administrative or research-based digital competencies.

The integration of EHR systems into medical education has been recognised as essential. Successful models in the U.S. and U.K. have embedded EHR systems into training, such as allowing students to write notes at primary clinical sites or use de-identified patient data for practice (Pereira et al., 2018; Pontefract & Wilson, 2019; Welcher et al., 2018). These approaches ensure hands-on learning and prepare students for modern healthcare environments. For broader applicability, partnerships with local healthcare institutions and technology providers can enable the development of localised EHR modules tailored to different healthcare contexts. However, over-reliance on EHR systems may reduce critical thinking or direct patient interaction. Mitigation strategies include embedding reflective practices into training and balancing EHR use with patient engagement activities. When successfully implemented, EHR training enhances data management skills and promotes patient interaction.

Telemedicine training varies globally, often focusing on rural healthcare placements, as seen in Australia and the U.K. (Rienits et al., 2016; Wootton, 1999). In Singapore, telemedicine exposure arose mainly during the COVID-19 pandemic’s social distancing requirements, highlighting its potential in urban healthcare. To ensure comprehensive telemedicine training, curricula should include simulated consultations, role-playing exercises, and coverage of diverse scenarios, such as breaking bad news over digital platforms. To address the challenge of interpreting body language, medical schools should incorporate modules that focus on interpreting non-verbal cues, such as facial expressions and gestures, which are essential for building rapport and understanding patients’ concerns. Courses that address the legal responsibilities in telemedicine, including patient confidentiality, informed consent, and documentation requirements, should also be integrated to ensure students are aware of the regulatory frameworks guiding virtual care. Case studies and real-life examples that discuss the legal implications of telemedicine can also help students navigate potential legal challenges. With regard to patient selection, it is crucial for professional bodies to develop frameworks that guide clinicians in determining when in-person care is more appropriate, especially for complex or high-risk cases. Additionally, the curricula should provide guidance on how to recognise red flags such as signs of mental health distress, urgent medical conditions, or patient non-compliance with digital tools, and escalate them appropriately. Providing continuing education opportunities for practising clinicians is also important to keep them updated on telemedicine advancements. The healthcare system can then pair students with experienced telemedicine practitioners who can provide the necessary mentorship and guidance.

POCUS has become an essential component of undergraduate medical education (Glass et al., 2021; Sheppard et al., 2023). However, its application is often limited to specific specialties, such as emergency medicine, obstetrics and gynaecology, and radiology (Glass et al., 2021). In contrast, our study advocates for a longitudinal POCUS curriculum spanning all years and specialties. Integrating POCUS training into medical curricula improves diagnostic accuracy, enhances bedside decision-making, and builds clinical confidence. A structured approach, such as Kern’s six-step model, provides a robust framework for designing and implementing a standardised curriculum with consistent competency assessments (Kern, 1998). Innovative teaching methods, including handheld devices and near-peer instruction, have been shown to improve ultrasound proficiency and student performance, as evidenced by successful implementations at the University of Connecticut School of Medicine (Boivin et al., 2022). While improper use of POCUS can result in diagnostic errors, these risks can be mitigated through routine competency evaluations and guided practice, ensuring students develop the necessary skills safely and effectively.

Addressing differing opinions regarding DHC priorities in schools requires collaboration among medical educators, technology developers, and healthcare providers. Medical curricula should include training on the responsible use of DHTs, and evaluating the reliability of apps. Developers should design apps that address clinicians’ data security concerns. Moreover, healthcare organisations should establish guidelines and protocols for healthcare-related app use to ensure patient safety and privacy. Integrating these competencies into medical curricula will better prepare future healthcare professionals for evolving demands of healthcare delivery.

Implementing DHC also requires consideration of diverse healthcare systems and resource availability. Local adaptations, coupled with ongoing evaluation and feedback, ensure curricula remain relevant and scalable. Training programmes must balance global standards with local needs, enabling students to navigate evolving healthcare landscapes effectively. By addressing the implementation strategies, risks, and benefits of DHTs, this study provides actionable insights for advancing DHE.

A. Strengths and Limitations

This qualitative study highlights the DHCs needed in the core medical curricula from the perspectives of students, clinical educators and teachers. The diverse sample of institutions and specialties enriched the data. Student feedback provided up-to-date information on curricula gaps, while senior clinicians’ experience enhanced credibility. Interviewing participants from different generations ensured medical education remains relevant to current and future healthcare needs.

A perceived limitation of this study is its small sample size, which may affect its generalisability, validity and reliability. With a small sample, the findings might not represent the broader population and could miss the population’s diversity (Sandelowski, 1995). Additionally, small sample sizes may not adequately capture the diversity within the population of interest (Sandelowski, 1995). Moreover, the unique socio-political, cultural and economic context of Singapore may limit the generalisability of our findings to other settings. Singapore’s relatively small population and centralised governance create conditions that may differ from other countries. Consequently, while the insights from our study provide valuable lessons, they should be interpreted with caution when applying them to contexts with different governance structures or cultural dynamics.

Despite the limitations, this qualitative study provides a contextualised understanding of participants’ expectations and concerns through in-depth narrative analysis. While not entirely generalisable, the findings have significant implications for medical curricula in other developed countries. They highlight valued competencies, informing curriculum design, training programmes and continuing education initiatives.

Furthermore, this study focused on clinicians from public healthcare institutions, which may influence their perspectives on DHCs. Public sector clinicians often work within more structured systems that prioritise certain competencies differently than in the private sector. While this focus provides insights specific to public healthcare education, it is important to note that the views of private-sector clinicians, who may face different digital health challenges, were not captured in this study. Future work comparing clinicians across both sectors could provide a more comprehensive view. The perspectives of clinicians from the private healthcare sector may also differ due to the distinct operational and financial frameworks in which they practise. 

Moreover, future research could explore the perspectives of clinicians in various roles beyond medical education, such as clinical researchers, healthcare administrators, or those involved in clinical governance. By comparing these viewpoints with those of clinical educators, a more comprehensive understanding of the DHCs required across different professional pathways in healthcare can be developed. Such studies could further inform curriculum development to ensure that medical students are adequately prepared not only for clinical practice but also for the evolving demands of digital health in research, administration, and leadership.

V. CONCLUSION

In conclusion, an inter-generational perspective in medical education leverages the strengths of both medical students and senior clinicians, ensuring a balanced approach that keeps pace with technological advancements while maintaining the core principles of patient care. This collaborative model prepares future healthcare professionals to navigate the evolving landscape of healthcare technology effectively. As the findings have shown, despite their varying levels of experience and diverse medical backgrounds, the DHCs deemed essential for future clinical practice are consistent across all stakeholders. While all stakeholder groups considered most basic clinical skills important, medical students viewed physical examination as replaceable by DHTs. In contrast, the clinical educators and teachers thought otherwise. To address the needs and concerns of all groups, DHCs should complement instead of replace traditional clinical skills.

We acknowledge that the DHTs deemed important in other countries may vary from those reported in this study. However, the type of DHTs to be introduced should not distract us from the main goal of ensuring that the curricula of medical schools around the world remain updated and relevant to current and future healthcare needs. Regularly comparing the perspectives of various stakeholders in the healthcare system is crucial, as it enables educational institutions to adapt and refine their curricula continuously. This iterative process ensures that the curricula remain responsive to the dynamic nature of clinical work.

Notes on Contributors

Humairah Zainal collected and analysed the data, wrote the initial drafts, revised the manuscript for publication and approved the submitted copy of the manuscript.

Xin Xiaohui reviewed, edited, read and approved the submitted copy of the manuscript.

Julian Thumboo reviewed, edited, read and approved the submitted copy of the manuscript.

Fong Kok Yong was involved in the conception and design of the study, reviewed, edited, read and approved the submitted copy of the manuscript.

Ethical Approval

Waiver for ethical approval was granted by SingHealth Institutional Review Board (Reference Number: 2020/2880). 

Data Availability

The data that support the findings of this study are available from the first author upon reasonable request. The data cannot be uploaded to the repository as it contains some confidential views of participants.

Acknowledgements

The authors extend their gratitude to the reviewers for their insightful feedback on the manuscript drafts. Special thanks go to Anisa Muhammad for transcribing the interviews, as well as to Dr. Warren Fong Weng Seng and Dr. Ng Qin Xiang for their assistance in recruiting some of the medical students. The authors also deeply appreciate the invaluable contributions of the study participants.

Funding Statement

This study was supported by SingHealth Duke-NUS Medicine Academic Clinical Programme under Seah Cheng Siang Distinguished Professorship in Medicine.

Declaration of Interest

There are no relevant financial or non-financial competing interests to report.

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*Fong Kok Yong
10 Hospital Boulevard
Singapore 168582
+65 6908 8949
Email: fong.kok.yong@singhealth.com.sg

Submitted: 29 February 2024
Accepted: 5 February 2025
Published online: 1 July, TAPS 2025, 10(3), 15-25
https://doi.org/10.29060/TAPS.2025-10-3/OA3259

Zaw Phyo¹, Titi Savitri Prihatiningsih², Ye Phyo Aung¹ & Tun Tun Naing¹

¹Department of Medical Education, Defence Services Medical Academy, Yangon, Myanmar; ²Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia

Abstract

Introduction: The effective implementation of changes in medical school curricula requires modifications to assessments alongside teaching strategies. The World Federation for Medical Education emphasises the need for assessment policies to align with educational outcomes. In Myanmar, the Defence Services Medical Academy (DSMA) has adopted an outcome-based curriculum since 2017, but the standard setting in assessments remains pending. This study explores concerns and challenges for enhancing assessment practices.

Methods: An explanatory sequential design was used. For a quantitative approach, 36 assessment committee members were surveyed using questionnaires, and pre-and post-test analyses were conducted using SPSS Statistics Version 25. Qualitatively, eight committee members were selected through purposive sampling for in-depth interviews using interpretative methodology with thematic analysis by MAXQDA Software 2022.

Results: It shows that most committee members acknowledge the advantages of standard settings, such as improved teaching and learning defect identification, staff knowledge application, enhanced educational programs, and personal contributions to education quality. Half of the committee members expressed concerns about the increased workload and administrative burden, while another half-supported standard-setting implementation. They all appreciate the integration of standard setting in the outcome-based curriculum, recognising its positive impact on student quality and accreditation standards. Challenges include limited human resources, resistance to change, time-consuming, and an increased workload.

Conclusion: Committee members suggested that targeted interventions are needed to improve awareness, collaboration, and successful implementation. These should consider perspectives, enhance understanding, define roles, and address resources and resistance. This will optimise standard setting, ensure educational quality, and meet accreditation standards.

Keywords:           Assessment, Standard Setting, Integrated Curriculum, Awareness, Perception, Attitude, Lifelong Learning

Practice Highlights

• Members of the committee think that having standards in DSMA’s curriculum is essential for raising the quality of students and the school’s standards.
• Most members know how important it is to set standards, especially for pass/fail exams, and stress how important it is to consider culture and institutional factors.
• Setting standards is thought to help with aligning the curriculum, giving students relevant tests, and meeting accreditation requirements.
• For implementation to go well, all stakeholders must be involved, the process must be in line with real evaluation principles, and teachers must continue to learn and grow.
• Not enough resources, resistance to change, limited time, and more work to do are problems that need solutions based on educational ideas.

I. INTRODUCTION

In the last 30 years, there have been many suggestions for changing the curriculum, but only a few medical schools have made significant changes (Supe & Burdick, 2006). Without altering assessments, modifying curricula or teaching strategies will be ineffective. In the global standards for quality improvement area of the World Federation for Medical Education (WFME), there are clear rules about primary medical education in chapter 3.1 of Assessment Policy and System:

“An assessment policy with a centralised system that guides and supports its implementation will entail using multiple summative and formative methods to acquire the knowledge, clinical skills, and behaviors needed to be a doctor. The policy and the system should be responsive to the school’s mission, specified educational outcomes, available resources, and the context” (World Federation for Medical Education, 2020).

In current Medical Education, with competency-based education becoming more popular, healthcare educational institutions and assessment bodies are being looked at more closely than ever before to make sure they are fair, transparent, and defensible when setting the expected level of performance and rating students’ performance to make decisions about their next steps (Lane et al., 2020). With competency-based assessment, the way the test is done must align with what the student has learned (Crespo et al., 2010).

Regularly setting, keeping, and evaluating assessment standards is essential in medical education. It is not an exact science to set standards. Most educational test validity arguments focus on how well the test matches the curriculum and how valuable the test’s content is (Barman, 2008).

Standards are an expression of values, so the ways to set them are systematic ways to gather people’s opinions on values, make agreements, and show that agreement as a single score on a test (Norcini, 2003). “Standard Setting” is a process used to make precise lines between things like “pass” and “fail” or “honors,” “proficient,” and “needs improvement.” Setting standards is “central to giving meaning to test results and, as such, is at the heart of validity arguments” (Wiliam, 1996).

There are two primary methods in which standards are set: (1) criterion-referenced or absolute methods, in which standards setting is not based on test results, and (2) norm-referenced or relative methods, in which setting standards is based on test results. No golden rule exists (Cohen-Schotanus & Van Der Vleuten, 2010).  In health professions education, it can be challenging to develop credible, defendable, and acceptable passing or cut-off scores for exams (Norcini & Guille, 2002).

In Myanmar, there are currently no private medical schools, although there are five public medical schools and one military medical school (Defence Services Medical Academy). Myanmar medical schools have used traditional lecture-based teaching methods, and many eminent physicians have emerged from teacher-centered educational programs (Myint, 2020).

Defence Services Medical Academy (DSMA), listed in the World Directory of Medical Schools, was founded in Mingalardon, Yangon, on November 19, 1992 (Naing et al., 2022). Since 2017, DSMA has been the first medical school in Myanmar to implement an outcome-based, integrated curriculum. According to the Dundee three circle models, the graduates of DSMA are supposed to be scholars and scientists, as well as practitioners and practitioners professionals (Harden et al., 1999).  The new DSMA curriculum is meant to encourage students to keep learning and give them more responsibility for their learning. It is presently focusing on meeting the criteria of WFME accreditation.

In DSMA, the assessment methods (written, practical, oral, and structured and unstructured observations) include accurate and standardised patients, objective structured clinical examination, patient management problems or simulations, etc. The assessments include continuous assessment, formative assessment, and summative assessment. However, there is no Standard Setting in DSMA, and it will be implemented soon (after training standard setting experts) to set the required basic minimum standards.

Even though accrediting organisations advise medical schools in general what the curriculum should cover and how it should be tested, most medical schools decide how and what to test (Epstein, 2007). There are five ways to figure out how valuable a method of assessment is: reliability (how accurate and repeatable the measurement is), validity (whether the assessment measures what it says it measures), impact on future learning and practice, acceptability to students and teachers, and costs (Van Der Vleuten, 1996). Therefore, the Assessment Committee’s DSMA meetings establish the process and procedures for conducting assessments throughout the undergraduate medical program. The Assessment committee must collect and evaluate feedback regularly, and faculty feedback revealed issues with the assessment process in DSMA.

