Published online: 7 April, TAPS 2026, 11(2), 1-3
https://doi.org/10.29060/TAPS.2026-11-2/EV11N2

Artificial intelligence (AI) is now a part of all areas of academic work. Journal reviewers and editors have noticed that more manuscripts are being written with the help of AI, specifically generative AI (GenAI), and reviews are being improved through chatbots. To make things more cost-efficient and effective, editorial workflows now include automated screening. The question is no longer if GenAI will affect scholarship. It already does! The key question is, how can we ensure authors are the primary agents of their conceptions and, thus, motivate authors to write articles in a transparent manner that authentically represents their own ideas.

Recent discussions across leading journal editorial boards reflect both optimism and caution. Commentaries in The Lancet Infectious Diseases warn that large language models may generate confident but flawed critiques, amplify bias and hallucinate references (Donker, 2023). Such systems lack epistemic responsibility. They predict language. They do not understand method. Peer review, however, is a moral and scholarly act. It demands judgement, accountability and contextual reasoning. Similarly, discussions in Health Affairs Scholar and Critical Care highlight GenAI’s growing presence in peer review processes. GenAI may assist with triage, language refinement, and detection of plagiarism or reporting omissions. Yet it cannot replace human oversight (Bauchner & Rivara, 2024; Cheng, Sun, Liu, Wu & Li, 2024). These perspectives are not anti-technology. They are pro-accountability. They call for stewardship. Major journal organisations now articulate consistent policy principles. The International Committee of Medical Journal Editors (ICMJE, 2024), the World Association of Medical Editors (Zielinski et al., 2024), the Committee on Publication Ethics (COPE Council, n.d.), and others converge on several points. GenAI tools cannot be authors. Authorship requires responsibility, the ability to declare conflicts of interest, and legal accountability. GenAI meets none of these criteria.

The key is transparency. This can be achieved if authors are required to identify the GenAI tool (e.g., ChatGPT, Claude, Gemini, and Microsoft Copilot) and its version. The JAMA Network further requires the author to describe how GenAI contributed to writing and or analysis (Flanagin et al., 2024). Disclosure is now part of scholarly honesty, which requires a sense of responsibility. The British Medical Journal and The Lancet adopt similar positions. GenAI may assist in writing or editing, but it cannot generate scientific insight, interpret data independently, or substitute researcher judgement (BMJ, 2024; The Lancet, n.d.). Confidentiality remains central. As for reviewers, they must not upload unpublished manuscripts into publicly available GenAI platforms. The National Institutes of Health (NIH, 2023) has formalised this requirement through revised nondisclosure agreements. The integrity of peer review depends on trust. That trust cannot be compromised for convenience. Human accountability remains the anchor.

Yet policy clarity does not eliminate deeper tensions.

First, enforcement remains uncertain. Disclosure depends largely on author and reviewer honesty. Detection tools are imperfect. Investing in digital literacy and understanding the GenAI technologies by journal editors should be the way forward rather than prohibiting them.

Second, GenAI use raises questions of equity. For many medical educators specially in the Asia-Pacific region where English is the second language, GenAI can improve clarity and confidence. For some others, access to expensive GenAI tools may widen disparities. Responsible governance must consider inclusion, not merely control.

Third, we must confront the educational implications. In medical education scholarship, GenAI shapes how learners write, search, and reflect. Editorial policies therefore signal curricular values. If we treat GenAI only as threat, we model fear. If we treat it uncritically as a cost-efficient mechanism, we risk eroding critical thinking. We must instead teach discernment. GenAI literacy should become part of scholarly professionalism. Basil et al. (2026) have conducted a comprehensive review of the impact of GenAI in health profession education and one of their policy suggestions is to regularly audit GenAI policies due to the evolving nature of GenAI technology.

At its heart, this moment is not about technology. It is about identity and professionalism. What does it mean to be an author? A reviewer? An editor? GenAI can assist with language, much like the use of a human proof-reader in the past. However, it cannot assume responsibility for truth as that would mislead and mask the true authorship of the idea being presented. That responsibility remains human.

For The Asia Pacific Scholar, the way forward is balanced and transparent. We should require clear disclosure of GenAI use in manuscript preparation. We should prohibit uploading confidential material into unsecured systems. We should allow cautious use for language improvement when declared. This is also important as English is not the first language of most of the scholars in the region. Journals may employ licensed GenAI tools for plagiarism detection or reviewer matching however with human oversight. It is important that we should preserve human judgement in decisions that shape academic careers and patient care.

GenAI is here to stay. And further to this, we need to be mindful of the dynamic nature of the development of AI technology, as Bennani (2024) amongst many others inform the academic world of the impending advent of artificial general intelligence (AGI). The idea of AGI being to make AI decisions more autonomous thus requiring greater vigilance to ensure these technological changes continue to align with human values of integrity and professionalism. Our task is not surrender, nor resistance for its own sake. It is stewardship and to continue to be well informed. As such, we must guide its use in ways that strengthen scholarship, protect integrity and support our diverse academic community across the Asia-Pacific region.

Technology can accelerate manuscript generation and reviews. However, it cannot replace wisdom.

And wisdom remains our responsibility!

Dujeepa D. Samarasekera
Centre for Medical Education (CenMED), NUS Yong Loo Lin School of Medicine,
National University of Singapore, Singapore

Marcus A. Henning
Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences,
University of Auckland, New Zealand

Basil, M., Ahmed, W., Hajeomar, R., Strawbridge, J., Lynch, M., & Mukhalalati, B. (2026). A scoping review of the use of generative artificial intelligence tools in health profession education. BMC Medical Education, 26, Article 291. https://doi.org/10.1186/s12909-025-08527-3

Bauchner, H., & Rivara, F. P. (2024). Use of artificial intelligence and the future of peer review. Health Affairs Scholar, 2(5), qxae058. https://doi.org/10.1093/haschl/qxae058

Bennani, T. (2024). Advancing Healthcare with GenerativeAI: A Multifaceted Approach to Reliable Medical Information and Innovation (Doctoral dissertation, Massachusetts Institute of Technology). https://hdl.handle.net/1721.1/156048

BMJ. (2024). AI use. BMJ. https://www.bmj.com/content/ai-use

Cheng, K., Sun, Z., Liu, X., Wu, H., & Li, C. (2024). Generative artificial intelligence is infiltrating peer review process. Critical Care, 28(1), 149. https://doi.org/10.1186/s13054-024-04933-z

COPE Council. (n.d.). COPE position – Authorship and AI – English. Committee on Publication Ethics. https://doi.org/10.24318/cCVRZBms

Donker, T. (2023). The dangers of using large language models for peer review. The Lancet Infectious Diseases, 23(7), 781. https://doi.org/10.1016/S1473-3099(23)00290-6

Flanagin, A., Pirracchio, R., Khera, R., Berkwits, M., Hswen, Y., & Bibbins-Domingo, K. (2024). Reporting use of AI in research and scholarly publication—JAMA Network Guidance. Jama, 331(13), 1096-1098. https://doi.org/10.1001/jama.2024.3471

International Committee of Medical Journal Editors (ICMJE). (2024). Recommendations for the conduct, reporting, editing and publication of scholarly work in medical journals (revised in January 2024): A Korean translation. The Ewha Medical Journal, 47(4). https://doi.org/10.12771/emj.2024.e48

National Institutes of Health (NIH). (2023). The Use of Generative Artificial Intelligence Technologies is Prohibited for the NIH Peer Review Process. https://grants.nih.gov/grants/guide/notice-files/NOT-OD-23-149.html

The Lancet. (n.d.). Editorial Policies. The Lancet. https://www.thelancet.com/editorial-policies

Zielinski, C., Winker, M. A., Aggarwal, R., Ferris, L. E., Heinemann, M., Lapeña, J. F., … & WAME Board. (2024). Chatbots, generative AI, and scholarly manuscripts: WAME recommendations on chatbots and generative artificial intelligence in relation to scholarly publications. Current Medical Research and Opinion, 40(1), 11-13. https://doi.org/10.1080/03007995.2023.2286102

Published online: 6 January, TAPS 2026, 11(1), 1-3
https://doi.org/10.29060/TAPS.2026-11-1/EV11N1

We are delighted to present this fourth thematic issue of The Asia Pacific Scholar (TAPS) on Developing a Holistic Healthcare Practitioner for a Sustainable Future. This issue encapsulates a wealth of contributions from authors across regions and disciplines, reflecting the shared agency in addressing the changing landscape of healthcare. Authors were invited to explore how sustainability, inclusivity, and innovation could be interwoven into the formation of the modern practitioner. In response, 14 thought-provoking papers were submitted and accepted. These papers explored the vital shift from siloed clinical training toward education that integrates empathy, well-being, interprofessional collaboration, and environmental consciousness.

Amid rising global healthcare demands, technological innovation and disruption, and environmental and psychological stressors, there is a pressing need to evolve health professions education. We need to train practitioners who are not only clinically competent but also emotionally intelligent, team-oriented, reflective, and resilient as well as being equipped to address both individual and planetary health.

This issue features three overarching themes:

1. Holistic practice and environmental concerns,
2. Faculty development and self-care, and
3. Curriculum advancement for future-ready healthcare professionals.

 

A. Theme 1: Holistic Practitioner and Environmental Concerns

Healthcare is increasingly shaped by ecological crises and shifting societal values. Ramachandran et al. present an insightful discussion on the multilayered nature of developing holistic practitioners. They contrast public and private health education models and stress the importance of aligning training with international standards while remaining deeply connected to local community needs. Their Malaysian case study underscores the importance of strong scientific grounding coupled with empathetic and technological capabilities, alongside ecological awareness. Importantly, they recognise that individual practitioners may vary in their strengths, hence advocating for a unified and complementary workforce where collective skills fulfil holistic objectives.

Woodall et al. explore the art and challenge of reflective practice during rural placements. Their study, involving educators such as doctors and nurses, reveals several enablers for deep reflection: fostering trust, embracing multidisciplinary collaboration, prioritising rural healthcare contexts, and encouraging meaningful reflective activities. A key inhibitor was the overuse of superficial reflection assessments. They also found that students’ life experiences and prior engagement with reflective practices could either enrich or limit their capacity for introspection.

The growing connection between climate change and psychological toll is examined by Teoh and Azim. They highlight how climate-related stressors impact mental health and urge the integration of planetary health into healthcare education.

B. Theme 2: Faculty Development and Self-Care

Health professionals must be equipped to care not only for others, but also for themselves. Al Rashid and Rajagopalan argue for personal development programs (PDPs) that strengthen emotional intelligence and communication within the healthcare workforce.

Ong et al. provide preliminary evidence on the use of a theatre-based medical humanities program in Singapore. Designed for faculty development, this approach suggests that exposure to medical humanities supports professional identity formation, builds communities of practice, and fosters emotional resilience.

Susilo et al. report on a qualitative study evaluating a workshop for Indonesian medical students that incorporates reflective and collaborative learning. Their findings identified five dimensions critical to developing resilience, particularly during crises like COVID-19. These include faith, endurance, adaptability, recoverability, and a sense of life calling. It was noted that resilience strategies are vital for healthcare workers navigating high-stress environments.

Krasner contributes to this discussion with a clear proposition, namely a thriving workforce leads to better patient outcomes. He introduces the globally adopted Mindful Practice in Medicine (MPiM) program which integrates contemplative methods and narrative medicine and focuses on empowering professionals to flourish, encouraging competencies like self-awareness, compassionate listening, and emotional regulation. This underscores the value of institutional support for such initiatives. Hassed echoes this call in his article on integrating mindfulness as a core curriculum initiative under Monash University’s Health Enhancement Program (HEP). This curriculum component enhances students’ coping and communication skills throughout their medical training.

Koh et al. share findings from their application of action research and Entrustable Professional Activities (EPAs) to enhance a pharmacy pre-registration program. Their iterative process identified several areas for improvement, which include refining documentation, optimising indirect patient care experiences, auditing assessments, and streamlining administrative protocols. This framework offers a valuable model for tailoring workplace-based training programs to better serve community health needs while improving professional readiness.

The article by Azim and Teoh explores the imbalance between patient care demands and the well-being of healthcare workers. The authors highlight the escalating mental health burden on medical students and junior doctors, who face distinct stressors – from academic pressure to overwhelming workloads. The paper advocates for a holistic and sustainable approach to supporting healthcare providers, including normalising help-seeking, modelling healthy behaviour by senior staff, and integrating evidence-based strategies like motivational interviewing. Ultimately, the authors argue that high-quality, sustainable care is inseparable from the psychological health of those delivering it.

C. Theme 3: Curriculum Advancement for Future Ready Healthcare Professionals

Curriculum innovation is essential to prepare practitioners for the complexities of modern healthcare. Lau describes how the National University of Singapore has responded to rapid technological advances, shifting demographics, and escalating care demands via the Common Curriculum Healthcare Professional Education (CCHPE), structured around five pillars including socio-ecological health, digital and data literacy, and interprofessional professionalism. The curriculum’s emphasis on experiential learning, such as Longitudinal Patient Experience and virtual case collaboration, equips graduates to thrive in modern, team-based care settings. van der Merwe and van Vuuren explore the use of theoretical frameworks in curriculum design, applying the theory of planned behaviour to scaffold communication skills training in an interprofessional South African context. Their findings emphasise the importance of shaping behavioural intentions and perceptions of control, particularly in nurturing cultural sensitivity and adaptability in team settings.

Omotoso and Peter consider the role of technology in transforming anatomical science education. With students increasingly using technologically driven learning tools, these authors advocate for a blended approach that embraces digital platforms while preserving core teaching principles. Their vision supports flexible and autonomous learning, aligning curriculum design with evolving student expectations.

Phang et al. offer a practical advancement in assessment tools by developing a Singapore-specific version of the Professionalism Mini Evaluation Exercise (P-MEX). Adapted from the mini-CEX, the P-MEX evaluates professionalism in terms of patient care, interprofessional relationship skills, and reflective practice. This tool reflects the growing need for culturally sensitive assessments that resonate with regional medical education contexts.

D. Conclusion

This thematic issue emphasises critical perspectives on preparing healthcare professionals for an uncertain and complex future. It highlights the necessity of providing practitioners with resilience, ecological awareness, emotional intelligence, and technological adaptability. At the heart of these discussions is the aspiration to develop a healthcare workforce that embodies holistic care. This can be summed up as a practitioner who cares for the individual, the community, and the planet with equal compassion and competence.

We thank the authors for their insightful contributions and the reviewers and editorial team for their dedication. May this issue inspire deeper dialogue, practical transformation, and a continued journey toward holistic, sustainable healthcare education.

Marcus A. Henning
Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences,
University of Auckland, New Zealand

Mabel Yap
Director (Professional Training and Assessment Standards),
Education Director Office, Ministry of Health, Singapore

Published online: 7 January, TAPS 2025, 10(1), 1-3
https://doi.org/10.29060/TAPS.2025-10-1/EV10N1

The present healthcare environment requires practitioners who are not only technically proficient but also compassionate, empathetic, and fully committed to a patient-centred approach. These professionals can be best described as “holistic practitioners,” given their emphasis on supporting the complete well-being of patients, as well as addressing patients’ physical, emotional, social, and spiritual needs. Our editorial explores strategies for nurturing such practitioners who focus on the person as a whole, rather than merely treating individual diseases.

Building Competence Through Integrated Knowledge and Skills

Competence in healthcare now requires more than a strong grounding in biomedical and clinical sciences. It requires blending knowledge and skills across various disciplines with a focus on a patient-centred approach. This holistic approach involves embracing interprofessional education, which allows students to learn alongside other healthcare roles, while fostering the teamwork essential for comprehensive care (Samarasekera et al., 2024).

Cultivating Empathy and Compassion

Empathy and compassion are key qualities that distinguish a healthcare provider as a genuine healer. Developing empathy involves understanding the patient’s perspective and their unique experiences. Techniques like role-playing, patient storytelling, and reflective exercises can help practitioners view health issues from the patient’s viewpoint. This approach nurtures true empathy that goes beyond simply recognising a patient’s emotions to fostering authentic concern. A medical education culture that values compassion as much as the technical skill underlying clinical practice creates and cultivates practitioners who truly care about the person behind the diagnosis (Samarasekera et al., 2022).

Promoting Efficient, Patient-Centred Care

While efficiency in healthcare is crucial, it must not overshadow patient attentiveness. Holistic practice prioritises streamlining processes to enhance outcomes without compromising empathy or care quality. Training in time management, communication, and systems-based approaches can help practitioners balance effectiveness with patient-centredness. This approach is aptly described by Groopman (2007), who highlights the need for practitioners to deeply listen to the patient narrative. The requirement for attentive listening can be augmented using digital tools, such as electronic health records and telemedicine, which can improve efficiency while supporting personalised care. Furthermore, emerging technologies like AI and wearable health devices offer proactive insights for practitioners, enhancing preventive care and lightening practitioner workload. In telemedicine, training in empathetic communication ensures patients feel genuinely heard, even during virtual appointments.

Recognising cultural diversity is essential in delivering patient-centred care. Cultural competency training helps practitioners respect and understand diverse healthcare beliefs and practices (Vella et al., 2022). Providing the groundwork for holistic patient interaction will likely require medical education to embrace role-play and simulations with diverse patient scenarios, which leads to preparing practitioners to meet the unique needs of various communities and facilitate more inclusive care.

The Role of Self-Care and Well-being in Clinical Practice

The phrase “Physician, heal thyself” highlights the importance of self-care for healthcare practitioners, emphasising the importance of professionals themselves initiating, promoting and cultivating personal health and wellbeing (Mills et al., 2018). Maintaining strong physical, mental, and emotional health enables practitioners to provide the highest quality of care. Self-care directly impacts patient care by building resilience, empathy, and sound decision-making, especially under pressure. Accentuating self-care among clinicians fosters a sustainable healthcare environment, preparing practitioners to meet the challenges of their roles more effectively and to minimise the occurrence of burnout, moral distress, and compassion fatigue (Sanchez-Reilly et al., 2013).

Resilience, often described as “grit”, is vital in healthcare, where professionals face high-stakes and emotionally taxing situations (Samarasekera & Gwee, 2020). This trait supports practitioners in maintaining focus and motivation, even under prolonged stress. When practitioners engage in holistic practices, such as prioritising their own well-being through regular exercise, mindfulness, and ensuring quality sleep, they can bolster resilience and adapt better to challenges, avoiding burnout (Rich et al., 2020). Practitioners with strong self-care habits not only enhance their own lives but also improve their ability to connect with patients meaningfully.