 For a successful, acceptable, and feasible assessment to implement an outcome-based, integrated curriculum, it is essential to explore how students, faculty, and assessment committee members perceive the implication of the standard setting for the assessment. Therefore, this study investigated what the Assessment Committee members think about setting standards in medical education and the most significant problems.

II. METHODS

A. Research Design

Figure 1 shows explanatory sequential mixed methods design (also called a two-phase model (Creswell & Clark, 2017)): Quantitative followed by qualitative was used to explore the views, opinions, beliefs, and feelings of the assessment committee members (Ivankova & Stick, 2007). For the quantitative, all assessment committee members were asked using questionnaires (Likert scale), and qualitatively, Individual In-depth Interviews (IDI) were asked of the selected assessment committee members.

Figure 1. Explanatory sequential mixed methods design

The main benefit of mixed methods research is that they make a potent mix when quantitative and qualitative data are combined (Miles & Huberman, 1994). In addition, a “complex” image of a social phenomenon might be created, for instance, by evaluating both the quantitative and qualitative aspects of a study’s results (Greene, 2006).

B. Data Collection

For Phase 1 (Quantitative): The survey consists of four parts: (1) Collecting demographic information; (2) Investigating people’s perception of standard-setting procedures; (3) Examining attitudes towards these procedures; and (4) Evaluating these procedures using five-point Likert scale items ranging from 5 (strongly agree) to 1 (strongly disagree).

For Phase 2 (Qualitative): An in-depth interview (IDI) with semi-structured questions was used to collect the data. The researcher made an interview guide, which helped shape the interview and get detailed comments from the assessment committee members. The IDIs lasted 30-45 minutes, and the researcher informed participants that their names and information would be kept private.

The researcher performed all the interviews in the participants’ local language (Myanmar). The IDI explored the themes of the conceptual framework. A video recording was made for continuous recording in a quiet, private section of the medical education department office. The researcher conducted open discussions with the assessment committee members and kept them confidential, especially the students. Each interviewer uses a different set of questions (10–12), and the sessions last between 45 and 60 minutes. The researcher kept doing interviews until it became clear that the stories, themes, and problems had been covered to saturation point. The researchers utilised constructivist reflexivity throughout the entire study procedure, as advised by Alvesson and Sköldberg (2017).

C. Sampling Procedure

In DSMA, there are 38 members of the assessment committee. The assessment committee comprises three groups: Discussant members, voting members, and secretariat.

For Phase 1 (Quantitative): All the assessment committee members of DSMA were recruited. Among the 38 eligible persons who met eligibility, approximately 95% of the population (36 participants) responded to the evaluation survey.

For Phase 2 (Qualitative): By using the purposes sampling methods, individual in-depth interviews (IDIs) with semi-structured questions were given to the selected eight members of the assessment committee who are information-rich persons (two discussant Members, five voting members, and one secretariat) to find out what they thought, what they had done, and how they did it.

D. Data Analysis

The survey data was stored in an Excel file and processed using SPSS software (version 25). Descriptive analysis explored assessment committee members’ perceptions, attitudes, and practices.

The MAXQDA 2022 program extracted themes and sub-themes (Côté & Turgeon, 2005). The recorded interviews were transcribed to do content analysis. First, the data were summarised, proofread, and translated into English. Second, for the data analysis, themes, sub-themes, and clusters were identified (Cresswell, 2012). Finally, conceptualisation and explanation throughout the later stages led to the development of concrete abstracts. Analytic coding was done while reading the transcripts, and emerging issues were thought to be included in the thematic statements.

E. Ethical Considerations

The study was done according to the guidelines published by the Ethical and Research Committee of DSMA. Participation in this study is entirely voluntary.

F. Informed Consent

Before conducting the study, informed verbal consent was obtained for respondents’ autonomy to participate in this study.

III. RESULTS

Quantitatively, thirty-seven questions were asked about each participant’s background, knowledge, perception, attitude, and practices regarding the standard-setting. The survey received responses from 36 participants. The data supporting this study’s findings are openly available in the Figshare repository, https://doi.org/10.6084/m9.figshare.25657875.v1 (Phyo et al., 2024).

A. Demographic Characteristics

According to an analysis of the committee’s demography (see Table 1), two-thirds of the members were older than 25, and males dominated. Faculty members (64%) were primarily doctoral holders on the evaluation committee. More than ten years of teaching experience can be found among half of the assessment committee members.

Table 1. Personal background information of the assessment committee members

B. Awareness of Standard Setting

In Table 2, most assessment committee members believe that DSMA has been implementing a standard setting in the assessment process, but it is still in the process of being fully implemented. However, 75% know the purpose behind establishing standard settings in DSMA. Furthermore, faculty members are debating whether DSMA is a precise standard-setting approach for standardisation and how DSMA intends to implement whatever assessment model.

No	Question	Answers	Total (n=36)
			Frequency	Percentage
1	Does DSMA have a standard Setting in the MBBS Programme?	Yes	23	63.9
		No	11	30.6
		Uncertain	2	5.6
2	Who Is the most Responsible person in the Implementation standard setting within DSMA?	Rector	9	25.0
		Assessment Committee	6	16.7
		All Staff	20	55.6
		Uncertain	1	2.8
3	Why did DSMA introduce a Standard setting?	Rector’s foresight and planning	8	22.2
		Requirement of MMCAC guideline	27	75.0
		Uncertain	1	2.8
4	How many types of standard settings?	One	6	16.7
		Two	22	61.1
		Three	8	22.2
5	The assessment system of the DSMA is designed by applying a ready-made model like programmatic assessment.	Yes	12	33.3
		No	12	33.3
		Uncertain	12	33.3
6	Does DSMA have an exact standard-setting method to standardise the assessment system?	Yes	17	47.2
		No	10	27.8
		Uncertain	9	25.0

Table 2. Awareness of standard setting

Table 3. Perception, attitude, and practice towards standard setting

The attitudes section indicates lower ratings (2.0–3.0) with worries about increasing workload (59% agreement) and administrative burden (56% agreement), revealing resistance or uncertainty among some staff members towards the practical implications of standard setting. They also feel that implementing standards creates an uncomfortable academic environment, but 81% think the standard-setting process is successful (4.0 ± 0.7).

The high mean scores (4.0–4.4) and agreement percentages (up to 88%) in sections on perceptions and practices indicate strong support for standard setting among respondents. This suggests a recognition of its value in improving educational quality.

The data suggests that standard settings are supported, but there’s a need for more engagement and clear communication about its processes. Apprehension about workload and administrative tasks may stem from a lack of understanding or poor implementation strategies. Institutions could benefit from transparent, inclusive, and efficient management of standard-setting processes, including regular updates, training sessions, and support systems. A balanced approach is needed to address apprehensions and ensure positive outcomes for educational quality and student success.

D. Thematic Analysis Outcomes

The participants were Assessment Committee Members (n=8) from the Assessment Committee of the DSMA who were involved in developing the Standard setting for the Assessment.  The data collected from IDIs were organised into five themes and 19 sub-themes in Figure 2.

Figure 2. Showing the main themes and sub-themes

1) Perceptions of the assessment committee members: The assessment committee members expressed appreciation for the incorporation of standard setting in the Outcome-based Integrated curriculum at our university. Most committee members showed enthusiasm for using this method, which they believed was fitting for assessing students in this program. Additionally, the committee aimed to enhance the assessment techniques used in the Outcome-based Integrated curriculum. They were convinced that implementing standard settings would improve student and DSMA quality.

“An outcome-based integrated curriculum has replaced DSMA’s old curriculum. The product of an outcome-based curriculum is not produced. So, we must prepare for that product to be assessed using the standard setting. It is a transitional period for our DSMA from the old curriculum to the outcome-based curriculum. So, the state holders and teachers from DSMA must understand the standard setting. We must set the standard for the assessment of DSMA, but slowly and steadily.”

(Participant 1)

“If the integrated curriculum is changed and outcomes are improved, the quality of the university will improve. Local or international qualifications will be enhanced, not only by students but also by the quality of the DSMA.” 

(Participant 3)

2) Understanding of standard settings: It was evident that members emphasised the importance of standard setting, particularly in the context of Pass/Fail exams for students. Furthermore, committee members demonstrated knowledge regarding various types of standard setting. They were able to identify the most suitable method for DSMA, taking into consideration factors such as cultural context and institutional requirements.

“The standard setting is a method designed to determine a student’s pass or fail scores, and it is also a technique for determining whether students will pass or fail a test.”

(Participant 4)

“DSMA has to set standards for the assessment according to our culture, values, and conditions. We have taken the standard setting of another prestigious university as a reference. It is not suitable to apply the ready-made model.”

(Participant 1)

3) Benefits of implementing standard settings: The assessment committee members recognised Standard Settings are essential for effective curriculum alignment, meaningful student assessment, and accreditation. DSMA can demonstrate its commitment to delivering high-quality education and meeting accreditation standards by aligning the curriculum, teaching practices, and assessments through Standard Settings. The committee members believe Standard Settings play a crucial role in enhancing the quality of education DSMA provides.

“It is beneficial for constructive alignment. So, we adopted and prepared the standard setting for assessing DSMA for accreditation. It is also essential for the teaching and learning process and method. We can check the teaching and learning process, and if errors occur, we can fix them and circle again for the following year.”

(Participant 1)

“I think the outcomes that come out improve not only the student’s quality but also the DSMA’s quality. If the integrated curriculum is changed and outcomes are improved, the quality of the university will improve. Local or international qualifications will be enhanced, not only by students but also by the quality of the DSMA.”

(Participant 3)

4) Roles and responsibilities while implementing standard setting in DSMA: The Assessment Committee members recognised the critical roles and responsibilities of implementing standard setting. They emphasised the need for an inclusive approach involving all stakeholders. Furthermore, they highlighted the importance of aligning standard setting with authentic assessment principles and providing continuous professional development for faculty members. By considering these factors, the committee members aimed to enhance the quality of assessment and promote meaningful learning outcomes for students.

“The standard setting must be built with support; all teachers at DSMA are responsible for it because only the medical education department knows about the standard setting, which is ineffective. Teachers in all departments, including professors, must know about the standard setting. That’s why all the teachers at the university need to understand when setting standards.”

(Participant 2)

“The assessment committee is in charge of the standard setting in DSMA, including the medical education committee, the curriculum committee, the quality assurance committee, the assessment committee, etc. The assessment committee can emphasise its role and responsibility, including implementing the standard setting. Thus, it is more reasonable and practical.”

(Participant 6)

5) Challenges and weaknesses of implementing the standard-setting: The Assessment committee members identified several challenges in implementing standard setting. These challenges include limited human resources, resistance to change, time-consuming processes, and increased workload. Understanding these challenges through the lens of educational theories can guide the development of strategies to address them effectively and ensure the successful implementation of standard-setting practices.

“Human resources are our main weakness. There are very few human resources in DSMA to apply the standard setting. Time-consuming is another area for improvement.”

(Participant 1)

“Most importantly, students don’t know what a “standard” setting is, and some teachers don’t know either. They need to know what a “standard” setting is.”

(Participant 7)

IV. DISCUSSION

The outcomes from the study at the Defence Service Medical Academy (DSMA) assessment committee shed light on essential aspects of standard-setting in medical education. In institutions like DSMA, which implement the outcome-based integrated curriculum, medical students must remember what they learned in their preclinical training to make sound clinical decisions based on reliable scientific principles (Lazić et al., 2006). In medical education, it is crucial to establish, maintain, and frequently review assessment criteria (Senanayake & Mettananda, 2005).

The study revealed a predominantly male composition within the assessment committee, highlighting the need for diversity and expertise among committee members. While increasing the diversity of academic medical leadership to address the underrepresentation of minorities and women in medicine has been proposed, there has been limited investigation into this topic (Meadows et al., 2023).  Encouraging diversity can contribute to robust discussions and decision-making processes related to standard-setting. While committee members demonstrate a solid grasp of standard-setting, the results indicate a requirement for continual education to translate this knowledge into practical application (Norcini & McKinley, 2007). Therefore, targeted interventions and professional development programs must enhance their knowledge and awareness.

Committee members show favorable attitudes towards standard-setting, but there is a discrepancy between their perceptions and actual practices. Implementing open communication strategies consistent with Downing’s (2005) emphasis on the value of clarity in assessment practices could close this gap. Moreover, the lack of active participation in the implementation process may indicate a more significant engagement problem within academic committees (Van der Vleuten et al., 2010).

The study highlights issues that align with existing literature on medical education reform, citing resource limitations and reluctance to change as typical obstacles to adopting innovative instructional approaches (Swing, 2007). The committee’s alignment with constructivist and cognitive theories advocates for a transition to more interactive and participatory learning methods, which a parallel change in evaluation methods should accompany (Harden & Crosby, 2000). Committee members emphasised the need for an inclusive approach involving all stakeholders and aligning standard-setting with authentic assessment principles, resonating with sociocultural theories emphasising social interaction and collaboration in the learning process.

The findings offer crucial insights into the committee’s perceptions and experiences with standard-setting in the integrated outcome-based curriculum. Aligned with educational theories, these insights underscore the importance of lifelong learning and can guide future research and targeted interventions to continuously enhance standard-setting practices.

V. CONCLUSION

In conclusion, the findings from both the quantitative and qualitative research provide valuable insights into the assessment committee’s knowledge, perceptions, attitudes, and practices regarding standard-setting in medical education at the Defence Service Medical Academy (DSMA). While there is a positive attitude towards the potential benefits of standard-setting, there are also concerns and doubts among some committee members.

The study emphasises the importance of targeted interventions in medical education to improve awareness, address concerns, foster collaboration, and support the successful implementation of standard-setting. The Assessment Committee Members appreciate the incorporation of standard setting in the outcome-based integrated curriculum and recognise its importance during the transitional period. They demonstrate a strong understanding of standard settings, particularly in Pass/Fail exams, and emphasise the need to consider cultural and institutional requirements. Standard settings can enhance curriculum alignment, meaningful student assessment, and accreditation purposes.

The committee members emphasise the roles and responsibilities associated with implementing standard setting, including an inclusive approach, continuous professional development for faculty members, and addressing challenges such as limited human resources, resistance to change, time-consuming processes, and increased workload. Strategies informed by educational theories are needed to improve human resource capacity, provide training on standard setting, and create awareness among students and teachers.

These findings underscore the importance of supporting the assessment committee in their understanding, implementation, and continuous improvement of standard-setting practices. By addressing concerns, providing necessary resources, and promoting collaboration, DSMA can optimise the benefits of standard-setting in medical education and ensure the quality of its educational programs. Incorporating lifelong learning fosters continuous professional development, keeping DSMA at the forefront of educational excellence and adaptability.