It is likely that holistic practitioners are better able to communicate, display empathy, and build trust with patients (Mills et al., 2018). They also maintain better focus and emotional balance, which are critical for accurate diagnoses and effective clinical decisions. Practitioners experiencing stress or burnout risk adversely impacting care quality, potentially leading to increased errors and reduced patient satisfaction (Sanchez-Reilly et al., 2013).

By modelling healthy behaviours, clinicians set an example for patients, subtly encouraging positive lifestyle choices. When practitioners view their own wellness as integral to patient care, they embody a holistic approach that values both practitioner and patient well-being. Promoting self-care within the curriculum is also essential. Institutions can support this by embedding wellness programmes, resilience training, and mindfulness practices, helping students value their own well-being. Mentorship programmes with experienced clinicians provide support, fostering a model of work-life balance, resilience, and self-care.

Addressing Holistic Skills Gaps

One major challenge in holistic training is the intensive academic and clinical workload, which often overshadows the human aspects of care (Mills et al., 2018). Medical education tends to focus heavily on medical knowledge, diagnostic and procedural skills, at times de-emphasising empathy, communication, and emotional intelligence. This can inadvertently lead practitioners to prioritise efficiency over patient connection. Furthermore, the rigorous demands of medical training may lead to a culture where self-care is undervalued, affecting practitioners’ overall well-being.

Another obstacle is the limited opportunity for interprofessional learning. Holistic care relies on collaboration across healthcare roles, yet many training programmes work in isolation, reducing exposure to real-world teamwork. This will likely limit understanding the interconnected nature of healthcare roles, making it difficult to deliver fully integrated care.

Healthcare practitioners practising holistic care may face ethical challenges, such as maintaining boundaries while showing empathy. Dedicated ethics training, with case studies on boundary management and unbiased care, can prepare practitioners to meet these challenges. Ethical frameworks, like the “Four Principles” of medical ethics namely autonomy, beneficence, non-maleficence, and justice—serve as valuable guidelines for balanced, patient-centred decision-making. Interprofessional education should be prioritised, allowing students to work alongside those from other healthcare disciplines and develop respect for each role’s contributions. Such collaboration enhances communication skills and prepares practitioners to deliver comprehensive, patient-centred care.

Conclusion

Creating a healthcare workforce that is competent, compassionate, and efficient begins with focusing on the practitioners themselves. By embracing self-care, healthcare providers build the resilience and empathy needed to face the demands of clinical practice while improving patient outcomes. Holistic practitioners not only treat patients but embody wellness, showing compassion, commitment, and integrity. Emphasising practitioner well-being as essential to holistic care strengthens the healthcare system, fostering a culture of respect, trust, and shared commitment to patient-centred health.

Dujeepa D. Samarasekera
Centre for Medical Education (CenMED), NUS Yong Loo Lin School of Medicine,
National University Health System, Singapore

Marcus A. Henning
Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences,
University of Auckland, New Zealand

Shuh Shing Lee & Han Ting Jillian Yeo
Centre for Medical Education (CenMED), NUS Yong Loo Lin School of Medicine,
National University Health System, Singapore

 

Groopman, J. (2007). How doctors think. Houghton Mifflin. https://doi.org/10.1172/jci33149

Mills, J., Wand, T., & Fraser, J. A. (2018). Exploring the meaning and practice of self-care among palliative care nurses and doctors: A qualitative study. BMC Palliative Care, 17, Article 63. https://doi.org/10.1186/s12904-018-0318-0

Rich, A., Aly, A., Cecchinato, M. E., Lascau, L., Baker, M., Viney, R., & Cox, A. L. (2020). Evaluation of a novel intervention to reduce burnout in doctors-in-training using self-care and digital wellbeing strategies: A mixed-methods pilot. BMC Medical Education, 20,  Article 294. https://doi.org/10.1186/s12909-020-02160-y

Samarasekera, D. D., Chong, Y. S., Ban, K., Lau, L. S. T., Gallagher, P. J., Chen, Z. X., Müller, A. M., Ngiam, N. S., Wong, M. L., Lau, T. C., Dunn, M. C., & Lee, S. S. (2024). Transforming healthcare with integrated inter-professional education in a research-driven medical school. Medical Teacher, 1-8. https://doi.org/10.1080/0142159x.2024.2409293

Samarasekera, D. D., & Gwee, M. C. (2020). Grit in healthcare education and practice. The Asia Pacific Scholar, 5(1), 1. https://doi.org/10.29060/TAPS.2020-5-1/EV5N1

Samarasekera, D. D., Lee, S. S., Yeo, J. H. T., Yeo, S. P., & Ponnamperuma, G. (2022). Empathy in health professions education: What works, gaps and areas for improvement. Medical Education, 57(1), 86-101. https://doi.org/10.1111/medu.14865

Sanchez-Reilly, S., Morrison, L., Carey, E., Bernacki, R., O’Neill, L., Kapo, J., Periyakoil, V., & Thomas, J. (2013). Caring for oneself to care for others: Physicians and their self-care. The Journal of Supportive Oncology, 11(2), 75-81. https://doi.org/10.12788/j.suponc.0003

Vella, E., White, V. M., & Livingston, P. (2022). Does cultural competence training for health professionals impact culturally and linguistically diverse patient outcomes? A systematic review of the literature. Nurse Education Today, 118, Article 105500. https://doi.org/10.1016/j.nedt.2022.105500

Published online: 2 January, TAPS 2024, 9(1), 1-2
https://doi.org/10.29060/TAPS.2024-9-1/EV9N1

The practice of medicine and provision of healthcare is evolving rapidly, driven not just by advancements in new treatment modalities but also by the integration of modern technologies in providing precision care to our patients. It is important to understand and embrace, where appropriate, innovative technologies to respond effectively to the evolving needs of a modern society. What will be seen in this transformative wave is how Artificial Intelligence (AI) has the potential to revolutionise various sectors in medicine and healthcare (Yu et al., 2018).

Focusing on health professions education, AI emerges as a pivotal force in training the future healthcare practitioners and preparing them for the multifaceted challenges of the modern medical landscape (Paranjape et al., 2019). There are 3 distinct uses of AI in education which was reported by Baker et al. (2019): Learner-oriented AI, Instructor-oriented AI and Institution-oriented AI. Let’s focus on some of these areas:

A. Enriched Learning Experiences

One of the most significant advantages of integrating AI into health professions education is the enhancement of learning experiences. AI-powered platforms can provide personalised, adaptive learning modules tailored to individual students’ needs and learning paces (Kong et al., 2021). This personalisation not only accelerates the learning process but also ensures that students grasp complex concepts thoroughly, laying a robust foundation for their future careers. Furthermore, AI provides the opportunity for the students as well as for the trainers to use and adapt the best materials from multiple sources. It also enhances their networking through AI search capabilities and the ability to link up with other experts in the field or learning communities (Luke et al., 2021).

B. Simulation and Practical Training

AI-driven simulations are revolutionising practical training in healthcare education. Medical students can now practice patient safety, surgical procedures, diagnose illnesses, and interact with virtual patients in a risk-free environment. These simulations not only refine their technical skills but also improve their decision-making and inter-professional teamwork abilities. By repeatedly engaging in realistic scenarios, students can hone their expertise, fostering confidence and competence before they enter real-world clinical settings, a critical step to ensure patient safety and ethical practice of medicine.

C. Data-Driven Insights

AI’s ability to analyse large amounts of data quickly and efficiently provide an excellent platform to improve systems and processes (American Medical Association [AMA], 2016). In the context of health professions education, this capability translates into valuable insights. Educational institutions can collect data on students’ performance, identify areas where they struggle, and provide targeted interventions. Educators can adapt their teaching methods based on this data, ensuring that their teaching-learning approaches are appropriate and leading to good outcomes. Moreover, AI can predict trends in learning, enabling institutions to proactively address challenges and optimise their curricula. Funding and resource allocations can also be done where it is needed most or areas of future needs to build capacity and relevance of programs.

D. Fostering Research and Innovation

AI-powered tools are accelerating Scholarship of Teaching and Learning in the areas of research and innovation. AI algorithms help to analyse large amounts of data quickly and identify patterns that researchers could potentially miss. This could help us better understand the complex datasets, find relationships between variables faster, and draw appropriate conclusions and recommendations. AI has also reduced the time required to conduct literature review by analysing large amounts of scientific articles, identifying relevant research, and summarising the content in seconds.

E. Addressing Global Health Disparities

Focusing on medical and health professions education, we believe that this is another area AI could assist and enhance the training of healthcare practitioners in resource poor settings. Unbundling of curricula and connecting with the best training materials as well as experts are key advantages of AI capable training environments could support the resource poor settings.

Another area that AI driven knowledge and skills sharing could be addressing the present shortage of skilled healthcare professionals, leading to significant disparities in healthcare access. AI-based education has the potential to bridge this gap. Online platforms and mobile applications powered by AI can deliver high-quality continuous professional development to remote and underserved communities, reaching out to healthcare professionals irrespective of their geographical location. With this unbundling, the present set programs or training, we believe has the potential to significantly reduce global healthcare disparities.