Notes on Contributors

Dr. Zaw Phyo contributed significantly to the manuscript development process, including reviewing existing literature, identifying research gaps, and addressing questions and goals. He helped draft and revise the manuscript, emphasising its importance for medical education.

Titi Savitri Prihatiningsih contributed to shaping the research question and framework, ensuring a systematic approach. She applied her expertise in evaluation to refine the research tools and meticulously reviewed the thesis and manuscript for accuracy.

Dr. Ye Phyo Aung engaged in the study’s methodology phase, endorsing the chosen research design, sampling strategies, and data collection techniques, adding valuable insights to the research execution.

Dr. Tun Tun Naing assisted in the meticulous proofreading of the article, ensuring clarity, coherence, and compliance with academic standards.

Ethical Approval

The Ethical Review Committee of the Defence Services Medical Academy,  Yangon, Myanmar, granted ethical approval. (2 / Ethics/ 2021).

Data Availability

The data supporting this study’s findings are openly available in the Figshare repository, https://doi.org/10.6084/m9.figshare.25657875.v1 (Phyo et al., 2024).

Acknowledgment

I would also like to thank the FAIMER Regional Institute of Indonesia for Educational Development and Leadership (FRIENDSHIP) for helping me finish this research project at the Faculty of Medicine, Public Health, and Nursing at Universitas Gadjah Mada (Indonesia).

I would also like to thank my supervisor, the head of the medical education department (DSMA), and my colleagues. Without their help, I would not have been able to survey my research. I am grateful to all the assessment committee members from DSMA, Myanmar, who helped me complete my survey by giving me their valuable opinions and experiences.

Funding

The research was carried out during the study period at the FRIENDSHIP-FAIMER Regional Institute of Indonesia for Educational Development and Leadership. No financing is associated with this publication.

Declaration of Interest

There is no conflict of interest in the current research.

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*Zaw Phyo
No.94, Pyay Road, Mingaladon Township,
Postal code – 1102
Yangon, Myanmar
Phone: 95 92032754
Email: dr.zawphyoo@gmail.com

Submitted: 27 November 2024
Accepted: 28 April 2025
Published online: 1 July, TAPS 2025, 10(3), 10-14
https://doi.org/10.29060/TAPS.2025-10-3/GP3589

Thilanka Seneviratne, Wathsala Edirisingha & Wathsala Palpola

Department of Pharmacology, Faculty of Medicine, University of Peradeniya, Sri Lanka

Abstract

Introduction: Pharmacology, though challenging, is fundamental in medical practice, necessitating effective knowledge acquisition and retention for future application. This study aims to analyse student perceptions of the newly introduced teaching method, peer assessment, to enhance pharmacology teaching.

Method: Eighty-six third-year medical students of the Faculty of Medicine, University of Peradeniya participated in the peer assessment. They were divided into two groups of 40-45 and a case scenario in pharmacology was given to answer. Three volunteers from each group presented the answers. Peers evaluated the answers using provided criteria and gave feedback. The teacher then facilitated discussions, highlighting key points. Assessors and assesses perceptions on the teaching learning method was assessed using questionnaire and focus group discussions (FGD).

Results: The majority of students (n=64) (74.41%) enjoyed the task of assessing their peers. 80.23% (n=69) acknowledged the value of peer assessment for student engagement. However, 34.88% (n=30) mentioned that they did not feel they had the skills and knowledge to assess their peers. 17.43% (n=15) mentioned that they were reluctant to be critical of their peers. In the FGD students mentioned that in this student-centered learning method all students actively participated than the usual small group discussion sessions. They could compare peers’ knowledge with their own knowledge and preferred the teacher grading to be combined with peer grading.

Conclusion: Peer assessment for enhancing pharmacology teaching was well received by the students. Also, students emphasise the importance of lecturer guidance and advocate for a combined assessment approach to improve engagement and learning outcomes.

Practice Highlights

• Peer assessment keeps the students more focused during teaching learning process.
• Peer assessment enhances critical thinking and allows student centered learning.
• Combined assessment approach improves engagement and learning outcomes.
• Peer assessment for enhancing pharmacology teaching is well received by the students.

I. INTRODUCTION

The focus in higher education has shifted from conventional teaching methods to a more learner-centric approach, moving away from teacher-centered management toward fostering student self-direction (Arnold et al., 2005). This transition has sparked a growing interest in the educational benefits associated with students evaluating both their own work (self-assessment) and that of their peers (peer assessment).

Peer assessment is defined as assessment by and of individuals who have attained the same general level of training or expertise, exercise no formal authority over each other, and share the same hierarchic status in an institution (Arnold et al., 2005).

Peer assessment can be summative or formative. This focuses on the formative side, helping students plan learning, identify strengths and weaknesses, improve, and build metacognitive and professional skills. Traditional teacher-centered assessments often limit such growth. Educators valuing dialogue and collaboration should actively involve students in assessments.

Evidence is scarce regarding the utilisation of peer assessment methods for undergraduate formative assessments of a particular subject.

Pharmacology is often perceived as challenging to remember and thus, less engaging for students. Consequently, there’s reduced enthusiasm for participation in lectures. However, pharmacology serves as a fundamental aspect of medical practice, necessitating students to acquire and retain knowledge effectively for future application. Interactive teaching offer distinct advantages over traditional, teacher-centered methods by facilitating long-term retention, contextual learning, and the development of essential skills and attitudes. Thus, we introduced this teaching and learning method related to the peer assessment that integrates student centered learning within the classroom setting.

II. METHODS

A. Study Setting

The study was conducted at the Faculty of Medicine, University of Peradeniya, Sri Lanka.

B. Informed Consent

Informed written consent was obtained from the students who volunteered to the study.

C. Participants

The study involved third-year medical students from the Faculty of Medicine, University of Peradeniya, Sri Lanka. These students participated in small group discussions, each consisting of 40-45 members.

D. Peer Assessment Process

Each group was assigned short essay questions on pharmacology and students encouraged to draft written answers. Three volunteers from each group presented their answers to the class, and peers assessed them gave feedback based on criteria set by the lecturer. The teacher then facilitated discussions, highlighting key points.

E. Gathering Student Perceptions

1) Using Questionnaires: All students, except the three who presented, were provided with a self-administered Likert scale questionnaire to capture their perspectives as “assessors,” drawing from McGarr and Clifford (2013). The students who presented their answers completed a different Likert scale questionnaire, designed to capture their viewpoints as “assesses,” referencing Tahir (2012).

2) Focus Group Discussions: Nineteen students volunteered. They were divided into 3 groups. Focus group discussions, using a structured interview guide led by one investigator, lasted 30 to 40 minutes each, continued until data saturation was reached. The discussions were recorded for transcription. Participants were assured of confidentiality, and their views were anonymised. During transcription, all identifying features were removed.

F. Analysis

Quantitative data from the questionnaires were analysed using percentages. Qualitative data from the focus group discussions were analysed separately by identifying common themes in the responses.

Transcribed data were analysed using inductive content analysis. The researchers first read the transcripts to familiarise themselves with the data. Then, each transcript was coded into broad content categories. The transcripts were reread sentence by sentence and further coded into categories and subcategories.

G. Ethical Considerations

Ethical clearance was obtained from the ethics review committee of the Faculty of Medicine, University of Peradeniya. (2024/EC/25).

III. RESULTS

Eighty-six students participated as assessors. Six students participated as assesses. The results from students who assessed their peers showed mixed perceptions. A significant portion (74.41%) enjoyed the task. 44.17% agreed they were nervous about the peer assessment at the start of the module, while 29.07% were neutral (Table 1).

The comments from students assessed by their peers were generally positive. 66.67% felt they received sufficient comments, while the rest remained neutral. All participants noted that peer assessment offered more opportunities for discussion and practice. Peer assessment is recognised as a valuable exercise for students shown in Table 2.

Table 1. Assessors’ perception regarding the peer assessment method

Table 2. Perception of the students who got assessed by peers

Several key themes were identified by the focus group discussion.

A. Benefits of the Peer Assessment

1) Less stressful: Students mentioned that being assessed by their peers was less stressful than being assessed by a lecturer. They also noted that this method encouraged active participation in the assessment process due to its more convenient and relaxed nature.

“No nervousness at all. Because I just assesses my colleagues”

2) Kept students focused: Students commented that peer assessment is fairer than the traditional method as it kept them focused on work more than usual.

“When students have to assess their peers, they have to focus on the presenting answer. So, all students fully focus on the process.  The lecturer will discuss the given scenario again. So, I think we do not miss any subject content, we can learn effectively.”

3) Peers are more accessible than lecturers: They accepted this method as a good alternative to traditional assessment methods as lecturers are not always available for the assessment.

“It’s unable to assess students by lecturers all the time, so peer assessment is a good approach to assess students.”

4) Improved understanding: Being able to know how their peers answer a question was found as a good way of comparing their knowledge and improving themselves.

“Can compare our knowledge with peers”

5) Confidence building: Another advantage they pointed out was an improvement in the level of confidence in facing an assessment as they felt more comfortable when they are assessed by peers.

“Improved confidence”

B. Challenges of Peer Assessment

1) Peers are not knowledgeable enough: Some students identified being assessed by the lecturers is better than the peer assessment as lecturers are more knowledgeable than the peers.

“Lecturers are more knowledgeable than students, so being assessed by them is essential.”

“We didn’t have deep, fine knowledge to assess peers, but we had superficial knowledge to assess them.”

C. Suggestions

A larger proportion of participants expressed appreciation for both traditional assessment methods and peer assessment, stating that using both simultaneously would be ideal.

“I think the lecturer grading is the best because we are not very experienced. However, with the time limitation, it is hard to assess students by lecturer frequently. In that case, peer assessment will be beneficial if it is combined with lecturer grading.”

Many participants expressed preference for using this in other courses.

IV. DISCUSSION

While superior assessment has been the traditional and more prevalent approach, it faces challenges due to increasing student numbers, limited lecturer availability, and time constraints. This study aims to explore students’ perceptions of peer assessment as a complementary evaluation method, addressing some of the limitations of superior assessment. The findings reveal several advantages and challenges of peer assessment.

A. Less Stressful, More Focused Learning Environment

One of the key advantages of peer assessment is its ability to create a less stressful and more focused learning environment. The results indicate that students feel more comfortable being evaluated by their peers, which allows them to engage more deeply in the learning process.

Presenters and assessors both noted that the peer assessment structure promoted active engagement, as assessors remained attentive throughout the session to provide meaningful feedback, and those not presenting felt more relaxed and focused compared to traditional SGD formats. This shows that peer assessment method enhances student focus in learning environment.

B. Increased Availability and Accessibility

Given the time constraints and growing student populations, continuous evaluation by lecturers is challenging. However, well-prepared peer groups can effectively bridge this gap, providing timely feedback and support. This aspect of peer assessment enhances students’ opportunities for formative feedback, which is critical for their learning process.

C. Improves the Assessor’s Understanding of the Subject/Confidence Building

Students gain valuable insights and deepen their understanding by evaluating and providing feedback on their peers’ written work, as this process enhances their critical thinking and analytical skills (Topping, 2009). This fact was noted by the participants of our study also. They appreciated the chance to analyse their peers’ answers.

The supportive environment of peer assessment enabled students to share and compare their knowledge openly, which in turn helped them refine their answers and learn better organisational techniques, which improve their confidence.

D. Addressing Knowledge Gaps

One challenge identified in peer assessment is the limited expertise of peers in accurately assessing their classmates. However, this challenge can be mitigated with proper preparation and guidance from lecturers. Topping (2009) has highlighted that training students to provide constructive feedback is a challenging process. However, the benefits it yields outweigh the burden of training peer assessors.

Literature also gives evidence regarding the doubt about the validity level of peer assessment among teachers and students (Holroyd, 2000). This attitude has been identified as a major barrier to the use of peer assessment as a standard method of evaluating students.

Fry (1990) highlighted that, when it is implemented in the right way, peer evaluation demonstrates results, which are comparable with lecturer evaluation.

E. Overcoming Personal Bias

A drawback noted by students was the difficulty of remaining objective when assessing their peers. Many students found it challenging to give low marks or critically evaluate their friends’ work as a lecturer might. This concern highlights the need for students to be properly trained as an assessor.

Several published studies shows that peer evaluation can be affected by negative social factors like peer pressure, favoritism, or fear of criticism, especially when done face-to-face. To address these issues, it’s important to use methods that ensure anonymity in peer reviews.

F. Recommendations for Future Application

Overall, students in this study expressed a positive view of peer assessment and suggested its use in other courses. They acknowledged that combining peer assessment with superior assessment could enhance learning outcomes. To ensure the effectiveness of peer assessment, students recommended conducting it under the supervision and guidance of lecturers. This combined approach would offer the benefits of peer-to-peer engagement while maintaining the academic rigor provided by expert feedback.

V. CONCLUSION

While peer assessment presents certain challenges, it offers substantial advantages in creating a more accessible, engaging, and confidence-building learning environment. With proper training and lecturer involvement, peer assessment can serve as a valuable complement to traditional assessment methods in higher education.

Notes on Contributors

Thilanka Seneviratne led the study’s conception, design, and implementation, contributed to data analysis and interpretation, drafted and critically revised the manuscript. Wathsala Edirisingha was involved in the implementation of the study and contributed to data acquisition and analysis. Himali Palpola contributed to the study’s implementation, data analysis, and manuscript drafting. All the authors have read and approved the final manuscript.

Ethical Approval

Ethical clearance was obtained from the ethics review committee of the Faculty of Medicine, University of Peradeniya, (2024/EC/25).

Acknowledgement

We acknowledge the staff of the department of Pharmacology, Faculty of Medicine, University of Peradeniya for their valuable contribution in material and organisational support.

Funding

No funding sources are associated with this paper.

Declaration of Interest

All authors declare no conflict of interest.

References

Arnold, L., Shue, C. K., Kritt, B., Ginsburg, S., & Stern, D. T. (2005). Medical students’ views on peer assessment of professionalism. Journal of General Internal Medicine, 20(9), 819–824. https://doi.org/10.1111/j.1525-1497.2005.0162.x

Fry, S. A. (1990). Implementation and evaluation of peer marking in higher education. Assessment & Evaluation in Higher Education, 15(3), 177–189. https://doi.org/10.1080/0260293900150301

Holroyd, C. (2000). Are assessors professional? Student assessment and the professionalism of academics. Active Learning in Higher Education, 1(1), 28–44. https://doi.org/10.1177/1469787400001001003

McGarr, O., & Clifford, A. M. (2013). ‘Just enough to make you take it seriously’: exploring students’ attitudes towards peer assessment. Higher education, 65, 677-693. https://doi.org/10.1007/s10734-012-9570-z

Tahir, I. H. (2012). A study on peer evaluation and its influence on college ESL students. Procedia-Social and Behavioral Sciences, 68, 192-201. https://doi.org/10.1016/j.sbspro.2012.12.219

Topping, K. J. (2009). Peer assessment. Theory Into Practice, 48(1), 20–27. https://doi.org/10.1080/00405840802577569

*Thilanka Seneviratne
Faculty of Medicine,
University of Peradeniya, Sri Lanka, 20400
Email: thilanka.medi@gmail.com

Submitted: 26 September 2024
Accepted: 25 March 2025
Published online: 1 July, TAPS 2025, 10(3), 5-9
https://doi.org/10.29060/TAPS.2025-10-3/GP3504

Shihoko Yamakawa¹, Olga Razvina², Fumiko Okazaki², Hiroshi Hibino³, Toshiyuki Someya⁴ & Tatsuo Ushiki⁴

¹Niigata University Institute of Global Affairs, Japan; ²Niigata University Medical Education Centre, Niigata University Graduate School of Medical and Dental Sciences, Japan; ³Department of Pharmacology, Osaka University Graduate School of Medicine, Japan; ⁴Niigata University, Japan

Abstract

Introduction: Niigata University School of Medicine and Niigata University Graduate School of Medical and Dental Sciences have been engaging in medical exchanges with Russian medical universities for over 30 years. In 2015, a double-degree program with Russian medical universities was initiated, leading to a multi-layered education project that included short-term undergraduate student exchange programs and graduate-level double-degree programs, resulting in the circulation of human resources.

Methods: The program was conducted in English, and a maximum of 15 credits could be transferred based on the universities’ regulations. Degree examinations were conducted independently, and successful candidates were awarded degrees from both Niigata University and their home university in Russia. The project was overseen by the G-MedEx Centre at Niigata University, which included staff with international experience.

Results: The difference in standard study duration between Japan and Russia was eliminated by using a four-year system in the graduate school doctoral programs. Three study models were proposed by Russian universities, considering each university’s regulations and various circumstances. The curriculum was determined based on the rules of the universities in Russia and the circumstances of the students. Agreements were made with each university in supplementary documents.

Conclusion: Despite the differences in educational standards and the lack of a common educational framework between Japan and Russia, the difficulties can be overcome, and educational compatibility can be increased.

Practice Highlights

• Thanks to a long history of interaction with Russia, we were able to organise a large educational project, which included multi-layered programs, one of which was a double degree program.
• As part of the project, we established a coordination centre (G-MedEx Centre) that effectively engaged with students, teachers, and university administration to address challenges and tasks as they arose.
• We successfully navigated the differences in educational standards between Russia and Japan and developed effective mechanisms for collaboration.
• Despite the challenges of the double degree program, we have two successful examples of students who completed their double degrees.
• We were able to train doctors and scientists who gained unique international experience and will be able to make significant contributions on the world stage in the future.

Figure 1. Credits and study hours (Niigata University and Russian Partner Universities)

Figure 2. Basic course curriculum and number of credits, Russian Graduate School doctoral program

We developed a group of courses for specialised classes to streamline the collation process. A unified evaluation standard based on Japan and Russia’s systems was adopted, significantly speeding up credit transfers.

C. Eliminating Differences in the Standard Study Period and Creating a Study Model

We have worked on eliminating the difference in standard study duration between Japan and Russia, which is a structural problem. Although undergraduate education in the medical field is six years both in Japan and Russia, the duration of graduate school doctoral programs differs. In Japan, it is four years, and in Russia, it is usually three years. Although DDP allows credits to be transferred, it is quite difficult to complete study programs at both universities and write two dissertations in three years. Therefore, we decided to use a four-year system.

The extra one-year study period in Russia has been an ongoing academic issue. After discussions between Japan and Russia, Russian universities proposed three study models based on regulations and circumstances. It was suggested that students spend the first two years in Russia and the remaining two at their home university. They also noted that compulsory subjects are concentrated in the first year, making it appropriate for students to start research and gain basic skills in their native language.

The three study models proposed were as follows:

– Model 1: After completing two years, the student takes a one-year leave at a Russian university. Then the student returns to school for the fourth year and completes the Japanese and Russian programs at the same time.

– Model 2: Establishing a new four-year doctoral course program at Russian universities. This is a special curriculum in which the 180 credits that should be earned over three years are distributed evenly over four years, resulting in 45 credits earned in one year.

– Model 3: At the end of the third year, all completion requirements except for thesis defense should be completed, and graduation is suspended. After it is confirmed that the students are expected to graduate from the university in their fourth year, they will proceed to the examination and officially complete their studies in Japan and Russia at the same time.

In the case of models 2 and 3, students have to pay tuition fees for four years in Russia based on the length of study. Additionally, in the case of model 3, upon completion of the third year, students are required to return to Japan temporarily for up to one month for graduation exams and related procedures. The curriculum was determined based on the rules of the universities in Russia and the circumstances of the students. The agreements were made with each university in supplementary documents.

Figure 3. DDP Models

D. Thesis Defense

Russia and Japan have different systems for evaluating theses. In Russia, dissertations are typically 100 to 150 pages long and are written in Russian. They are reviewed by the Higher Accreditation Commission. In contrast, in Japan, dissertations must be written in English and be published in an international journal. Because of these regulatory differences, a single-thesis evaluation approach was not feasible, resulting in separate reviews for each thesis. While foreign examiners can attend public hearings for dissertations in Russia, they are not allowed to serve on examination committees due to government restrictions.

E. Building a Network with a Dedicated Project Team

Since the G-MedEx Centre’s establishment, its international network has expanded across Russia, with exchange agreements established with nine universities. Appointing liaison professors at Russian universities significantly motivated local faculties and had an unexpected positive impact. Regular information exchange enabled the swift identification and resolution of issues, contributing to the project’s success and improvements in the study environment and safety management for international students.

IV. DISCUSSION

This paper highlights the challenges faced in implementing the Double Degree Program (DDP) and the measures taken to address them. Six students were enrolled in the program, and two of them have already obtained their degrees. While most of the academic and curricular challenges have been resolved, some issues still need to be addressed. Although credit transfer can reduce some duplication of study content, fulfilling the graduation requirements of two universities within the standard study period is challenging. After gathering feedback from students participating in the program, we learned that many found it very challenging, particularly those conducting research that required wet experiments. In contrast, students focused on statistical research did not express similar concerns.

Another factor contributing to the program’s complexity was that the research topics at the two universities often had no connection, forcing students to manage two entirely unrelated projects. This increased their workload and sometimes hindered their ability to complete the program successfully.

Consequently, we concluded that for future programs, it is essential to choose departments that can coordinate their projects, ensuring they engage in collaborative research. This approach would make it easier for students to complete both projects on time. Regarding the credit system, a transfer method based on the “competency-based” approach is being considered, where students are evaluated based on the acquired results of comprehensive and specialised abilities and skills required for the subject, rather than assigning academic training per credit by the time spent in it. To speed up the process, we have limited credit transfer to specialised subjects at our university. However, as the number of students increases and the scale of projects grows, it will be essential to systemise credit transfer and simplify administrative procedures further. Therefore, we need to build a system that guarantees a higher level of educational quality between the two countries while referring to the framework provided by ECTS and the Erasmus Project (European Community Action Scheme for the Mobility of University Students), which are the standard in Russia. From the viewpoint of human resource circulation, some graduates have become post-doctoral fellows or faculty members at Niigata University, while others have returned to their home countries to work as doctors.

V. CONCLUSION

Witnessing young medical scientists grow and start playing active roles in both countries is the greatest joy of international collaboration in education. Russia recently withdrew from the Bologna Process. As a result, the country may develop its own education system that does not depend on the European framework. Russian students may face challenges in integrating into the European education system and accessing European educational grants.

However, interactions with countries not part of the Bologna process—such as Japan, India, and China—will remain unaffected, since these countries operate according to their own independent systems. The key will be finding common ground and promoting academic mobility, though this won’t be straightforward based on our past experiences.

Thus, cooperation with these countries will require careful attention. It is essential to focus on the future effects on education and ensure the educational environment’s protection for students, drawing on the knowledge and experience gained so far.

Notes on Contributors

SY, the first author, contributed significantly to the design, wrote and edited the paper, and reviewed the literature. OR was responsible for data collection, resource verification, reviewing and editing the manuscript. FO conducted resource verification, reviewed and edited the manuscript. HH provided critical feedback during the writing process, analysed the data, implemented and supervised the project. TS led the project, interpreted the data, and provided guidance. TU, the lead conceptualiser, designed the study, was responsible for  conceptualisationand obtaining funding.

Acknowledgement

We would like to express our sincere gratitude to professors of Krasnoyarsk State Medical University, Far Eastern State Medical University, and Pacific State Medical University for their cooperation in conducting this study.  

Funding

This research was supported by JSPS Grant-in-Aid for Scientific Research 20K02936.

Declaration of Interest

The authors declare that they have no conflict of interest.

References

Jargin, S. (2024). Medical education and postgraduate training in Russia: An update. Journal of Integrative Medicine & Therapy, 7(1), 1. https://doi.org/10.13188/2378-1343.1000019 

Obst, D., & Kuder, M. (2012). International joint- and double-degree programs. International Higher Education, 66, 5-7. https://doi.org/10.6017/ihe.2012.66.8585

Sitnikov, V., & Bizunkov, A. (2016). The higher education at the post-Soviet territories: The long echo of the Bologna process. Vestnik Otorinolaringologii, 81(4), 72-77. https://doi.org/10.17116/otorino201681472-77

Teplyashina E., Petrova M., Salmina A., & Razvina O. (2017) The experience of networking postgraduate training programmes. The Education and Science Journal, 19, 4. https://doi.org/10.17853/1994-5639-2017-4-118-129

Yamakawa, S., Razvina, O., Ito, M., Hibino, H., Someya, T., & Ushiki, T. (2018) Medical exchange project for students and young doctors between Japan and Russia. Medical University, 1, 32-39. https://doi.org/10.2478/medu-2018-0005

*Shihoko Yamakawa
1-757, Asahimacho-dori, Chuo-ku,
Niigata, Japan 951-8510
-81 (025) -227-2063
Email: yamakawa@med.niigata-u.ac.jp

Submitted: 29 July 2024
Accepted: 24 February 2025
Published online: 1 July, TAPS 2025, 10(3), 1-4
https://doi.org/10.29060/TAPS.2025-10-3/GP3478

Tayzar Hein¹, Ye Phyo Aung¹, Khin Aung Htun¹ & Tin Tun²

¹Department of Medical Education, Defence Services Medical Academy, Myanmar; ²Department of Human Resources for Health, Ministry of Health, Myanmar

Abstract

Introduction: The medical education system of Myanmar has evolved through a dynamic history influenced by colonial legacies, national development efforts, and global collaborations. This article explores the progression of medical education in Myanmar, focusing on its historical milestones, challenges, and advancements in response to societal and healthcare needs.

Method: This study is based on a comprehensive review of historical records, policy documents, and academic literature, with “A Concise History of Medical Education in Myanmar” by Aung Than Batu as a primary reference. Key milestones, collaborations, and innovations were analysed to trace the evolution of medical education from the colonial period (1907) to the present day. Quantitative data, including the number of medical universities, training durations, and infrastructure developments, were included for a clearer perspective.

Results: The analysis highlights transformative milestones, including the establishment of the first medical school in 1907 and Rangoon Medical College in 1927. Over time, Myanmar has adapted to challenges such as resource constraints and political instability by fostering international collaborations and leveraging technology. Teaching methods have evolved significantly, integrating modern technologies alongside traditional pedagogies.

Conclusion: Myanmar’s medical education exemplifies resilience and adaptability. By aligning its system with global standards, fostering research, and leveraging international expertise, the nation continues to contribute to global medical education and healthcare. This narrative serves as an inspiration for countries navigating similar challenges in medical education.

Practice Highlights

• Myanmar’s medical education journey began in 1907, blending indigenous practices with Western methodologies, and expanded post-independence with the establishment of multiple medical universities.
• Myanmar overcame challenges like resource limitations and political instability by fostering global collaborations and integrating modern technologies into medical education.
• The MBBS program combines robust theoretical knowledge with clinical training, while postgraduate education emphasises research, making Myanmar a contributor to global medical advancements.

I. INTRODUCTION

Myanmar, a nation of profound cultural richness and historical depth, unfolds a narrative that intricately intertwines with the evolution of its medical education system. This comprehensive overview embarks on a journey through the diverse facets of Myanmar’s medical education landscape (Batu, 2015). Beyond a mere chronological exploration of historical administrative periods, it endeavors to unravel the intricate threads woven into policy development, the establishment of medical universities, and the ceaseless pursuit of addressing challenges and seizing opportunities within the nation’s healthcare and educational sectors. The journey begins in 1927, with the establishment of the Rangoon (Yangon) Medical College, a milestone in introducing formal medical education during the British colonial era (Batu, 2015). This marked the fusion of indigenous healing traditions with Western medicine, laying the foundation for a unique and dynamic approach to healthcare education (Coderey, 2021). After independence in 1948, the nation’s commitment to advancing medical education became evident with the expansion of medical facilities and the development of policies aimed at addressing the healthcare needs of its population. By the 1960s, the establishment of additional institutions, such as the Institute of Medicine (I), reflected Myanmar’s growing emphasis on training a competent cadre of healthcare professionals. In 1970, the establishment of the University of Medicine 2 in Yangon further demonstrated this dedication to expanding medical education access (Batu, 2015). Infrastructure development and facility expansions in subsequent decades signaled foresight that extended beyond immediate requirements, highlighting a long-term vision for excellence and capacity-building in medical education (Batu, 2015).

Amidst challenges such as resource limitations and periods of political instability during the 1980s and 1990s, the story Myanmar of took a resilient turn, transforming obstacles into opportunities. International collaborations, such as partnerships initiated in the 2000s, and the adoption of technological advancements emerged as beacons of progress, underscoring the adaptability and determination of Myanmar to elevate the standards of its medical education (Saw et al., 2019). As Myanmar enters the 21st century, it not only continues to address its domestic healthcare needs but also contributes to the global context. Its influence reverberates through research contributions, milestones in undergraduate and postgraduate medical education, and a commitment to integrating public health perspectives (Saw et al., 2019). Myanmar emerges not just as a nation shaping its healthcare narrative but also as a participant in the broader discourse on global health, contributing to the collective effort to address worldwide health challenges (Proserpio, 2022).

II. ADMINISTRATIVE PERIODS IN MYANMAR

Colonial Era (1824–1948): Under the shadow of British rule, the colonial period of Myanmar bore witness to the initial introduction of Western medicine. The 1860s marked the beginnings of formal medical education when the British established training programs for healthcare workers to address the needs of colonial administration and military personnel. In 1927, the foundation of the Rangoon (Yangon) Medical College became a pivotal moment in the integration of Western methodologies into Myanmar’s medical education system. This era marked the confluence of indigenous healing practices with the methodologies imported during colonial occupation (Coderey, 2021).