F. Ethical Considerations and Collaboration

While the potential of AI in health professions education is immense, it is crucial to navigate ethical challenges. In the process of developing AI capable environments, we must ensure that the systems are transparent, unbiased and fair. However, we do not see in any medical school or a healthcare training site developing or having conversations on the use of guidelines/protocols on ethical use of AI in health professional education. Educators, policymakers, and technology developers must collaborate to establish ethical guidelines that ensure the responsible use of AI. This collaboration should prioritise transparency, fairness, and equity, safeguarding the integrity of healthcare education and the welfare of future patients (Chan & Zary, 2019).

Artificial Intelligence provides huge benefits to health professions education in many ways. By embracing AI-powered tools and methodologies, educational institutions can produce a generation of healthcare professionals who are not only adept at leveraging advanced technologies, but also compassionate and skilled in delivering patient-centred care. As we advance and evolve, it is clear that we need to channel our efforts into the investment of AI capabilities, aiming to elevate the learning experiences of our students and residents, propel educational scholarship and research forward, and foster enhanced collaboration. This strategic commitment is essential to maximising the potential advantages of this technology, with a primary objective of ultimately enhancing the health and well-being of patients within both local and global communities. The achievement of success in this pursuit necessitates a united front, where educators, institutions, and policymakers collaborate seamlessly. Only through such concerted efforts can we guarantee that AI not only benefits current learners but also ensures future positive impact on the well-being of the patients they will serve.

Dujeepa D. Samarasekera, Shuh Shing Lee & Han Ting Jillian Yeo
Centre for Medical Education (CenMED), NUS Yong Loo Lin School of Medicine,
National University Health System, Singapore

 

American Medical Association. (2016). Digital Health Study Physicians’ motivations and requirements for adopting digital clinical tools. https://www.ama-assn.org/practice-management/digital

Baker, T., Smith, L., & Anissa, N. (2019). Educ-AI-tion Rebooted? Exploring the future of artificial intelligence in schools and colleges. Nesta. https://www.nesta.org.uk/report/education-rebooted/  

Chan, K. S., & Zary, N. (2019). Applications and challenges of implementing artificial intelligence in medical education: Integrative review. JMIR Medical Education, 5(1), Article e13930. https://doi.org/10.2196/13930

Luke, N., Taneja, R., Ban, K., Samarasekera, D., & Yap, C. T. (2021). Large language models (ChatGPT) in medical education: Embrace or abjure? The Asia Pacific Scholar, 8(4), 50-52. https://doi.org/10.29060/TAPS.2023-8-4/PV3007

Paranjape, K., Schinkel, M., Nannan Panday, R., Car, J., & Nanayakkara, P. (2019). Introducing artificial intelligence training in medical education. JMIR Medical Education, 5(2), Article e16048. https://doi.org/10.2196/16048

Yu, K. H., Beam, A. L., & Kohane, I. S. (2018). Artificial intelligence in healthcare. Nature Biomedical Engineering, 2(10), 719-731. https://doi.org/10.1038/s41551-018-0305-z

Published online: 4 April, TAPS 2023, 8(2), 1-3
https://doi.org/10.29060/TAPS.2023-8-2/EV8N2

Shuh Shing Lee¹ & John Norcini²

¹Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; ²Foundation for Advancement of International Medical Education and Research, United States of America

It has been almost three decades since Boyer (1990) introduced the concept of the Scholarship of Teaching and Learning (SoTL). In their own disciplines, faculty members are required to stay abreast of emerging knowledge and to contribute to the literature so that they advance their field through well-informed inquiry and disseminated work. Although they also have educational responsibilities, faculty are neither similarly motivated nor are they incentivised to participate in educational scholarship. Consequently, their efforts in this regard are often based on personal belief and opinion rather evidence and scientific inquiry. This problem persists despite a growing body of evidence that adopting sound instructional practices and pursuing scholarly work related to teaching, will increase the quality of the institution’s educational processes. In turn, this will enhance student learning and ultimately lead to better patient care. To achieve this end, teaching and learning must be scrutinised in terms of theory, methods, evidence, and outcomes. And faculty members who engage in teaching need to be rewarded for their participation in educational scholarship just as they are for efforts in their own disciplines.

In supporting educators’ SoTL journey and enhancing the quality of their teaching, this special issue “Celebrating Excellence in Scholarship of Teaching and Learning” aims to demonstrate how educators adopt a scholarly approach and how they collect and present rigorous evidence of their effectiveness. It encompasses much of current health professions education, touching on topics such as interprofessional education, the globalisation of healthcare, the impact of COVID-19, vaccine hesitancy, and digital badges.

Educators from Indonesia shared their strategy for enhancing interprofessional education through community-based education (Kristina et al., 2023). Teams of students developed solutions to family health issues together. The authors found implementation challenges when applying this model, especially in terms of scheduling home visits. However, through this experience the students learned the value of teamwork and the roles of each of the representatives.

As a result of globalisation, there is a significant increase in the number of patients being admitted to hospitals outside of their home countries. The Emergency Department is often the first point of contact for these foreign patients and cultural differences naturally pose challenges. To address this issue and to help patients with different backgrounds obtain high quality care, some hospitals in Japan have initiated cultural awareness training for their doctors. While this is a positive step, doctors in the Emergency Department in Japan still face difficulties in this area. To address these challenges going forward, educators from Japan would like to identify the difficulties still encountered and eventually design scenarios, based on real life cases, for use in simulations (Oikawa et al., 2023).

COVID-19 has changed the way teaching has occurred and it has accelerated the use of technology in all phases of education. This special edition contains two Case Studies related to this issue. The report by Kushare et al. (2023) takes on the use of blended learning that occurred synchronously at different campuses in Malaysia. The report by Lim et al. (2023) focuses on student perspectives on the prohibition of direct patient contact during pandemic. It will be important to follow future developments in these areas as restrictions are lifted.

COVID-19 has not only affected teaching, but it has also had a profound influence on the practice of medicine. Vaccine hesitancy among patients is a growing phenomenon for which not all health care providers are prepared. Physicians may have misconceptions about what drives patient behaviour leading to the less effective provision of information and counselling. To better understand this issue and design a relevant curriculum to create awareness, Jenkins et al. (2023) explored medical students’ reactions to vaccine hesitancy and their reflections on their own biases in patient interactions. The qualitative analysis of students’ reflections offered by the authors is a useful basis for working with students around this issue. 

In recent years, digital badges have increasingly become a part of the educational landscape. They constitute an innovative instructional strategy combing the teaching and credentialing of competencies to provide evidence for achievement. However, research in this area is scare. Truskowska et al. (2023) introduced a pilot project regarding the use of digital badges in a Psychiatry module offered as part of a continuous assessment programme. They evaluated the effectiveness of the digital badges based on students’ perspectives of their utility, their level of engagement with the module, and their motivation to study. Students found the badges rewarding but noted that their value was unclear which would eventually lead to a loss of motivation.

Assessment has been a main topic of discussion in SoTL because it shapes how student learn and informs teachers about the effectiveness of their own work. Dayanidhi et al. (2023) present information about a radical curriculum and assessment reform that has been taken place in India. Forensic Medicine and Toxicology, a major competence, is often underrepresented in assessment. The authors established this through an analysis and comparison of the distribution of content tested, domain of learning and construct of the questions derived from undergraduate summative examination question papers on the topic from six universities across India. Also focused on assessment, Lim and Lim (2023) share an innovative assessment method – oral interactive assessment– which they have implemented among the occupational therapy students. Instead of multiple-choice questions or short written answers, each student was assessed with a standardised actor who simulate concerned parents, asking questions about their children’s development. While students are more anxious with this format, an interactive oral assessment has real world relevance.

There are several articles discussing initiatives that were conducted for faculty members in this special issue. For example, Lim et al. (2023) described a coaching programme aimed at providing educators a framework that helps students make discoveries and work towards their goals and training them how to question students. Field et al. (2023) offered a study in training their faculty members to teach and assess students’ clinical thinking skills using a model. Goh and Schlegal (2023) examined the journey of scholarship in health professions education and suggested tangible small steps to start, sustain, and succeed along the SoTL journey.

Felten (2013) in his paper “Principles of Good Practice in SoTL” mentioned that good scholarship should be grounded in context because it takes place in a particular classroom, institution, organisation, and education system where the culture is bounded. Tan et al. (2023) elaborated this aspect in his article using Bronfenbrenner’s Ecological Systems theory (EST). Grant (2023), similarly, highlighted the notion that the practice of teaching is socially bound and highly dependent on the culture, content and context. She further described the relationship between medical educationalists and teachers in the entire SoTL journey.

Good teaching is multidimensional, challenging, and contextual as demonstrated by all the authors in this special issue. However, this is an excellent place to start and it encourages all of us to apply the same thoughts processes to our teaching as we do in our discipline-specific research. Teaching is a process of reflection on our practice and if we follow this dictum, more scholarly teaching will result in higher quality in learning among our students. 

 

Shuh Shing Lee & John Norcini
Guest Editors 
The Asia Pacific Scholar (TAPS) 

 

Boyer, E. L. (1990). Scholarship revisited: Priorities of the professionals. Carnegie Foundation for the Advancement of Teaching.