Post-Independence Era (1948 onwards): The post-independence period signaled a fervent drive by Myanmar to shape its own destiny. The establishment of the Institute of Medicine (I) in the 1960s marked a significant step toward creating specialised medical education institutions to cater to the nation’s healthcare needs. This commitment was further exemplified by the opening of the University of Medicine 2 in Yangon in 1970, ensuring broader access to medical education. In 1992, the Defence Services Medical Academy (DSMA) was established as the nation’s sole military medical university, dedicated to training medical professionals for the armed forces. With six medical universities in total five civil institutions and one military. The country has demonstrated a sustained effort to expand medical education. This era also saw the formulation of policies aimed at strengthening public health systems and addressing resource limitations, particularly during the politically turbulent 1980s and 1990s. These efforts laid a strong foundation for Myanmar’s aspiration to build a healthcare system reflective of its cultural identity and societal requirements (Coderey, 2021).

III. MEDICAL EDUCATION POLICY IN MYANMAR AND DEVELOPMENT OF MEDICAL UNIVERSITIES

The evolution of medical education policies in Myanmar from 1950 onwards has been a dynamic and adaptive process. Over the years, these policies have responded to societal needs, embraced technological advancements, and aligned with global standards in medical education. A key focus has been the alignment with international benchmarks, ensuring that the education imparted equips Myanmar’s medical graduates to meet and exceed global standards in healthcare delivery. Myanmar’s journey in medical education began in 1907, with the establishment of the Government Medical School in Yangon, which laid the groundwork for structured medical training. The pivotal moment came in 1927, with the establishment of the Rangoon (Yangon) Medical College, formalising Western medical education. Following independence in 1948, the nation prioritised medical education policy development, leading to the creation of the Institute of Medicine (I) in the 1960s and the University of Medicine 2 in 1970 (Batu, 2015). The subsequent decades witnessed the growth of additional medical universities, including the University of Medicine, Mandalay, and the University of Medicine, Magway, which were established to decentralise medical education and improve access. Infrastructure development and the expansion of facilities became pivotal strategies, particularly during the 1980s and 1990s, to accommodate the surging demand for medical education and enhance the overall quality of healthcare provision. These initiatives reflect the commitment of Myanmar to fostering a robust and sustainable healthcare system (Batu, 2015).

IV. CHALLENGES, OPPORTUNTIES AND MEDICAL EDUCATION RESEARCH

Throughout its history, the medical education system of Myanmar has faced formidable challenges, ranging from resource limitations to periods of political instability, such as during the politically turbulent 1980s and 1990s (Saw et al., 2019). Despite these adversities, these challenges have served as crucibles for transformation, providing opportunities for resilience and innovation. By the 2000s, Myanmar actively embraced international collaborations, partnering with global institutions to strengthen its medical education framework. These collaborations have acted as catalysts for overcoming structural and educational challenges, fostering knowledge exchange, and enhancing training methodologies (Proserpio, 2022). In recent decades, technological advancements have presented unprecedented opportunities to bridge gaps in medical education delivery. For instance, the integration of e-learning platforms and simulation-based training since the 2010s has improved both accessibility and quality, enabling students across Myanmar to benefit from innovative educational tools (Saw et al., 2019). This dual narrative of challenges and opportunities paints a dynamic picture of Myanmar’s medical education landscape one that is continuously evolving and adapting to the shifting sands of the global healthcare arena.

Myanmar’s indelible mark on medical education research is a testament to its commitment to academic excellence. The country has emerged as a significant contributor to the global knowledge base in medical education, particularly since the early 2000s, fostering an environment where researchers explore innovative methodologies and address critical questions within the field in 1990s (Saw et al., 2019). Myanmar’s researchers, often collaborating across borders, have played a pivotal role in advancing educational practices worldwide. The research landscape in Myanmar is characterised by a diverse array of studies, including pedagogical approaches, curriculum development, and assessments of educational outcomes. Researchers have delved into the effectiveness of various teaching methods, the impact of cultural nuances on medical education, and the integration of technology into learning strategies (Coderey, 2021). These endeavors not only enhance the quality of medical education within Myanmar but also contribute valuable insights to the broader international community. the commitment of Myanmar to medical education research extends beyond national boundaries, with researchers actively engaging in cross-cultural studies and collaborative projects. Examples include partnerships with institutions in Southeast Asia and beyond, leading to impactful studies on public health education and global health challenges (Proserpio, 2022). This collaborative spirit enriches the local research landscape and fosters a global exchange of ideas, ultimately elevating the standards of medical education on an international scale.

V. UNDERGRADUATE MEDICAL EDUCATION AND POSTGRADUATE MEDICAL EDUCATION

Undergraduate Medical Education in Myanmar: The structure of undergraduate medical education in Myanmar has undergone a transformative journey, evolving into a robust system that imparts a comprehensive understanding of medical science. The curriculum, meticulously developed over the decades, strikes a balance between theoretical knowledge and practical application, ensuring that graduates are well-equipped to navigate the complexities of healthcare. Milestones in curriculum development have played a pivotal role in shaping an adaptable and rigorous educational framework. Since the establishment of the Government Medical School in 1907 and the introduction of formal undergraduate medical training at Rangoon Medical College in 1927, Myanmar has continually refined its approach to align with global standards while addressing local healthcare needs (Batu, 2015). The integration of foundational medical sciences with clinical training, particularly from the 1960s onward, has created a holistic educational experience.

Clinical Training: Clinical training is a cornerstone of undergraduate medical education, offering students invaluable exposure to patient care, medical decision-making, and collaborative healthcare practices. From the 1970s, rotations in diverse medical specialties were formalised, enabling students to gain insights into the multifaceted nature of healthcare delivery. This hands-on approach fosters the development of critical thinking, diagnostic acumen, and a patient-centered mindset. Despite challenges such as resource constraints and political instability during the 1980s and 1990s, the resilience of Myanmar has been evident. By the 2000s, international collaborations and advancements in technology allowed for significant improvements in medical education delivery (Batu, 2015). Initiatives such as e-learning platforms and virtual simulations have enhanced accessibility and quality, ensuring a dynamic learning environment.

Outcomes and Global Impact: Graduates of Myanmar undergraduate programs emerge with a blend of strong theoretical knowledge, practical skills, ethical grounding, and communication proficiency. Many contribute to the global medical community, bringing cultural understanding and internationally recognised expertise to diverse healthcare settings.

Postgraduate Medical Education in Myanmar: Myanmar postgraduate medical education system has witnessed substantial transformation, adapting to the increasing demand for specialised expertise in healthcare (Saw et al., 2019). The diversification of postgraduate programs since the 1980s reflects a commitment to align with global standards while addressing the unique challenges of the nation’s healthcare system.

Specialised Training and Research: Postgraduate training emphasises advanced clinical skills and specialisation across medical disciplines. From the 1990s, research became an integral part of postgraduate education, fostering innovation and addressing critical healthcare gaps. Myanmar postgraduate students actively contribute to cutting-edge research, positioning the nation as a hub for medical advancements (Batu, 2015). This dual focus on research and clinical expertise ensures the preparation of professionals capable of tackling evolving healthcare challenges.

Collaborative Endeavors: International collaborations have played a pivotal role in enhancing postgraduate medical education. Partnerships with regional and global institutions have facilitated the exchange of expertise and best practices, enriching both training programs and research initiatives (Proserpio, 2022). These efforts underscore Myanmar’s commitment to participating in and contributing to the global medical community.

Outcomes and Ethical Practice: Myanmar postgraduate medical education is characterised by a dynamic interplay of specialised training, collaborative research, and a steadfast commitment to ethical medical practice (Rosenbaum et al., 2021). This multifaceted approach elevates the capabilities of healthcare professionals and enhances the overall standard of healthcare delivery, both nationally and internationally.

VI. CONCLUSION

Myanmar’s history of medical education is a dynamic narrative marked by resilience, adaptability, and the ability to turn challenges into opportunities. From its early adoption of Western medical practices during the colonial era to the establishment of a robust and evolving educational framework, Myanmar has consistently demonstrated a commitment to excellence. This global perspective highlights Myanmar’s efforts to align its medical education system with international benchmarks, contribute substantively to medical research, and actively engage in global public health initiatives. As Myanmar continues to shape its medical education landscape, it stands poised to make lasting contributions to global healthcare. Myanmar’s unwavering dedication to excellence not only enhances its own healthcare system but also enriches the global discourse on medical education and public health, positioning the nation as a vital contributor to the collective effort of improving global health outcomes.

 Notes on Contributors

Tayzar Hein contributed to this manuscript’s first draft version , and revised its subsequent draft. Ye Phyo Aung, Khin Aung Htun, and Tin Tun contributed to the manuscript and critically revised the first draft. All the authors discussed and contributed to the final manuscript.

Funding

The activity is undertaken for the sake of personal and professional growth, and does not require any financial support.

Declaration of Interest

There is no conflict of interest in the current research. 

References

Batu, A. T. (2015). The history of medical education in Myanmar (1886 to 2010). Myanmar Academy of Medical Science.

Coderey, C. (2021). Myanmar Traditional Medicine: The making of a national heritage. Modern Asian Studies, 55(2), 514-551. https://doi.org/10.1017/S0026749X19000283     

Proserpio, L. (2022). Myanmar higher education in transition: the interplay between state authority, student politics and international actors.

Rosenbaum, S. A., Tushaus, D., Hubbard, B., & Sharp-Bauer, K. (2021). The Myanmar Shwe: Empowering law students, teachers, and the community through clinical education and the rule of law. Indiana Journal of Global Legal Studies, 28(1), 153-230.

Saw, Y. M., Than, T. M., Thaung, Y., Aung, S., Shiao, L. W.-S., Win, E. M., Khaing, M., Tun, N. A., Iriyama, S., & Win, H. H. (2019). Myanmar’s human resources for health: Current situation and its challenges. Heliyon, 5(3), e1390. https://doi.org/10.1016/j.heliyon.2019.e01390

*Tayzar Hein
No.94, D-1, Pyay Road, Mingaladon Township,
Yangon, Myanmar Postal code – 11021
+95 95188093
Email: dr.tayzarhein@gmail.com

Submitted: 13 March 2025
Accepted: 18 March 2025
Published online: 1 April, TAPS 2025, 10(2), 1-3
https://doi.org/10.29060/TAPS.2025-10-2/GP3694

Shuh Shing Lee, Jillian Han Ting Yeo & Dujeepa D Samarasekera

Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

Abstract

Introduction: The Asia Pacific Medical Education Conference (APMEC) 2025 focused on evolving medical education amidst global transformations. The theme, “Developing a Holistic Healthcare Practitioner for a Sustainable Future,” emphasised integrating sustainability, inclusivity, and advanced technologies like AI into healthcare education.

Methods: APMEC 2025 featured a comprehensive program including 29 workshops, 1 special course, 2 keynote speeches, 6 plenary sessions, 19 symposia, and 3 panel discussions, with 84 free communications and 107 short communications presented. The conference facilitated dialogues on innovative curriculum design, sustainability in healthcare education, AI integration, and interprofessional education.

Results: Key discussions emphasised incorporating “Possibility Thinking” and student-centered learning, embedding planetary health in curricula, and integrating AI while preserving essential human skills like empathy. The NUS Common Curriculum for Healthcare Professional Education demonstrated significant improvements in empathy and teamwork. The conference highlighted the importance of faculty development and inclusivity, particularly concerning disability in medical education.

Conclusion: APMEC 2025 demonstrated a commitment to transforming medical education through collaboration and innovation. By aligning educational practices with global trends and regional needs, APMEC serves as a catalyst for comprehensive curriculum reforms. Ongoing efforts are needed to translate these insights into actionable strategies, ensuring future healthcare professionals are well-prepared to address dynamic global challenges.

Practice Highlights

• Student involvement in curriculum planning is essential to enhance student-centered learning and competency-based education.
• AI’s role in augmenting healthcare education while ensuring the retention of essential human skills.
• Incorporating planetary health concepts into medical curricula to prepare healthcare professionals for environmentally responsible practice.
• Implementing structured models like NUS’s Common Curriculum to improve empathy and teamwork in healthcare training.
• Enhancing teaching quality and leadership through structured faculty training programs, crucial for sustained educational improvements.

I. INTRODUCTION

The APMEC conference was held this year from January 13th (Monday) to 18th (Saturday) at Yong Loo Lin School of Medicine, National University of Singapore.  Medical education is in the midst of a global transformation, influenced by technological advancements, new pedagogical techniques, and a focus on sustainability and inclusivity. The Asia Pacific Medical Education Conference (APMEC) serves as a crucial platform for medical educators, researchers, and policymakers to discuss and shape the future of healthcare education. This year’s theme, “Developing a Holistic Healthcare Practitioner for a Sustainable Future – Trends ● Issues ● Priorities ● Strategies,” highlights the alignment of medical education with sustainable practices, innovative learning, and inclusive policies. The conference featured 29 workshops, 1 special course, 2 keynotes, 6 plenary sessions, 19 symposia, 3 panel discussions, 84 free communications, and 107 short communications, providing a comprehensive platform for exchange and learning.

II. LEARNINGS FROM VARIOUS SESSIONS

The concept of “Possibility Thinking” advocating for a shift beyond disease-focused approaches toward holistic healthcare strategies was shared in Plenary 1 by Professor Ronald Harden. Prof Harden emphasised the need for student engagement in curriculum planning, fostering a more integrated and participatory learning experience. This aligns with global calls for student-centered learning, competency-based education, and the co-creation of curricula with learners. In line with this year’s theme, symposiums explored how to embed sustainability in medical education. Climate change is affecting global health, making sustainability a key focus in health professions education worldwide.

In the opening keynote, Prof Yang Faridah shared practical approaches for resource-poor countries. She gave examples from Malaysia, showing how medical schools are integrating planetary health into their curricula. This prepares future healthcare professionals for environmentally responsible practice. The use of artificial intelligence (AI) is reshaping health professions education. It enhances decision-making, improves efficiency, and boosts diagnostic accuracy. However, panellists stressed the irreplaceable value of human skills like empathy, communication, and ethical judgment. The discussion highlighted a global shift towards integrating AI in healthcare education while ensuring technology complements, not replaces, the human touch. Another key aspect discussed at the conference was how best to restore engagement and joy in learning by revitalising medical. Several sessions focused on applying practical strategies to boost engagement and create supportive learning environments. Key discussions covered creative learning approaches that use playfulness to improve concept retention. Panellists highlighted the importance of teamwork in reducing loneliness and enhancing performance. They also stressed the need for inclusive, psychologically safe spaces that nurture enthusiasm for medical education. The speakers also emphasised mentorship and peer support as critical factors in reducing burnout and increasing overall satisfaction. Participants explored strategies to encourage work-life balance, recognising the importance of self-care and having hobbies outside medicine. Addressing burnout triggers and implementing sustainable changes within medical education institutions were highlighted as necessary steps to prioritise joy and well-being alongside academic excellence.