Dayanidhi, V. K., Datta, A., Hegde, S. P., & Tiwari, P. (2023). Evaluating the content validity of the undergraduate summative exam question papers of Forensic Medicine & Toxicology from 6 medical universities in India. The Asia Pacific Scholar, 8(2), 57-65. https://doi.org/10.29060/TAPS.2023-8-2/OA2778

Felten, P. (2013). Principles of Good Practice in SoTL. Teaching & Learning Inquiry: The ISSOTL Journal, 1(1), 121-125. https://doi.org/10.2979/teachlearninqu.1.1.121

Field, S., Croskerry, P., Love, S., & Alexiadis Brown, P. (2023). An online programme in teaching and assessing critical thinking for medical faculty. The Asia Pacific Scholar, 8(2), 66-69. https://doi.org/10.29060/TAPS.2023-8-2/SC2894

Goh, P. S., & Schlegal, E. F. M. (2023). Small, sustainable, steps to success as a scholar in Health Professions Education – Micro (macro and meta) matters. The Asia Pacific Scholar, 8(2), 76-79. https://doi.org/10.29060/TAPS.2023-8-2/SC2861

Grant, J. (2023). The Scholarship of teaching: Who is the truth teller? The Asia Pacific Scholar, 8(2), 83-85. https://doi.org/10.29060/TAPS.2023-8-2/PV2874

Jenkins, M. C., Paul, C. R., Chheda, S., & Hanson, J. L. (2023). Qualitative analysis of reflective writing examines medical student learning about vaccine hesitancy. The Asia Pacific Scholar, 8(2), 36-46. https://doi.org/10.29060/TAPS.2023-8-2/OA2855

Kristina, T. N., Asmara, F. Y., Sudaryanto, S., Nuryanto, N., & Bakri, S. (2023). Increasing the value of Community-Based Education through Interprofessional Education. The Asia Pacific Scholar, 8(2), 4-13. https://doi.org/10.29060/TAPS.2023-8-2/OA2755

Kushare, V., MK., B., Pamidi, N., Selvaratnam, L., Sen, A., & Dominic, N. A. (2023).  Vertical integration of anatomy and women’s health: Cross campus blended learning. The Asia Pacific Scholar, 8(2), 89-92. https://doi.org/10.29060/TAPS.2023-8-2/CS2806

Lim, M. J., Wee, J. C. P., Han, D. X. T., & Wong, E. (2023). Perspectives of medical students towards the prohibition of direct patient contact during a pandemic. The Asia Pacific Scholar, 8(2), 93-96. https://doi.org/10.29060/TAPS.2023-8-2/CS2849

Lim, S. M., & Lim, C. Y. (2023). Use of interactive oral assessment to increase workplace readiness of occupational therapy students. The Asia Pacific Scholar, 8(2), 86-88. https://doi.org/10.29060/TAPS.2023-8-2/SC2804

Lim, S. M., Shahdadpuri, R., & Pua, C. Y. (2023). Coaching as an educator: Critical elements in a faculty development program. The Asia Pacific Scholar, 8(2), 70-75. https://doi.org/10.29060/TAPS.2023-8-2/SC2802

Oikawa, S., Ashida, R., & Takeda, S. (2023). Increasing cultural awareness in emergency departments with simulation scenarios created through a survey. The Asia Pacific Scholar, 8(2), 14-35. https://doi.org/10.29060/TAPS.2023-8-2/OA2762

Tan, K., Foo, Y. Y., & Tan, N. C. K. (2023). Refocusing SoTL – Myopia, context lenses and ecological systems theory. The Asia Pacific Scholar, 8(2), 80-82. https://doi.org/10.29060/TAPS.2023-8-2/PV2842

Truskowska, E., Emmett, Y., & Guerandel, A. (2023). Digital badges: An evaluation of their use in a Psychiatry module. The Asia Pacific Scholar, 8(2), 47-56. https://doi.org/10.29060/TAPS.2023-8-2/OA2869

Published online: 3 January, TAPS 2023, 8(1), 1-2
https://doi.org/10.29060/TAPS.2023-8-1/EV8N1

COVID pandemic created worldwide disruptions to all services and had profound impact on training of health professionals, posing serious challenges to maintaining essential healthcare services. During the height of the pandemic, most of the undergraduate learners were prevented from clinical training sites, restricted intra, inter-institutional and overseas learning opportunities and in many institutions, there were termination of onsite learner-educator engagements (Ng et al., 2021; Renaud et al., 2021; Samarasekera et al., 2020). Less face to face, peer and faculty interactions and restricted mobility of learners led to some of them facing poor mental wellbeing and health issues.  The learning activities were mostly restricted to online platforms during the pandemic for students following health professional programs. During the latter part of the pandemic, however, there were changes when better preventive measures and immunisation were developed. The students were also allowed to provide limited care services to assist the practitioners who were providing critical services (Lau et al., 2021).

The silver lining, however, was that several new curricular designs, teaching-learning and assessment modalities were developed due to the sheer necessity. The faculty members and students were forced to adapt and adopt these new measures, mostly online systems and processes, to continue the training and provide that much needed support to the healthcare services (Shorey et al., 2022). This became critical when it was apparent that the pandemic would continue for several years. There are some such innovations in teaching-learning highlighting not only the innovation and their impact but also the challenges faced by students and faculty members. Most of these changes to student learning environment were done hurriedly and, unfortunately, without the proper grounding in best evidence practices or taking a systematic approach to incorporate changes to a curriculum. Another reason was the lack of knowledge and support of educators to develop impactful curricula and learning environments leveraging on technology (Popa, 2022).

We are now emerging from the pandemic and many lessons have been learnt from this experience. We now have an opportunity to leapfrog from these experiences. The key to creating an impactful and sustainable post-pandemic learning environment lies with the faculty members. There are several important areas we need to focus on if we want to sustain and further improve the education based on our past experience.

As part of faculty development, it is necessary to engage our faculty members to share best practices and assist them to co-create with their learners teaching-learning activities. For faculty leadership, it is critical to create that safe practice environment for all stakeholders to reflect on and improve what they have developed. Through these collaborative activities, not only the faculty members learn about what works and what to avoid, but also build trust with other stakeholders including the students. Furthermore, it supports them to critically analyse the learning and assessment activities with regard to their relevance in one’s context. Providing a structured and timely faculty support with the necessary resources will augment the building of trust (Connolly et al., 2022).

Another important area we learnt especially during the pandemic and as we currently emerge from the pandemic is the necessity to modify the existing policies and guidelines. These should support systematic and rapid development of learning environments. What worked in the past may not be appropriate now, and even hinder the development of innovative strategies. We need to relook at how we evaluate an educator’s performance and the learning impact from traditional matrixes in place at present in health professional training institutions. Aligned to the performance evaluations, there needs to be supportive schemes to incentivise and reward faculty members who contributed to enhance the learning environment for students and residents.

Medical education is very much context-based and situation-focused. What worked in one setting may not be appropriate in another learning context. The leadership, planners, and educators must be aware of this and carefully design and incorporate innovations and new approaches to learning that have worked in another setting to one’s own. This is especially true when one is incorporating technology-enhanced learning activities such as simulation based or remote distance online learning formats. Finally, the quality improvement and quality assurance processes in health professions education must be aligned to the local context needs. These standards, however, should be benchmarked to internationally accepted best practices, but situated very much on the local needs and promoting impactful changes to student learning environments (Samarasekera & Gwee, 2021).

A quick literature search at present will demonstrate large number of innovations and changes that were incorporated to medical and health professional training curricula over the pandemic period (Ng et al., 2021). It is an opportune time now to focus on developing these changes, based on best evidence practices., The impact of these changes need to be subsequently evaluated to further enhance student learning. At the end of it all, what is most vital is to provide quality care to our patients by competent, caring, and empathetic health professionals.

 

Dujeepa D. Samarasekera 
Centre for Medical Education (CenMED), NUS Yong Loo Lin School of Medicine,
National University Health System, Singapore

 

 

 

Connolly, K. K., Olson, H. L., & Buenconsejo-Lum, L. E. (2022). Medical school faculty development post-pandemic – Opportunities in the digital shift. Hawai’I Journal of Health & Social Welfare, 81(11), 316-318.

Lau, T. C., Chong, Y. S., Loo, B. K. G., Ganapathy, S., Ho, J. M. D., Lee, S. S., Yeo, J., Samarasekera, D. D., & Goh, D. L. M. (2021). Adapting undergraduate paediatric medical education to the challenges of COVID-19 pandemic: Perspective of NUS medicine. Singapore Medical Journal, 62(1 Supp), S39-S42. https://doi.org/10.11622/smedj.2021075

Ng, N. B. H., Chiong, T., Lau, P. Y. W., & Aw, M. A. (2021). Delivering medical education amidst COVID-19: Responding to change during a time of crisis. The Asia Pacific Scholar, 6(3), 111-113. https://doi.org/10.29060/TAPS.2021-6-3/PV2375

Popa, S. (2022). Taking stock: Impacts of the Covid-19 pandemic on curriculum, education, and learning. PROSPECTS, 51, 541-546. https://doi.org/10.1007/s11125-022-09616-7

Renaud, C. J., Chen, Z. X., Yuen, H.-W., Tan, L. L., Pan, T. L. T., & Samarasekera, D. D. (2021). Impact of COVID-19 on health profession education in Singapore: Adoption of innovative strategies and contingencies across the educational continuum. The Asia Pacific Scholar, 6(3), 14-23. https://doi.org/10.29060/TAPS.2021-6-3/RA2346

Samarasekera, D. D., Goh, D. L. M., & Lau, T. C. (2020). Medical school approach to manage the current COVID-19 crisis. Academic Medicine, 95(8), 1126-1127. https://doi.org/10.1097/ACM.0000000000003425

Samarasekera, D. D., & Gwee, M. C. E. (Eds.). (2021). Educate, train and transform: Toolkit on medical and health professions education. World Scientific.

Shorey, S., Pereira, T. L.-B., Teo, W. Z., Ang, E., Lau, T. C., & Samarasekera, D. D. (2022). Navigating nursing curriculum change during COVID-19 pandemic: A systematic review and meta-synthesis. Nurse Education in Practice. 65, Article 103483. https://doi.org/10.1016/j.nepr.2022.103483

Published online: 4 January, TAPS 2022, 7(1), 1-2
https://doi.org/10.29060/TAPS.2022-7-1/EV7N1

The practice of medicine has been rooted strongly in traditions. Discipline-based academies, colleges, societies, and associations regularly practice “rituals” based on context-specific traditional norms and cultural practices. Medical education and training are no different. Being part of a larger, higher education institution and preparing graduates for a future profession, they too have deeply embedded rituals such as the whitecoat ceremony, the silent mentor appreciations, oath taking, and the commencement. These practices have a strong influence of the institutions in which the programs are conducted giving each of these practices not only the professional but the context and institution specific angle and colours.

It is important to explore further why the traditions and heritage are important elements in training a future healthcare professional. The practice of medicine is intertwined with people’s values, beliefs, and culture. Patients and their families’ understanding of health and illness, their illness management and treatment preferences are all significantly impacted by the society they live in, and their cultural practices and traditions. The eastern cultures belief that some foods are heaty, plain or that some others are cold, therefore either good or bad for certain illnesses, stem from the ancient eastern philosophy of “Ying and Yang”. (Xie et al., 2020).  This can have a direct effect on illness and care outcomes. (Kindig et al., 2004; Petri et al., 2015). This has to be incorporated into medical training early in the curriculum, to highlight its significance to the students and trainees.

Another area where the institutional and professional traditions and heritage play a part is in the development of professional identity of the learner (Wahid et al., 2021). This is critical in medicine to develop a sense of belonging to their future profession and to the institution from a very early stage of the student or trainee program. This will enable them to understand that they are part of an institution and a profession that strive to alleviate human suffering and improve lives. This will enable them to be resilient and develop their grit to successfully face the rigours of their challenging profession in the future. (Samarasekera & Gwee, 2021). This is important in the present context where, due to the pandemic, we are seeing an unprecedent number of doctors and other healthcare professionals leaving the profession or getting burnout, leading to a severe negative impact on providing quality care to our patients and communities (Kisa, 2020).

Another interesting aspect is how these context-specific cultural practices, norms, and traditions impact one’s development and conceptualization of patient empathy. There is evidence that students in medical programs from different localities show differences in the development of empathy (Ponnamperuma et al., 2019).

As professionals, when we engage with fellow colleagues, in public or during patientcare, we exhibit our learnings from role models and our cultural beliefs and practices that are deeply rooted in the institutional heritage. This is the reason why those activities during educating and training the future healthcare workforce become important in shaping the next generations of doctors and healthcare professionals. It is difficult to practise medicine and provide healthcare efficiently and effectively without having a good understanding of the traditions and cultural practices of the institution in which they trained and the profession to which they belong as well as the communities they care for. In all systems of healthcare practice, the place of training and the practice settings become important for the new practitioners to   enhance their skills (Buckley et al., 2010).  Therefore, it is important for the healthcare training institutions to place much emphasis on incorporating core values rooted in the institutional traditions. This could be an ideal platform to build new cultural norms and practices aligned to the 21^st century society and clinical practice. Whether we are conscious of it or not, our beliefs, values and traditions shape the way we behave and practice. It forms the practice culture of our graduates and determine the quality of care. Therefore, providing a good foundation of cultural understanding will assist the future practitioner to embrace the challenges they may face in a rapidly changing, dynamic clinical practice without losing the notion of one’s identity, self-worth, or getting burnout in providing care.  Furthermore, the training institutions could use examples from their rich traditions and heritage to imbibe a strong sense of servant leadership, an excellent service culture as well as to develop learner and, subsequently, practitioner grit. These measures will help improve efficiency and quality healthcare.

Dujeepa D. Samarasekera & Matthew C. E. Gwee
Centre for Medical Education (CenMED), NUS Yong Loo Lin School of Medicine,
National University Health System, Singapore

 

 

Buckley, J. D., Joyce, B., Garcia, A. J., Jordan, J., & Scher, E. (2010). Linking residency training effectiveness to clinical outcomes: A quality improvement approach. The Joint Commission Journal on Quality and Patient Safety, 36(5), 203-208. https://doi.org/10.1016/s1553-7250(10)36033-8

Kindig, D. A., Panzer, A. M., & Nielsen-Bohlman, L. (Eds.). (2004). Health literacy: A prescription to end confusion. National Academies Press.

Kisa, S. (2020). Burnout among physicians and nurses during COVID-19 pandemic. European Journal of Environment and Public Health, 4(2), Article em0055. https://doi.org/10.29333/ejeph/8447

Petri, R. P., Jr., Delgado, R. E., & McConnell, K. (2015). Historical and cultural perspectives on integrative medicine. Medical Acupuncture, 27(5), 309-317. https://doi.org/10.1089/acu.2015.1120

Ponnamperuma, G., Yeo, S. P., & Samarasekera, D. D. (2019). Is empathy change in medical school geo‐socioculturally influenced? Medical Education, 53(7), 655-665. https://doi.org/10.1111/medu.13819

Samarasekera, D. D., & Gwee, M. C. E. (2021). Adapting to change during challenging times. The Asia Pacific Scholar, 6(1), 1-2. https://doi.org/10.29060/TAPS.2021-6-1/EV6N1

Wahid, M. H., Findyartini, A., Soemantri, D., Mustika, R., Felaza, E., Steinert, Y., Samarasekera, D. D., Greviana, N., Hidayah, R. N., Khoiriyah, U., & Soeselo, D. A. (2021). Professional identity formation of medical teachers in a non-Western setting. Medical Teacher, 43(8), 868-873. https://doi.org/10.1080/0142159X.2021.1922657

Xie, A., Huang, H., & Kong, F. (2020). Relationship between food composition and its cold/hot properties: A statistical study. Journal of Agriculture and Food Research, 2, Article 100043. https://doi.org/10.1016/j.jafr.2020.100043

Published online: 13 July May, TAPS 2021, 6(3), 1-4
https://doi.org/10.29060/TAPS.2021-6-3/EV6N3

Lambert Schuwirth¹ & Ardi Findyartini²

¹Prideaux Centre for Research in Health Professions Education, College of Medicine and Public Health, Flinders University, Australia; ²Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Indonesia

This quote is attributed to Nicolo Machiavelli, an Italian Renaissance political philosopher. And it may sound reasonable, but at a time where the Covid-19 pandemic is still very active around the world it is also callous to think of a crisis as an opportunity. We want to acknowledge this and we want to send our deepest sympathy to all those who have been personally affected by this pandemic.

Nevertheless, it is also fair to say that in many places in the world the pandemic has served as a catalyst for changes in a variety of human domains–not in the least in health professions education. When we say catalyst, we use the word very purposefully, because there are many developments that were already taking place prior to 2020 and which have already produced quite disruptive changes in society. This crisis is a catalyst, therefore, in the sense that it has heightened the awareness that such fundamental changes will be very soon have an impact on the way we educate future health professionals.

We could easily fill 20 thematic issues with examples of how medical schools around the world have rapidly adapted their educational processes to allow them to continue whilst complying with Covid-19 related restrictions. These changes were necessary and often quite successful. However, it also has to be stated that they were often merely the proverbial Plan B rather than really fundamental innovations. And while Plan B is a good solution for the short term it also has to be a steppingstone for more fundamental innovations. In other words, our attention should not only focus on ‘what where the changes and how were they made, but also ‘why did the changes take place and in what ways can they improve education’.

So, let us quickly reflect on what are these changes that are taking place in the world around us and conjecture about what they could mean for health professions education. Not surprisingly, many of these changes have to do with the rapid development in information and communication technology. These have opened up completely new ways of dealing with the important aspects of society and those in health professions education.

The first example concerns the way we conceptualise knowledge. This is quite different to what it was 50 years ago. Fifty years ago, knowledge was typically seen as the possession of the experts, and out of altruism or for a tuition fee, the expert was willing to share their knowledge with the learner. The typical business equivalent of this was the traditional encyclopaedia. In an encyclopaedia the knowledge of the group of experts is laid down and sold to clients. Nowadays, in contrast, knowledge/information is seen as something that can or even must be constructed collaboratively, by a community of people each adding small pieces to the whole ‘puzzle’. Such a re-conceptualisation has found its crystallisation in wikis, with Wikipedia as the most well-known example. There was a time when businesses tried to put the traditional encyclopaedia on a CD-ROM and made it more feasible to use. However, an encyclopaedia on a CD-ROM is just still a traditional encyclopaedia, just a technical delivery differs. Needless to state that this wasn’t a profitable business development; it wasn’t a real innovation but rather a sort of Plan B. It is therefore, plausible to assume that online lectures are a similar form of Plan B in health professions education.