Interprofessional education (IPE) is gaining global recognition as a key strategy to break down professional silos and prepare healthcare graduates for integrated, patient-centred care. In the opening ceremony speech, the Dean of the Yong Loo Lin School of Medicine, National University of Singapore, Prof Chong Yap Seng, introduced NUS’s Common Curriculum for Healthcare Professional Education, launched in 2023. This structured approach to IPE aims to enhance collaboration. Early evaluations of the program show improvements in empathy, teamwork, and collaborative practice.

Inclusivity, particularly support for students with disabilities in medical and health professions education, was a key focus at APMEC this year. The updated Canadian technical standards were shared by Professor Cheryl Holmes from University of British Columbia defining core competencies based on functional abilities. These standards were developed through collaboration with a diverse group, including learners and physicians with disabilities. This initiative sets a precedent for regional collaboration. It encourages other countries to update educational standards to promote equity, support students with physical challenges, and improve the quality and accessibility of medical education.

Amid these evolving trends, faculty development remains a cornerstone of advancing medical education. Stories shared during the faculty development session illustrated how structured programs empower educators to drive change at institutional, national, and regional levels. Investments in faculty training are critical in ensuring sustained improvements in teaching quality and leadership in health professions education. By exposing participants to global best practices, it encourages the adoption of innovative teaching strategies. These approaches are tailored to address specific regional challenges and opportunities, enhancing the overall quality of medical and health professions education.

III. GLOBAL TRENDS AND IMPACT IN THE ASIA PACIFIC REGION AND BEYOND

The themes discussed at APMEC align with several global trends shaping the future of medical education. One key shift is the growing adoption of competency-based medical education (CBME), which is gradually replacing traditional time-based models. CBME prioritises the acquisition of practical skills and the application of knowledge in real-world settings, ensuring that graduates are better prepared for clinical practice.

Technological advancements are also playing a transformative role. Artificial intelligence (AI), virtual reality (VR), and simulation-based training are becoming more accessible, revolutionising the way medical students learn. These innovations enhance diagnostic accuracy, refine clinical decision-making, and provide immersive, hands-on learning experiences in a risk-free environment.

At the same time, sustainability in healthcare education is gaining momentum. With increasing awareness of environmental challenges, medical schools are integrating planetary health concepts into their curricula. This ensures that future healthcare professionals are equipped to adopt sustainable practices and address the impact of climate change on global health.

These evolving trends reflect a broader movement towards a more adaptive, technology-driven, and socially responsible approach to training the next generation of healthcare practitioners. Another key area of discussion was student and faculty well-being. There is a growing focus on addressing mental health challenges and reducing burnout in medical training. Faculty well-being is especially crucial, as educators play a vital role in shaping future healthcare professionals. Supporting their mental and emotional health ensures they can provide high-quality education while maintaining their own resilience and job satisfaction.

IV. CONCLUSION

APMEC continues to align global trends with regional needs, acting as a hub for advancing medical education. It drives transformation by offering a platform for knowledge exchange, enabling collaboration among educators and policymakers. The conference strengthens connections between institutions across the Asia-Pacific region, promoting shared learning and research. As participants return to their institutions, the focus must shift to translating insights into concrete actions that improve medical and health professions education. Through collaboration, innovation, and inclusivity, APMEC ensures that future healthcare professionals are prepared to tackle the evolving challenges of a dynamic world.

Notes on Contributors

LSS  contributes to the conception of the work. LSS, JHTY and DDS drafts the work and revising it, approves the final version to be published, and agrees to be accountable for all aspects of the work.

Acknowledgement

We extend our gratitude to all participants, speakers, and organisers of APMEC for their invaluable contributions to advancing medical education.

Funding

There is no funding for this paper.

Declaration of Interest

The author declared no conflict of interests.

*Lee Shuh Shing
10 Medical Drive,
Singapore 117597
66013452
Email: medlss@nus.edu.sg

Submitted: 18 May 2024
Accepted: 25 November 2024
Published online: 1 April, TAPS 2025, 10(2), 4-7
https://doi.org/10.29060/TAPS.2025-10-2/GP3347

Juliet Mathew¹, Hazlina Binti Abu Bakar² & Shilpa Murthy²

¹Clinical Skills & Simulation Centre and School of Medicine, IMU University, Malaysia; ²Department of Clinical Skills and School of Medicine, IMU University, Malaysia

Abstract

Introduction: Medical students are known to have a higher prevalence of psychological distress although they begin medical school with better mental health than their peers. Depression and burnout rates are high among them and many of these students do not seek help due to the associated stigma linked with mental health concerns. At present, there are several known resilience-enhancing modules incorporated within the curriculum to improve students coping skills, however, there are no known modules yet that introduce this concept within the early medical curriculum, especially within the pre-clinical years.

Methods: IMU University introduces a Resilience Workshop within early pre-clinical years to appropriately engage students to recognise and address common challenges. This can be tackled by understanding the various coping mechanisms that can be adopted. This workshop describes four main areas: introduction to resilience, interactive activities, discussions, and reflection platforms. This initiative aligns with the university’s curriculum focus on person-centred care, emphasising personalised care as a priority.

Results: Preliminary results suggest that the Resilience Workshop can aid in developing suggested and self-regulated interventions to manage adversities faced by medical students. Attention to individual students’ coping reservoirs can help promote well-being and minimise burnout. Formal and informal offerings within medical schools can help fill the reservoir.

Conclusion: This article provides a perspective on fostering resilience building within the early medical curriculum to cultivate core strengths among medical students for managing adversities.

Practice Highlights

• Psychological distress is prevalent among medical students.
• Challenges occur in medical students seeking help.
• Resilience strength is vital to medical students to recognise and address common challenges.
• A gap exists in the curriculum to improve medical students’ coping skills in the early years.
• Fostering resilience in early medical curricula can cultivate core strengths among medical students for managing adversities.

I. INTRODUCTION

IMU University’s Resilience Workshop was designed and implemented within the medical curriculum in pre-clinical years to develop students’ core inner strengths to their possible highest growth. This is so that they are fully equipped and ready to meet the challenges of competent care delivery to patients. In line with IMU University’s revised medical curriculum’s direction which focuses on the philosophy of person-centred care with humanistic values, this workshop emphasises self-care as a priority before embarking on to selfless care of patients.

In this revised curriculum, much emphasis is placed on the development of skills, behaviours, and attitudes within the delivery of care to patients, encompassing the basic concepts of human interaction, patient safety, quality improvement, and systems thinking; while enhancing the skills of teamwork, effective communication, leadership, negotiation, and cooperation.

The aim has been to best prepare our graduates to practice within the needs of the health profession in the 21st century. This includes equipping them in communication, clinical, cultural, interpersonal, research, and system thinking competencies. These prepare our students to be ready for any advanced clinical training within local or international institutions.

The curriculum’s goal is also to produce graduates who are person-centred and with humanistic values, with professional attributes of being empathetic, compassionate, responsive, and adaptive besides being a transformative leader, lifelong learner, and professionally competent.

Thus, the new curriculum emphasises graduates’ wellness, person-focus services, effective communication, personalised care, multi-disciplinary collaboration & approach, coordinated, continuous & seamless care delivery manner; & application of system thinking and value-based care.

In aligning with this direction and ensuring that our graduates are fit to practice as global doctors with opportunities to practice internationally, the Resilience Workshop engages and guides students in building their own core coping mechanisms while reviewing the principles of determinants of resilience. It is designed to inspire and empower students to be resilient. The postulation is that the students would have retained a substantial knowledge base which constitutes an increasing resource for coping with the diverse challenges they will be exposed to in their medical journey, and for building core resilience strength.

II. METHODS

A. Structured Workshop Flow

The lesson outcomes from this workshop aim at achieving student’s understanding of the importance of adapting well in the face of adversity, threats, or even significant sources of stress, as well as engaging in resilience throughout medical school. With inspiring themes such as “Bend, But Do Not Break” in semester two and “Be Managing Adversities Delightfully (Be MAD)” in semester four, pre-clinical medical students are exposed to challenging scenarios that they may encounter. These scenarios extend beyond their roles as students, to include their relationships with friends, roommates, peers, and more.

The workshop is designed to engage students in four main areas:

Session 1: Introduction to Resilience

Session 2: Activity on Resilience

Session 3: Discussions on Resilience

Session 4: Reflection on Resilience

At the beginning of the workshop, students are provided with The Brief Resilience Scale adapted from Ohio University. It consists of simple and focused scoring scales. It is concise and has good psychometric properties including strong validity and reliability, capturing resilience effectively. Students can score and gauge their resilience levels with easy-to-follow instructions. This allows them to understand their coping strengths, identify their ability to recover from adversities, focus on areas for improvement, and guide them toward improved performances within medical training.

Subsequently, students are introduced to the concept of resilience. They are then led into small group discussions to engage, brainstorm scenarios presented, and grasp levels of coping and managing difficult scenarios that are commonly encountered. They are also given opportunities to share their experiences and discuss possible solutions to the scenarios and their insights. Debriefing includes discussions based on structured questions that could engage students in their thought processes and emotional experiences. It also focuses on their possible courses of action, ideas, or solutions in managing difficult situations within the scenario presented.

B. Reflection Analysis

Students are encouraged to reflect on their experiences and take-home messages from the workshop. They are required to submit a 500-word essay via e-mail, documenting the challenges and strengths that surfaced for them during the session. This must be submitted within a stipulated time frame after the workshop, via e-mail to facilitators for assessment. These reflection essays are reviewed and students with potential mental health concerns are identified. They are then followed personally or referred to their mentors for appropriate support.

III. RESULTS

The scenarios used exposed students to common issues encountered during their early medical training. It encompassed adjustments to the new environment on campus and hostels, adjustments to a new culture of peers, understanding new subjects, meeting professionalism requirements, and addressing unique and individualised adversities.

These scenarios stimulated discussions in the breakout sessions, where standard questions were posed to ignite the development of possible solutions to the simulated adversities faced: (A) How would you handle this situation? (B) What would you do? (C) How would you feel? (D) Explain.

Students were encouraged to narrate their experiences and explore their thoughts and emotions. This helped students realise that there are common issues that are endured by many. Most students reported that the workshop helped them to understand the various coping mechanisms that can be adopted to solve issues that may arise within their journey and progress in medical school. Verbal responses received include:

“I didn’t realise how important managing stress was until I was hit by a personal issue. It affected my studies. This workshop showed me how I can handle stress better…”

“I didn’t want to attend this workshop at first.  But the scenarios discussed were mostly what I had endured. I wish I knew these coping strategies earlier…”

IV. DISCUSSION

Students can establish strong foundations in coping strategies, emotional intelligence, and stress management by introducing resilience throughout the preclinical years. The hurdles are mostly theoretical and academic, making it a less demanding environment to begin honing these talents. Students can study the fundamentals of resilience, through such workshops. The basic ideas from the preclinical years could be modified and built upon to deal with the interpersonal, ethical, and emotional difficulties that may arise in their academic obligations and their clinical practice.

The challenges encountered can be described within the following phases:

A. Pre-workshop Challenges

The lack of facilitators with adequate skills in resilience science and mental health advocacy was the main challenge. As mental health issues require more in-depth management, the deliverance of such workshops had to be done by facilitators who are skilled in strong communication skills, empathy, patience, and compassion. The initial perspective was that all faculty would be well-equipped with these skills, however, it became clear post-workshop, that this was not the case. The selection of such facilitators to deliver the context of this workshop in a non-lecturing but inspiring way posed a challenge. The solution is to include training for faculty before the workshop.

B. Workshop Challenges

During the Malaysian Movement Control Order (M.C.O.) when this workshop was first introduced to help students cope, it was delivered online.  Hence, the active involvement of students was limited as being on camera had its challenges. Further, many students considered such a workshop to be non-mainstream and non-exam oriented, thus, needing much encouragement to participate fully. The solution is to introduce face-to-face workshops to better engage students.

C. Post-workshop Challenges

Most students who attended the workshop completed and e-mailed the reflection exercises. However, a certain percentage of them failed to do so. This presents a challenge in identifying any student who may have a serious underlying issue with managing adversities resiliently. The solution is to track attendance when delivering assignments.        

A possible way to capture all reflections would be to make attendance marked only upon receiving the assignment. As these are medical students in their early years, this approach may not be effective and can lead to non-genuine or robotic responses. While addressing and reinforcing professionalism may be another goal for obtaining reflective essays, it may seem forced. More self-regulating and motivating strategies should hence be developed and applied.

This two-hour workshop is a brief intervention within the time-limited curriculum within semesters two and four. Moving forward, a half-day workshop with more time for interaction with peers and educators could better engage students. A survey could be conducted post-workshop to assess students’ feedback. Providing progression reports of students’ resilience levels could be a more accurate measure of the workshop’s impact. Also, the BRS could be re-used in semester four, to review recovery or the ability to regain equilibrium after adversity.

The students’ submissions of their reflective essays constitute a dataset that can be analysed for further studies in this field, to address and create various aspects of positive interventions within mental health access and stress-relief resources. The aim is, to create better impacts on students’ learning and experience in medical school.

V. CONCLUSION

Above all, we need to understand that resilience is a lifelong ability that cannot be acquired in a single workshop. It needs to be constantly supported through different educational stages, within challenging and stressful circumstances.

Attention to individual students’ coping reservoirs can help promote well-being and minimise burnout. Formal and informal offerings within medical schools can contribute to this effort. Helping students cultivate the skills to sustain their well-being throughout their careers has important payoffs for the overall medical education enterprise.

IMU University’s Resilience Workshop can aid in the development of suggested as well as self-regulated interventions to manage adversities faced by medical students. A formal study is ongoing to substantiate this. Further to this, the development of a student-led multifaceted approach that promotes not only care-taking behaviours but also focuses on institutional and cultural change to empower students to participate in these resiliency strategies can be considered.

This and other models of coping should be empirically validated, for students to not stumble through medical school, but soar.

Notes on Contributors

Dr Juliet Mathew is the first author who designed and wrote this article. Director of the Clinical Skills & Simulation Centre at IMU University, she teaches simulation concepts to pre-clinical students. She confirms sole responsibility for this article’s conception, design, analysis, interpretation of results of context, and manuscript preparation.

Dr Hazlina Binti Abu Bakar supervised the conception of this project and contributed to the critical review of the manuscript. She is a lecturer teaching clinical skills and simulation concepts at the School of Medicine University, IMU University. She also holds a master’s degree in healthcare and medical simulation.

Dr Shilpa Murthy contributed to the continuous review of the important intellectual content and final version of the manuscript. She also contributed to the conception of this project. She is a senior lecturer teaching clinical skills and simulation concepts to pre-clinical medical students at the School of Medicine, IMU University.

Acknowledgements

The authors would like to express our sincere appreciation to Dr Cheah Xian-Yang for his invaluable assistance in proofreading this article. We also extend our gratitude to Associate Professor Dr Sow Chew Fei for her guidance.

Funding

There is no funding for this paper.