Another important development concerns the way we manage trust. From a society that has institutionalised trust we are gradually moving into a society that relies on distributed trust (Botsman, 2017). In an institutionalised trust society, important transactions and the trust in those transactions are managed by a trusted institution. For example, we transfer large sums of money preferably via a bank, we negotiate house sales through a conveyancer, and so on. Many of these still exist, but increasingly trust is distributed. Previously, if you wanted to go out for fine dining and spend a lot of money on a fancy restaurant, you could consult the Michelin guide. In fact, this means that you ‘outsourced’ your trust in finding a good quality restaurant to a trusted organisation. Most people no longer used this guide; they just go online and read the long list of customer reviews and evaluate the way the restaurant has dealt with the reviews. This is an example of distributed trust, as a community with direct experience we collectively construct ‘quality’. Our universities still operate as trusted institutions, they provide the transaction–education–and the trust and transaction–academic degrees–in one. Of course, recognition of prior learning are early steps to disconnect the educational transaction from the management of trust, but there is still a long way to go.

For instance, in order to organise recognition of prior learning and the disentanglement of trust and transaction effectively, there is a need of a trusted dossier/portfolio that can be managed across educational phases and by different stakeholders in a fully authenticated way. Open ledger or block chain technology is very likely able to provide such systems, although much may still be under development (Mikroyannidis et al., 2018, June). It is not a huge leap of faith to imagine what this would mean for future employers. Instead of having to trust an academic transcript with only a few numbers or grades and with seals and signatures, an employer would have the opportunity to ‘interrogate’ an applicant’s whole dossier of learning, improvement and achievements. Such developments are likely to also severely disrupt the way accreditation works and probably influence how learners engage in more meaningful way to achieve competence in health professions education.

For the learner this means that they would easily be able to fill such a portfolio with a combination of course material, micro credentialing and elements obtained from the cognitive surplus (Shirky, 2010). ‘Cognitive surplus’ refers to the fact that, increasingly, knowledge is provided or shared for free in the Internet. The probably most well-known example of this is the Khan Academy (Khan Academy, n.d.). Tuition and learning that were previously only available to feepaying students, is now available for free. Of course, not all that is offered in the cognitive surplus is of high quality and there is a challenge for learners to distinguish between offerings of poor and of good quality, but it does mean that most modern learners are increasingly used and expecting to be able to access knowledge for free or for a negligible fee. This will place an increasing burden on universities to demonstrate their added value to a feepaying student’s learning, including in instilling students’ ability to critically think and reflect on the abundant information they can access freely. One could argue that the higher education industry is still highly regulated in most countries and the only way to achieve a credible degree in the health professions is by going through a university. Such industry which has to rely purely on a regulatory framework is vulnerable.

Finally, the development that most people are talking about are artificial intelligence and machine learning. It is very difficult to predict what the future will hold, but it is likely that artificial intelligence and machine learning will significantly augment or even substitute what currently is most doctors’ specific expertise; making a diagnosis and deciding on therapeutic management plans. The former is generally a categorisation task, something at which artificial intelligence is becoming better and better. The latter is becoming ever more patient specific, especially with the emergence of precision medicine, which will increasingly require decision support systems. This does not automatically mean that patients will not be needing somebody to care for them, to partner with them or to help them make meaning in periods of illness, angst and uncertainty. Obviously, this will require health professionals with more elaborate so-called ‘soft’ skills which enable them to develop empathetic and professional connections with their patients either for better cure or care.

Such changes to what makes a ‘good’ doctor will require changes to health professions education. On the one hand, education should equip students with data and technology literacies, but on the other, it should allocate sufficient resources for the development of human literacy (Aoun, 2017). Development of soft skills means the training of doctors who can partner with their patients, who can nurture them and help them make meaning. It also requires students who eventually will be able to embrace uncertainty and who will be equally comfortable with ‘knowing’ and with ‘not knowing’; which further highlights the importance of creativity and innovations, self-awareness, and lifelong learning skills.

Obviously, there are implications for health professions education. Firstly, a purely transactional process of passing on knowledge may not need to take a central role in a curriculum. The traditional lecture was an educational ‘technology’ that was designed to cater to students who did not have access to books. The lecturer, the reader, read the knowledge to the students who either were able to write it down or had to memorise it. The purely transactional process of passing on knowledge should no longer have a central role in the learning process, and it has implications for assessment as well. The assessment arm of it is the typical structured and standardised knowledge test in which the candidates reproduce the knowledge that they’ve been provided with. This no longer seems current nor relevant one of which because of a lot of changes and uncertainties this pandemic has taught us. Modern students, through their laptops, tablets or smart phones, have accesses to a whole world of information. This is quite recent because even in the early days of problem-based learning, the university had control over the quality of the resources students could use for their learning. Nowadays, there is a whole Internet of information–some relevant and some absolutely incorrect nonsense–that is absolutely not under the control of the University. It is under the control of the students, though, and they will use that information. In order to manage this huge affordance educationally, changes will have to be made to develop curricula that incorporate both the formal and informal educational spaces. To successfully combine those spaces, curricula may have to give more room to students and teachers to develop a dialogue in such a positive relationship that it better facilitates students’ critical thinking and professional identity formation.

Such changes cannot happen in an educational context in which the students are not allowed or supported to exhibit agency over their own learning, and as a consequence, over their own assessment. But changing this organisational mindset culture is probably the biggest challenge ahead of us. It requires a culture shift from distrust and control to one of trust and empowerment. Thinking about trust and empowerment is not idealism but we think it is pure necessity. The dramatic events in the world of online proctoring are a clear demonstration that the choice to go further down the pathway of distrust and control has not been the best use of what technology affords.

Furthermore, trust and empowerment are not only needed during training but also after graduation. Where in our time as students it could still be reasonably expected that upon graduation we were equipped with all the knowledge, skills, problem-solving ability and attitudes to last us for the rest of our career–bar some updating through Continuing Medical Education (CME)–it is now clear that the world, the healthcare environment and the expectations of patients are changing rapidly. No longer can we assume that upon graduation our students will be a complete ‘product’. Instead, they will have to continue to learn, to develop and probably to reinvent themselves continually. But if we as universities have never empowered them or allowed them to take agency over their own learning and assessment, it is implausible that our graduates would suddenly and magically be capable to do this after graduation. The implication for assessment is obvious. The notion of single moment assessments of final examinations is not in alignment with these views. Assessment will have to take on a more longitudinal and integrated form to be aligned with more than educational processes and the lifelong learning requirements.

A final point relates to the so-called affordances modern students have (Friedman & Friedman, 2008). There are several listed in the literature, but some are most pertinent in the short run. Through their laptops, tablets or smart phones, students are able to be in multiple communities and entertain multiple communications at the same time. They can be in a practical session working with one group of peers, but also texting to other members of the student cohort or more general friends about what they currently learning or even about completely unrelated issues. There are numerous examples of Information and Communications Technology (ICT) afforded learners–or academics for that matter–who entertain to communications with two communities at the same time. Everyone who has been in an online meeting and has used the chat function at the same time, has had experience with this. Of course, this rapid switching between communities and communications, this time slicing, comes at the expense of cognitive load, but it can also be used in a very enriching way for learning. The same applies to collaborations. Any student who is a tutorial group or even in a lecture hall and accesses the cognitive surplus or Wikipedia is in fact in two knowledge creation collaboratives at the same time.

Unfortunately, our students are not yet very well experienced in how to use these affordances well, but also most educational designers or curriculum developers are not able to incorporate them and take maximum advantage of what they enable the learner to do.

The challenge that lies ahead of us is to bring these developments to health professions education. One ramification is already inevitable, ICT in most contexts has dramatically reduced power asymmetries. In the example of the restaurant and the reviews, any customer now has the power to publicise their experience and restaurant owner would be wise to respond appropriately, in healthcare patients come to the consulting room prepared with Dr Google and whether what they found is relevant or not, they do have knowledge that the doctor will have to deal with, and finally in education students have point of care access to a whole world of information which will make them more equal partners in their education. Students who are well prepared for lectures are able to disagree with their lecturers or even be better informed on details than the lecturer. Universities may need to increase efforts to better engage students and to facilitate their personalised learning needs, as well as to enable more co-creation in knowledge development. Universities that do not acknowledge these changes run the risk of quickly becoming obsolete. But acknowledging this also means better preparation of teachers through more comprehensive faculty development programmes.

However, this editorial is not about doom and gloom or risks, it is about opportunities. All the affordances that are already or could be incorporated in modern health professions education make it possible to educate even better health professionals for the future, who are agile and optimally positioned to an ever-changing healthcare system and align better with their patients. The potential and opportunities are vast. Whether or not these disruptive changes give us those opportunities, will depend both on how we adapt for the short-term needs and how we prepare to embrace substantial and necessary changes in our health professions education for the future.

 

Lambert Schuwirth & Ardi Findyartini
Guest Editors &
International Editorial Board Members
The Asia Pacific Scholar (TAPS) 

 

 

Botsman, R. (2017). Who can you trust?: How technology brought us together and why it might drive us apart. Hachette.

Mikroyannidis, A., Domingue, J., Bachler, M., & Quick, K. (2018, June 25-29). A learner-centred approach for lifelong learning powered by the blockchain. EdMedia+ Innovate Learning, Amsterdam, Netherlands.

Shirky, C. (2010). Cognitive surplus: Creativity and generosity in a connected age. Penguin Books.

Khan Academy. (n.d.). https://en.khanacademy.org/

Aoun, J. E. (2017). Robot-proof: Higher education in the age of artificial intelligence. The MIT Press.

Friedman, L. W. & Friedman, H. H. (2008). The new media technologies: Overview and research framework. Social Science Research Network. http://dx.doi.org/10.2139/ssrn.1116771

Published online: 5 January, TAPS 2021, 6(1), 1-2
https://doi.org/10.29060/TAPS.2021-6-1/EV6N1

In our January 2020 Editorial, we drew the attention of our readers to “Grit in Healthcare Education and Practice”. In particular, we focused on developing the “Grit” of students and trainees; medical students who are well-equipped with the ‘Power of Grit’ will display a “passion for patient well-being and perseverance in the pursuit of that goal [which] become social norms at the individual, team and institutional levels” (Lee & Duckworth, 2018). However, never could we imagine then that such an attribute (i.e. ‘Grit’) would become contextual so soon, as exemplified by the passion and perseverance of healthcare practitioners in patient care in their response to the serious disruptions in individual health (including fatalities) caused by the Covid-19 pandemic!

We are pleased to have this opportunity to share with our readers, yet once again, the unexpected course of events associated with the Covid-19 pandemic which brought out the best in many on a global scale. In particular, as the education and training of medical students, residents and those in allied health institutions were disrupted by the Covid-19 pandemic. The educators supported by the administration in medical and health professions institutions designed curricula innovations that incorporated culturally sensitive interventions to develop individual resilience and well-being in order to support the community of learners—including students, faculty, administrators involved and of course, patients.

The current Covid-19 pandemic served as a catalyst that provided opportunities for educators to rapidly and creatively design safe, yet effective, novel and innovative solutions to ensure continuation in the education and training of medical and closely allied health professional students (Samarasekera, Goh, & Lau, 2020). Thus, there is a need to break away from decades of tradition in designing such educational strategies for continued student learning, as a rapid response to the Covid-19 pandemic. In this context then, both, institutional as well as program leadership are required to facilitate the process for the design of creative, yet safe, effective and innovative strategies for the continuation of student learning; such a step is expected to mitigate the disruptive effects of the Covid-19 pandemic! In this context then, educators leverage on available technology as the preferred mode for the delivery of instruction to students. The learning environment was also transformed from one that was predominantly classroom-based to one that is mainly online. It is also gratifying that, both, junior and senior faculty have embraced the use of technology, although some degree of ‘resistance’ to the use of technology in education was experienced earlier. Perhaps, a caveat should be added: student learning using technology over a long period of time may result in a lack of social interaction among the students and, consequently, a lack of preparation for teamwork which is so critical for healthcare practice in the 21st century.

The Covid-19 pandemic has also exposed wider societal gaps which were seldom evident previously, but needs to be addressed. It is useful then to note that The Lancet Global Independent Commission had already expressed, in its Report (Frenk et al., 2010) that “Indeed, the use of IT might be the most important driver in transformative learning ….” and that “Advanced information technology is important not only for more efficient education of health professionals; its existence also demands a change in competencies.” The ‘Report’ also drew attention to the fact that “IT-empowered learning is already a reality for the younger generation in most countries, ….” However, due to financial constraints, the ‘Report’ also cautioned that “Not all students, of course, have full access to IT resources” and suggested “A global policy to overcome such unequal distribution of digital resources [referred to as the digital divide] ….” Attention to such inequalities have also been recently addressed by Blundell, Costa Dias, Joyce, and Xu (2020).

A major concern of medical and allied health professional institutions is the well-being of students and staff who ensure the continuation of student education and training disrupted by the Covid-19 pandemic. Many institutions provided strong support to students and staff in such challenging times. Students received financial support and, if required, counselling as well in order to enhance their psycho-social well-being. Students infected by the virus or who were quarantined received special care. Many institutional policies were swiftly revised to match the rapidly changing environment: clear lines of communication were established for staff and students (Ashokka, Ong, Tay, Loh, Gee, & Samarasekera, 2020).

A more resilient community of staff and students have remarkably emerged from the trials and tribulations experienced: students have adapted rapidly to blended and virtual learning environments. Students have also organised their learning engagements around virtual student communities, as most institutions have minimised their face-to-face classroom activities. Faculty responded by designing a more adaptive curriculum that is flexible to the needs of the learner. Pre-clinical and clinical learning activities were further refined and streamlined with the removal of some content and examinations—a process unthinkable prior to the crisis (disruptions) of the Covid-19 pandemic; the prior status involved strict control of the curricula which was managed by the institution and/or professional / statutory bodies. Within a short period of time newer course materials and assessment instruments, all aligned to support online, blended or hybrid learning requirements, were developed. However, the most significant contribution from staff to the disrupted student learning is the proactive support to optimise and meet the needs of learners in the crisis triggered by the Covid-19 pandemic! Such an action by the staff were greatly appreciated; stronger bonds with a closer community spirit between the students and staff were soon established.

In conclusion, it can be said that medical and allied health professional educators have benefitted much (lessons learnt) from the disruptive effects of the Covid-19 pandemic on student learning. Instead of wallowing in self-pity, sadness and simply awaiting time-out. A determined and focused faculty can mitigate the effects of the formidable challenge posed by the Covid-19 pandemic by responding rapidly to make changes to the learning environment—using appropriate technology to deliver instruction to students, in order to ensure the continuation of safe, timely, and quality education!

Providing constant support to students by the staff and the institution will help students develop relevant coping strategies that foster their resilience and well-being. Ultimately, a community of learners and practitioners will emerge with the ability to provide and maintain quality healthcare during challenging times like the one we are now experiencing.

 

Dujeepa D. Samarasekera & Matthew C. E. Gwee
Centre for Medical Education (CenMED), NUS Yong Loo Lin School of Medicine,
National University Health System, Singapore

 

 

Ashokka, B., Ong, S. Y., Tay, K. H., Loh, N., Gee, C. F., & Samarasekera, D. D. (2020). Coordinated responses of academic medical centres to pandemics: Sustaining medical education during COVID-19. Medical Teacher, 42(7), 762-771.

Blundell, R., Costa Dias, M., Joyce, R., & Xu, X. (2020). COVID‐19 and Inequalities. Fiscal Studies, 41(2), 291-319.

Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., … & Kistnasamy, B. (2010). Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. The Lancet, 376(9756), 1923-1958.

Lee, T. H., & Duckworth, A. L. (2018). Organizational grit. Harvard Business Review, 96(5), 98-105.

Samarasekera, D. D., Goh, D. L. M., & Lau, T. C. (2020). Medical school approach to manage the current COVID-19 crisis. Academic Medicine, 95(8), 1126-1127.

It is with pride and joy that we take this opportunity to communicate with the readership of our online journal The Asia Pacific Scholar (TAPS). Of course we greatly appreciate the professional advice provided by our Board of Advisers as well as the patience of Reviewers of manuscripts submitted to TAPS for publication. To one and all we say a big thank you to you. We would also like to convey special thanks to our home team who have worked so conscientiously to ensure the success of our humble contribution to medical education; our educational venture would not have been able to reach this milestone without the hardwork of our home team. A very special thank you to everyone in the team.

In this issue of TAPS  (Volume 2, Number 2, May 2017) we have published several interesting aspects that relate to medical education, not only in our region, but also globally, namely:

• ORIGINAL ARTICLES

1. Sleep, fatigue and burnout in postgraduate year 1 residents have been studied: the authors conclude that faculty are more likely than residents to “possess protective mechanisms” against “burnout”.
2. The authors of this investigation concluded that research studies should have clear study aims that would contribute to “clarification research purpose”.
3. A highly illuminating and global view of ‘leadership theories’ that contribute to ‘identity formation’ in the health professions.
4. A useful investigation into the educational value of the ‘Flipped Classroom Model’ with an interesting conclusion by the authors.

• SHORT COMMUNICATIONS

The perceptions of medical and physiotherapy undergraduates on the important ‘roles and qualities of a medical teacher’ were investigated: the authors applied the 12-role model of the teacher proposed by Harden and Crosby (2000) and concluded that “Students perceived that good communication skills, professional skills, knowledge and respect for patients as most important qualities in an educator.”

• LETTER TO THE EDITOR

The author specifically draws attention to the educational value of ‘Brainstorming Activity in Class’ and the likely impact of ‘technology’.

We wish you pleasant reading and learning. Please provide feedback should you wish to communicate with us or any of our authors directly. Thank you.

Dujeepa D Samarasekera & Matthew C E Gwee
Centre for Medical Education (CenMED), NUS Yong Loo Lin School of Medicine,
National University Health System, Singapore