Declaration of Interest

The authors of this paper have no conflicts of interest to declare.

References

Bird, A., Tomescu, O., Oyola, S., Houpy, J., Anderson, I., & Pincavage, A. (2020). A curriculum to teach resilience skills to medical students during clinical training. MedEdPORTAL, 16, Article 10975. https://doi.org/10.15766/mep_2374-8265.10975

Cook, M. C., & Stewart, R. (2023). Resilience and sub-optimal social determinants of health: Fostering organizational resilience in the medical profession. Primary Care: Clinics in Office Practice, 50(4), 689-698. https://doi.org/10.1016/j.pop.2023.04.013

Omari, O. A., Yahyaei, A. A., Wynaden, D., Damra, J., Aljezawi, M., Qaderi, M. A., Ruqaishi, H. A., Shahrour, L. A., & AlBashtawy, M. (2023). Correlates of resilience among university students in Oman: A cross-sectional study. BMC Psychology, 11, Article 2. https://doi.org/10.1186/s40359-022-01035-9

Rotenstein, L. S., Ramos, M. A., Hom, J., & Gardner, A. (2016). Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: A systematic review and meta-analysis. JAMA, 316(21), 2214-2236.https://doi.org/10.1001/jama.2016.17324

Thompson, G., McBride, R. B., Hosford, C. C., & Halaas, G. (2016). Resilience among medical students: The role of coping style and social support. Teaching and Learning in Medicine, 28(2), 174-182. https://doi.org/10.1080/10401334.2016.1146611

*Dr Juliet Mathew
IMU University, 126, Jalan Jalil Perkasa 19,
Bukit Jalil, 57000 Kuala Lumpur
Federal Territory of Kuala Lumpur
+6012 – 574 1723
Email: julietmathew@imu.edu.my

Submitted: 15 June 2024
Accepted: 12 September 2024
Published online: 1 April, TAPS 2025, 10(2), 8-12
https://doi.org/10.29060/TAPS.2025-10-2/GP3440

Galvin Sim Siang Lin¹, Tong Wah Lim² & Mariana Minatel Braga³

¹Department of Restorative Dentistry, Kulliyyah of Dentistry, International Islamic University Malaysia, Malaysia; ²Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R.; ³Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, Brazil

Abstract

Introduction: Dental education is undergoing a major transformation due to evolving healthcare needs, technological advancements, and the demand for dental practitioners to meet the diverse needs of a global patient community. Competency-based education (CBE) is at the forefront of this change, focusing on what students are competent in upon graduation. Unlike traditional models, CBE emphasises practical skills, critical thinking, and problem-solving.

Methods: This article explo res the shift towards CBE in dental education, examining frameworks that support CBE like Miller’s Pyramid and guidelines from organisations such as the Accreditation Council for Graduate Medical Education (ACGME) and the American Dental Education Association (ADEA). It also involves a detailed analysis of these frameworks and their application in designing competency-based curricula.

Results: The findings reveal that CBE facilitates a student-centric approach, enhancing critical thinking, problem-solving, and autonomous self-assessment. These frameworks guide the design of curricula including identifying core competencies, defining competency levels, mapping competencies to learning outcomes, selecting effective teaching methods and utilising various assessment strategies. However, implementing CBE faces challenges, including measuring soft skills and resistance from educators and students.

Conclusion: CBE represents a paradigm shift in dental education, ensuring graduates are not only knowledgeable but proficient in practical skills. Future recommendations include incorporating technology-enhanced learning, global health competencies, and sustainability practices into the curriculum. Continuous professional development for educators and robust feedback mechanisms are needed to maintain the curriculum’s relevance and effectiveness, ensuring dental graduates are well-equipped to meet the demands of modern dental practice.

Practice Highlights

• Dental education is evolving to meet global healthcare needs and technological advancements.
• CBE focuses on practical skills, critical thinking, and problem-solving
• CBE ensures dental graduates are competent and ready for modern practice challenges.
• Several frameworks can be used to guide CBE in developing clinical
• Designing CBE curricula involves defining core competencies and using diverse assessment methods.

I. INTRODUCTION

Dental education is at a pivotal moment, facing a profound transformation influenced by the dynamic intersection of changing healthcare needs, technological advancements, and the urgent call for dental practitioners to cater to the diverse requirements of a globalised patient community. Amid this swiftly evolving landscape, traditional approaches to dental education are undergoing a fundamental reimagination. The aim is to nurture a generation of dental professionals not only well-versed in theoretical knowledge but, crucially, equipped with the competencies vital for thriving in modern dental practice. Competency-based education (CBE) emerges as a key player in this educational revolution. This approach to curriculum design and teaching revolves around a central question: What should students be able to do or achieve at the culmination of their course or program? In the realm of dental education, CBE moves beyond the traditional focus on accumulating knowledge and places a spotlight on the practical skills students need to excel in their future roles. It is not just about what students know; it is about what they can proficiently do. Why adopt competency-based education in dentistry? The answer lies in its power to enhance student learning by emphasising hands-on skills, critical thinking, and problem-solving abilities. CBE ensures that graduates are not merely well-informed in dental theory but are also competent practitioners capable of meeting the ever-changing demands of contemporary dental care.

II. THE SHIFT TOWARDS COMPETENCY-BASED DENTAL EDUCATION

In recent years, the field of dental education has undergone a transformative shift, pivoting away from the traditional education models to embrace the principles of competency-based dental education. This evolution is rooted in a fundamental recognition that the mastery of dental skills and knowledge is a dynamic process, necessitating an educational paradigm that transcends mere adherence to a predetermined timeframe (Chuenjitwongsa et al., 2018). While various definitions of competency-based education exist, there is a consensus that it revolves around outcome-based learning, ensuring the production of graduates with the requisite knowledge, skills, and attitudes to serve society effectively, meeting the standards of national qualifications frameworks, stakeholders, and the labour market.

Traditional-based dental education has faced criticisms for its potential to produce graduates who may lack practical proficiency or struggle to adapt to emerging trends in dentistry. It emphasises time spent in the classroom, irrespective of individual mastery. Furthermore, traditional models may sometimes struggle to keep pace with the rapid advancements in dental technology and shifting paradigms in patient care, underscoring the need for a more adaptive and outcomes-focused approach. On the other hand, CBE signifies a departure from traditional education, characterised by its teacher-centred, examination-focused, time-constrained, and discipline-oriented approach. It transitions towards a student-centric educational model using an outcome-based approach that enhances students’ capabilities in critical thinking, problem-solving, and autonomous self-assessment.

Moreover, in CBE, the focus shifts from completing a predefined course of study to ensuring that learners attain proficiency in specific competencies, enabling them to navigate the complexities of dental practice effectively. In a competency-based framework, success is measured by demonstrating specific skills, ensuring that graduates are not merely knowledgeable but possess the practical expertise required for clinical practice. Besides, future professionals tend to be able to make decisions even when ideal/learned circumstances are changed. This paradigm shift promotes a deeper understanding of concepts and fosters a culture of continuous improvement. In CBE, novice dental students commence their training in simulation laboratories, preparing them to progressively attain beginner and competent levels in clinical settings.

III. FRAMEWORK FOR COMPETENCY-BASED DENTAL EDUCATION

A. Miller’s Pyramid

The Miller Pyramid of Competence, introduced by psychologist George Miller in 1990 (Miller, 1990), stands as a foundational framework for evaluating clinical proficiency in healthcare education. This pyramid encapsulates a four-tiered hierarchy, delineating the progressive stages of competence acquisition. At its base, the pyramid begins with “knowledge”, representing the foundational cognitive understanding of concepts typically assessed in classroom-based environments. Moving upwards, the tiers evolve into “competence” and subsequently “performance”, encompassing knowledge translation into practical skills through simulated clinical settings. The higher echelons of the pyramid, namely “action”, signify the culmination of clinical competence in real-world scenarios. Here, learners demonstrate their ability to apply theoretical knowledge and practical skills in authentic clinical environments. The Miller Pyramid’s distinction between cognitive and behavioural components is particularly noteworthy. The lower tiers, focusing on knowledge and competence, mention the importance of classroom-based assessments in gauging cognitive understanding. In contrast, the apex tiers of performance and action underline the significance of evaluating behavioural aspects within simulated and real clinical settings. This hierarchical structure provides a great understanding of competency development, guiding educators in designing competency-based curricula.

B. Accreditation Council for Graduate Medical Education (ACGME)

The ACGME plays a role in shaping the educational standards for healthcare professionals. ACGME has delineated six core competencies, transcending traditional disciplinary boundaries and applicable to various healthcare practitioners (Batalden et al., 2002). These competencies form a holistic approach to evaluating the proficiency of healthcare professionals and are integral to fostering well-rounded practitioners capable of meeting the complex demands of modern healthcare. The six core competencies identified by ACGME are Patient Care, Medical Knowledge, Professionalism, Interpersonal and Communication Skills, Practice-Based Learning and Improvement, and Systems-Based Practice. Patient Care centres on delivering compassionate, effective, evidence-based care to individuals and populations, while medical knowledge encompasses the understanding needed for sound clinical decision-making. Professionalism emphasises ethical behaviour, accountability, and a commitment to the well-being of patients. Interpersonal and Communication Skills are crucial for effective collaboration and patient interaction, whereas practice-Based Learning and Improvement involves the ability to critically assess and improve one’s own clinical practice continuously. Systems-Based Practice involves comprehending healthcare delivery systems and endorsing high-quality and cost-effective patient care within the broader healthcare system context. Customising these competencies for the dental context allows dental educators to align educational objectives, ensuring their curriculum imparts technical skills while cultivating the ethical, communication, and systemic perspectives essential for a well-rounded dental practitioner.

C. American Dental Education Association (ADEA) Competencies for the New General Dentist

The ADEA has crafted the Competencies for the New General Dentist, a set of guidelines tailored specifically for dental education (American Dental Education Association, 2017). Ratified by the ADEA House of Delegates on 2^nd April 2008, this framework is a decisive step in defining the essential competencies for individuals entering the dental profession as general dentists., This document reflects a departure from the 1997 competencies, aligned with patient care responsibilities, public oral health needs, and contemporary trends in dental practice and draws inspiration from the 2002 Institute of Medicine’s core competencies with a heightened emphasis on quality patient care and safety. Structured into six domains—Critical Thinking, Professionalism, Communication and Interpersonal Skills, Health Promotion, Practice Management and Informatics, and Patient Care—the competencies are thoughtfully organised, allowing for more flexible and adaptable integration into dental education curricula. This framework serves as a central resource for the ADEA at the national level and individual dental schools at the local level, fostering an environment conducive to innovation in predoctoral dental school curricula. Overall, the ADEA competencies serve as a benchmark, enabling dental educators to design curricula that not only meet but exceed the contemporary expectations and requirements of the dental profession.

D. The Graduating European Dentist Curriculum

The Graduating European Dentist Curriculum, under the auspices of the Association for Dental Education in Europe (ADEE), presents a contemporary framework embodying the optimal academic practices for undergraduate dental education in Europe (Field et al., 2017). This curriculum is structured across five integral domains, each contributing to a comprehensive educational experience: (1) Professionalism, (2) Safe and Effective Clinical Practice, (3) Patient-Centred Care, (4) Dentistry and Society, and (5) Research. Crafted through a collaborative process involving consultation, consensus-building, and collegial learning, this curriculum highlights the importance of patient safety, teamwork, and teaching excellence. Aligned with European Quality in Higher Education benchmarks, “The Graduating European Dentist” introduces an innovative approach reflecting the pinnacle of academic standards in European dental education. The revised framework features a more explicit linkage between “Learning Outcomes” and the defined curriculum, accompanied by detailed guidance specific to each competence domain, encompassing “Methods of Teaching and Learning” and “Methods of Assessment”. It is anticipated that this framework would facilitate an enriched educational experience for dental students across Europe.

IV. DESIGNING A COMPETENCY-BASED DENTAL CURRICULUM

To effectively design and develop a competency-based dental curriculum, educators need a comprehensive framework that aligns with the unique challenges and requirements of dental practice. The following components are some of the basic summarised steps that serve as foundational guides for the implementation of a competency-based curriculum:

A. Identifying Core Competencies

Begin by identifying the core competencies that future dental practitioners must possess. This involves collaboration with practitioners, educators, and stakeholders to ensure that the curriculum reflects the evolving needs of the dental profession. Core competencies might encompass knowledge acquisition, clinical skills, patient communication, ethical practice, and the ability to integrate new research findings into practice.

B. Defining Competency Levels

Once core competencies have been identified, it is crucial to define distinct competency levels for each skill or knowledge area. These levels serve as benchmarks for assessing student progress and proficiency. They facilitate a granular approach to education, where learning and assessment can be tailored to students’ individual needs, recognising that learners progress at different rates and may require differentiated levels of support to achieve competency.

C. Mapping Competencies to Learning Outcomes

Each identified competency should be mapped to specific learning outcomes within the curriculum. This mapping process ensures that the curriculum is logically structured, with a clear progression from foundational knowledge to applying skills in complex clinical scenarios. It allows educators to design courses and modules that systematically build upon each other, guiding students on a clear path towards achieving the essential competencies required for successful dental practice.

D. Selecting Effective Teaching Methods 

Adopt diverse and innovative teaching methods that cater to different learning styles and encourage active engagement. Techniques such as problem-based learning (PBL), case-based learning (CBL), team-based learning (TBL), simulation exercises, and hands-on clinical practice are effective in helping students develop critical thinking and practical skills. Incorporating technology, such as virtual reality (VR) and digital simulations, can also enhance learning experiences and prepare students for real-world challenges.

E. Utilising Assessment Strategies

Implement a variety of assessment methods to evaluate students’ competency levels. This may include practical exams, case-based assessments, and objective structured clinical examinations (OSCEs). These should be complemented by regular, formative assessments and feedback, which are instrumental in identifying areas where students may struggle and providing them with the support needed to overcome these challenges. The ultimate goal of assessment within a competency-based curriculum is not merely to test knowledge but to facilitate the development of skilled, reflective, and adaptable dental practitioners.

V. LIMITATIONS AND CHALLENGES IN IMPLEMENTING A COMPETENCY-BASED CURRICULUM

Authenticity and the ability to accurately measure skills have been identified as the primary challenges in CBE for dentistry. In this field, knowledge and skills are often assessed as separate entities, leading to a potential loss of authenticity throughout the learning process. While CBE incorporates a variety of subjective and objective evaluations, measuring certain soft skills, such as clinician-patient communication, ethics, and values, remains a challenge due to their complex and intangible nature. Moreover, implementing CBE in dental education may face additional obstacles, including the limited availability of established theoretical frameworks to guide the teaching-learning process, insufficient training for educators in adapting to this curriculum style, and resistance from both teaching staff and students. Addressing these challenges is essential for ensuring the successful adoption and integration of competency-based education within dental programs.

VI. CONCLUSION

The transition towards competency-based dental education marks a significant paradigm shift aimed at equipping future dental professionals with the practical skills, ethical understanding, and critical thinking abilities necessary for success in the contemporary dental landscape. Future recommendations include the further integration of technology-enhanced learning tools, the development of global health competencies, and the emphasis on sustainability and ethical practices within the curriculum. Additionally, establishing robust feedback mechanisms and promoting continuous professional development among educators will be crucial in maintaining the curriculum’s relevance and effectiveness.

Notes on Contributors

GSSL and TWL were involved in the conception and design of the study. GSSL, TWL and MMB reviewed the literature, collected the data, and wrote the original draft. TWL edited the original draft. All authors have read and approved the final manuscript.

Funding

No funding is required for this paper.

Declaration of Interest

All authors have no conflicts of interest.

References

American Dental Education Association. (2017). ADEA competencies for the new general dentist. Journal of Dental Education, 81(7), 844-847. https://doi.org/10.1002/j.0022-0337.2017.81.7.tb06299.x

Batalden, P., Leach, D., Swing, S., Dreyfus, H., & Dreyfus, S. (2002). General competencies and accreditation in graduate medical education. Health Affairs (Millwood), 21(5), 103-111. https://doi.org/10.1377/hlthaff.21.5.103

Chuenjitwongsa, S., Oliver, R., & Bullock, A. D. (2018). Competence, competency‐based education, and undergraduate dental education: A discussion paper. European Journal of Dental Education, 22(1), 1-8. https://doi.org/10.1111/eje.12213

Field, J. C., Cowpe, J. G., & Walmsley, A. D. (2017). The graduating European dentist: A new undergraduate curriculum framework. European Journal of Dental Education, 21 Suppl 1, 2-10. https://doi.org/10.1111/eje.12307

Miller, G. E. (1990). The assessment of clinical skills /competence/performance. Academic Medicine, 65(9), S63-67. https://doi.org/10.1097/00001888-199009000-00045

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

Submitted: 5 July 2024
Accepted: 25 November 2024
Published online: 1 April, TAPS 2025, 10(2), 13-16
https://doi.org/10.29060/TAPS.2025-10-2/GP3456

Eng Koon Ong^1-4,7 & Wen Shan Sim^4-6

¹Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore; ²Office of Medical Humanities, SingHealth Medicine Academic Clinical Programme, Singapore; ³Division of Cancer Education, National Cancer Centre Singapore, Singapore; ⁴Duke-NUS Graduate Medical School, Singapore; ⁵Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore; ⁶PGY1 Programme, SingHealth, Singapore; ⁷Assisi Hospice, Singapore

Abstract

Introduction: The medical humanities (MH) have the potential to support medical education (ME) by developing observational skills, promote reflective practice and transformative growth. However, contextual content and methods relevant to our local and regional learners and teachers are lacking.

Methods: We describe three MH-based ME programmes within SingHealth to illustrate our considerations in the choice of conceptual frameworks and content selection in programme development and evaluation.

Results: Highlighting pertinent challenges in developing the field due to poor awareness, lack of resources and research capability, we emphasise the importance of interdisciplinarity, engaging leadership, and generating research output. Broad strategies to achieve these goals are then presented.

Conclusion: Highlighting challenges due to the lack of awareness, administrative and funding support, and research capability, we propose strategies to overcome such barriers and hope that readers will be inspired to contribute to this developing landscape where science and art intersect.

Practice Highlights

• Established frameworks and methods should be employed in programme development and evaluation.
• Art, literature, and theatre may be employed in medical humanities-programmes.
• Interdisciplinarity, leadership engagement and development of research capability are essential.
• Alignment with organisational needs and vision will ensure relevance and sustained support.
• The impact of the humanities on fostering wellbeing should not be neglected.

I. INTRODUCTION

The medical humanities (MH) is an interdisciplinary field characterised by critical enquiry and engagement of humanities disciplines. In medical education (ME), content or pedagogy derived from the arts and humanities may be employed to develop observational skills, promote reflective practice and transformative growth, and support humanistic clinical practice and communications (Dennhardt et al., 2016). However, while the integration of the MH in ME in Western countries has been widely supported and reported, a similar movement within Asian countries appears to be lacking and challenging. Educators in Arab-Muslim environments have lamented the lack of culturally-relevant content and concepts that remain predominantly Western-centric (Daher-Nashif & Kane, 2022), while additional challenges cited in China, Hong Kong, and Taiwan include limited awareness exacerbated by conflicting priorities of academic institutions (Tan et al., 2021; Wu & Chen, 2018). These factors result in a lack of impetus for higher education reform and slow research advancement of the field. To address these gaps, we first describe three educational programmes to highlight how local content and methods of co-facilitation may be employed. Next, we list the respective conceptual frameworks, learning objectives and programme evaluation methods selected. Finally, we discuss strategies to increase awareness, maintain leadership and participant interest, secure sustained funding, and promote scholarly efforts. We hope that this article will support and inspire like-minded clinician educators with structurally relevant guidance that is currently lacking in the literature.

II. PROGRAMME DESCRIPTION

One of the first programmes we implemented was the HAPPE (Humanistic Aspirations as a Propellor for Palliative care Education) workshop, a 1.5-hour small group discussion session for junior doctors in a palliative care rotation at the Division of Supportive and Palliative Care, National Cancer Centre Singapore, facilitated by an accredited clinical psychologist and art therapist. Schon’s theory of Reflective Practice defined by reflection-in-action and reflection-on-action guided the discussions that focused on the participants’ experience with challenging clinical encounters that they expressed through readings of literary work and art-based craftwork. Parts of Gagne’s model of lesson planning such as the importance of gaining the learner’s attention, stimulating recall, presenting stimulus, and providing learning guidance were aptly supported by our choice of materials and facilitation. The themes of empathy and wellbeing were discussed and highlighted the importance of reflective practice on past challenging encounters. As a pilot educational intervention started since 2018, we chose to investigate the feasibility and acceptability of the MH-based workshop using self-reported quantitative scales such as the Consultation and Relational Empathy (CARE) Measure and Jefferson Physician Empathy Scale (JPES) pre- and post-workshop. Both scores improved after attendance of the workshop, supporting continual efforts for future runs of the workshop.

One year later, the half-day ADEPT (Arts and Drama to Enable Perspective Taking) workshop was implemented. In contrast to HAPPE, ADEPT was conducted for final year medical students from the Duke-NUS medical school within their core rotation to palliative care. Addressing the lack of adequate clinical exposure and role-modelling due to the brevity of the week-long rotation, a full recording of a local play A Good Death which portrayed theatrical presentations of severe pain, end-of-life conversations, and physician burnout was shown to the students. They then participated in small group discussions about perceptions of palliative care, professional identity formation, clinical communications, and physician wellbeing. These discussions were co-facilitated by a palliative care specialist, trained counsellor, and the director of the play and served to dispel myths about palliative care, promote self-awareness, and introduce coping strategies. The workshop was guided by Knowles’ theory of adult-learning and we ensured that a sense of agency and empowerment was promoted, with the students participating in self-directed reflection and learning. Building on the quantitative results of the HAPPE workshop, ADEPT was evaluated through a qualitative lens where students were invited to participate in individual semi-structured interviews by an independent interviewer to share their experiences of the workshop.

Finally, the full-day HEARTEN (Harnessing Educational approaches with the Arts to encourage End of life Conversations) workshop was started in 2022 and employed theatre-based techniques to address healthcare professionals’ discomfort in initiating advanced care planning (ACP) conversations with patients. The workshop marked our first formal collaboration with a local professional theatre group (ArtsWok) external to the SingHealth Duke-NUS Academic Medicine Centre and was attended by physicians, nurses, and various allied health professionals. This collaboration further cemented our approach of engaging local content and co-facilitators. Together, the team of physicians, social workers, art therapists, humanities researchers, and a theatre director employed Mezirow’s framework of transformational change to design experiential theatre- and acting-based exercises to trigger discussions about deep-seated perceptions and misgivings about initiating ACP discussions. We evaluated participants’ change in confidence levels in ACP discussions pre- and post-workshop through the Self-Competence in Death Work Scale (SC-DWS) survey quantitatively. An open-ended question was also embedded within the post-workshop survey to allow triangulation of the quantitative data collected. Preliminary data analysis showed an improvement in the SC-DWS surveys, with participants reflecting that their pre-existing concerns about triggering unhappiness and anxiety in patients might have been unfounded.

III. CHALLENGES

The HAPPE, ADEPT, and HEARTEN workshops illustrate a spectrum of MH-based ME programmes in terms of scale (5 to 20 participants per workshop; workshop durations of 1.5 to 8 hours), learning objectives, involvement of co-facilitators, choice of materials, and evaluation methods. In addition, all three workshops were supported by local institutional academic research funding, the amount of which increased over the years (SGD$5,000 – $42,000). By clearly enunciating our choice of educational conceptual frameworks and validated scales for programme evaluation, and consistently incorporating local content and engaging local stakeholders, we posit that some of the challenges such as the lack of contextually relevant content and frameworks and rigor in programme development and evaluation may be addressed.

However, several pertinent challenges exist. Firstly, awareness about the MH remains poor, with its integration into ME at a nascent stage compared to Western countries. Competing with other educational programmes that are better established, the small group size and similar pools of participants who enrolled in our programmes risk the case of “preaching to the choir.” This in turn may lead to challenges in garnering leadership support to encourage staff participation. In addition, securing sustained programme funding is challenging as education grants are limited to smaller, project-based programmes. Relative to clinical research, institutional management and administrative teams have less experience and expertise in supporting medical education research. Often, the project team members find themselves overwhelmed with administrative tasks including financial processes and manpower recruitment. These barriers towards research capacity building may deter interested but busy clinician educators from contributing to scholarly work that is crucial to support the growth of the field.

IV. PROPOSED STRATEGIES

We propose three areas of consideration that we have found helpful in navigating challenges in the landscape. While our experience stems from a single local healthcare centre, similar cultural, societal, and systemic factors in other parts of the Asia-Pacific region will allow applicability and relevance to other clinician educators.

A. Promoting Interdisciplinary Teaching and Learning

The MH is defined by an interdisciplinary approach and we adopt a collaborative approach in engaging various stakeholders such as local and regional humanities scholars, creative arts therapists, professional artistes, and community arts organisations. This allows us access to content from diverse subjects including anthropology, literature, history, philosophy, and other social sciences and to methods such as narrative inquiry, close reading, narrative therapy, and conversational analysis which were previously unfamiliar to us. Learners have described our programmes as refreshing and eye-opening.  However, we are also mindful that some may not take to the arts and humanities naturally. Thus, co-facilitators take extra care to emphasise that learners need not be experts in the arts to engage in reflective practice, and co-facilitators from the humanities are always paired with a clinician educator to ensure the discussions are balanced and relevant.

B. Alignment with Individual Needs and Organisational Goals

An awareness about existing needs and organisational vision is crucial to ensure relevance of the MH programmes. In the SingHealth Duke-NUS Academic Medicine Centre (AMC), our programmes support pillars of the medical education (ME) masterplan such as interprofessional education, educational excellence, and fostering wellbeing. By including other health professions besides doctors, approaching programme development and evaluation through established educational frameworks and methods, and promoting wellbeing by engaging in the arts, the ADEPT workshops have now been adopted by the SingHealth College of Allied Health and Singapore Institute of Technology for allied health professionals and trainees respectively. Notably, the impact of the arts in fostering wellbeing by providing an avenue for expression of difficult emotions, building a sense of community, and processing grief for healthcare professionals provides further impetus for leadership support of our programmes. While MH programmes are not psychotherapy-based per se, participants have shared that the experience was therapeutic and with an increased awareness about struggles, some have been prompted to seek support from professional mental health professionals after programme attendance. Seeing the value of the MH, various offices of the medical humanities have been set up within the AMC since 2019. In 2023, the SingHealth Duke-NUS Medical Humanities Institute was established to further provide centre-wide administrative and funding support for MH programmes within ME. Supported by social media platforms, these offices have organised webinars, colloquiums, and Medical Humanities conferences that increase the visibility of our endeavours and continue to engage leadership, increase interest, and sustain awareness of MH-based programmes.

C. Developing Research Capability

Despite its rich history and diverse cultural perspectives, research in the medical humanities (MH) in medical education (ME) within Asian countries remains at a nascent stage compared to our Western counterparts. To develop research capability, we adopt a two-pronged approach. Firstly, all of our programmes follow a best practice approach towards development and evaluation guided by established educational theoretical frameworks and methods respectively. Secondly, all of our programmes include a scholarly component, as illustrated above. We are currently analysing qualitative data collected from the ADEPT and HEARTEN workshops and preliminary findings suggest that more data is needed to guide the choice of content, teaching methods, learning objectives, and matching of these aspects to different learner populations. Future funding from the MH offices coupled with national and regional funding on a larger scale made possible by our cross-institutional and interdisciplinary collaborations will allow us to embark on further research to address these gaps.

V. CONCLUSION

The medical humanities (MH) have the potential to impact medical education (ME) learning and teaching outcomes but contextual content and methods relevant to our local and regional learners are lacking. We have described three MH-based ME programmes to illustrate considerations in programme development and evaluation. Highlighting considerations in awareness, administrative and funding support, and research capability, we propose strategies to overcome such challenges and hope that readers will be inspired to contribute to this developing landscape where science and art intersect.

As Carlo Rubbia, Nobel prize winner in physics says,

“Science for me is very close to art. Scientific discovery is an irrational act. It’s an intuition which turns out to be reality at the end of it – and I see no difference between a scientist developing a marvellous discovery and an artist making a painting.”

Notes on Contributors

Both OEK and SWS contributed to the conceptualisation of the paper through their experience and work in both undergraduate and postgraduate training. With repeated discussions, the approach towards explaining the value of the paper and learning points for readers were finalised. Both authors worked on the initial draft of the manuscript, before refining the contents though an iterative process of literature review and discussions with other educators and participants of the various programs. The final draft of the paper was reviewed by both authors who reached the consensus that the paper was ready for submission for publication. Both authors agree to be accountable for all aspects of the paper.

Acknowledgements

We would like to thank Ms Chiam Min and Ms April Thant Aung for proofreading the article.

Funding

No funding was received.

Declaration of Interest

Both OEK and SWS state no conflicts of interest.

References

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Ong, E. K., & Anantham, D. (2019). The medical humanities: Reconnecting with the soul of medicine. Annals of the Academy of Medicine Singapore, 48(7), 233-237.

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Wu, H. Y. J., & Chen, J. Y. (2018). Conundrum between internationalisation and interdisciplinarity: Reflection on the development of medical humanities in Hong Kong, Taiwan and China. MedEdPublish, 7(184). https://doi.org/10.15694/mep.2018.0000184.1

*Ong Eng Koon
National Cancer Centre Singapore
30 Hospital Blvd, Singapore 168583
Email: ong.eng.koon@assisihospice.org.sg