Submitted: 24 September 2024
Accepted: 3 June 2025
Published online: 7 October, TAPS 2025, 10(4), 81-83
https://doi.org/10.29060/TAPS.2025-10-4/II3527

Nathasha Luke, Shing Chuan Hooi & Celestial T. Yap

Department of Physiology, Yong Loo Ling School of Medicine, National University of Singapore, Singapore

I. INTRODUCTION

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

Modern-day medical practice is rapidly revolutionising. The increasing content and complexity of medical knowledge are often beyond the human capacity to process and synthesise. A study in 2019 revealed there was an overall 2620% increase in the number of knowledge syntheses published over 20 years, from 1999 to 2019 (Maggio et al., 2020). Medical students and doctors struggle to stay updated with the expanding knowledge and find it difficult to cope with information overload. A successful practitioner should have excellent foundational knowledge, be up-to-date, know when and where to seek additional information, and understand optimal practices in the work environment. Such practitioners will adopt technologies to make their lifelong learning more effective and targeted toward improving patient care.

Artificial intelligence (AI) is at exponential growth, particularly in the field of medicine. AI inventions span across multiple dimensions such as AI-aided diagnostic systems, image interpretation, medical records, patient communication, and community-based care. Future practice environments are likely to be heavily AI-integrated. AI-based knowledge management systems and search engines will streamline the process of practitioners keeping themselves up to date with evolving medicine.

Developing lifelong learning among students is an important domain of medical education, that will them to keep abreast of rapid advances in medicine. Medical schools foster the development of lifelong learning habits through strategies such as (1) adaptive learning (2) collaborative learning (3) coaching and (4) incorporating evidence-based learning into the curriculum. This article focuses on how AI could be harnessed to facilitate and enhance these strategies to inculcate lifelong learning among medical undergraduates.

II. HOW COULD AI ENHANCE THE PROCESS OF ADAPTIVE LEARNING?

Adaptive learning is a process that customises individual learning experiences by determining an individual’s strengths and weaknesses and specifically addressing them. The concept of adaptive learning has become popular in recent years. However, this concept was originally highlighted more than a century ago. In 1912, Edward Thorndike introduced the idea of the learning machine, where the machine could ask questions from the learner and suggest areas that need improvement. With the rise of Generative AI, this concept is coming to reality. Generative AI, which produced content like text, videos and music in response to user prompts, powers adaptive learning tools that assess student knowledge, offer personalised feedback, and pinpoint areas for improvement to help guide their learning process toward mastery (Luke & Hooi, 2024).

Rapid advancements in generative AI have made this technology accessible to many users, allowing learning institutions to customise adaptive AI platforms at a relatively lower cost. Such tools may not only facilitate the learning journey of medical students but also make them strive for continuous feedback-driven improvement as practitioners. In the future, AI-driven adaptive learning may revolutionise continuous professional development (CPD) to pinpoint and address learning gaps, allowing efficient and relevant learning for busy clinicians.

III. WILL AI-DRIVEN LEARNING ENVIRONMENTS PROMOTE COLLABORATION?

Collaboration is defined as the mutual engagement of participants in a coordinated effort to solve the problem together (Roschelle & Teasley, 1995). Collaborative learning by means of peer learning, interdisciplinary learning, and interprofessional learning should be promoted to ensure students develop the skills and confidence to collaborate as clinicians in the future. In clinical environments, doctors learn from each other in both formal and informal ways. This type of learning is particularly important in learning new skills and encourages self-learning behaviours in individuals. In medical school, collaborative learning skills are enhanced through group work, simulations, and collaborative activities among students from different related streams such as medicine, nursing, and pharmacy. These approaches strengthen interprofessional communication, knowledge sharing, and enhance learning.

AI-based virtual reality simulated clinical environments are adopted by multiple medical schools to promote experiential learning. Promoting collaboration should be incorporated as a learning outcome when possible into such simulations. For example, simulations can focus on students’ decision-making skills as what team members are to be activated in a simulated encounter and developing communication skills for effective collaboration. In addition, in the future, AI-based platforms may allow more widespread collaboration crossing boundaries, such as enabling clinicians to find the ‘expert’ to seek opinions on a particular condition, where AI-based systems can facilitate collaboration.

IV. COACHING FOR LIFE-LONG LEARNING – CAN AI DO THIS?

Coaching is a development process that enables a person to identify and enhance their own capabilities to reach personal and professional goals. This process has been demonstrated to be beneficial for students in educational settings (Breslin et al., 2023). How does coaching promote lifelong learning? Coaching, which allows the person to learn about self, enables one to identify own impediments towards learning. This will enhance behaviours facilitating learning. AI coaching or virtual coaching is now being explored. The advantages of AI coaching are accessibility, lack of bias, and convenience. Human coaching is still believed to be superior due to the aspects of the ability to express empathy, pick up non-verbal cues during conversation, and be more adaptive. Though the current technology of AI is unable to surpass an experienced human coach (Terblanche et al., 2022), these hurdles may be overcome with future advancements of the technology.

V. EMPHASISE EVIDENCE-BASED APPROACHES WITHIN THE CURRICULUM

Reading journals, critically appraising relevant publications, and adopting them in one’s own practice are essential elements of the lifelong learning process for doctors, which should be developed from undergraduate days themselves. The main hurdle for such incorporations is the tight schedule within the curriculum and the content load. Despite traditional teaching being replaced by integrated teaching, the content load covered within the curriculum remains substantial. The depth and breadth of the content taught in medical school have not proportionately evolved over the years, despite major changes happening in clinical environments with AI integration. AI acts as an instant source of knowledge, aiding clinical decision-making and patient care. Bearing this in mind, educators should revise their curricula to reduce the depth of certain elements that could be easily retrieved digitally. However, students should have a sound knowledge on foundational principles on which advanced concepts can build on.

Re-evaluating the curriculum to reduce the content load would free more time in the schedule to promote critical appraisal of scientific literature, enabling students to wisely use scientific literature to stay up to date. A thoughtful and pragmatic approach to curriculum revaluation for lifelong learning involves embedding core competencies such as critical thinking, adaptability, self-directed learning, and interdisciplinary collaboration instead of overloading content.

VI. EQUIP UNDERGRADUATES WITH BASIC AI KNOWLEDGE AND SKILLS

Some medical schools, including NUS Medicine, have incorporated AI into the curricula. Exposing medical undergraduates to the foundations of AI technology can help them foresee the revolutionisation of future practice and equip themselves to embrace the technology. In addition, this will enable them to pursue new career pathways combining AI and Medicine. With regards to lifelong learning, clinicians may be equipped with AI-based tools to learn from real-time patient data for clinical decision-making, rather than waiting for prospective clinical trials or research. For example, students with foundational knowledge of AI will be able to use AI analytical skills to draw conclusions based on real-time and latest clinical data, as well as to detect trends of emerging diseases and antibiotic resistance, promoting early intervention.

Equipping future generations with AI knowledge will improve the quality of care and reduce diagnostic errors. Also, AI knowledge will guide practitioners to remain vigilant about data privacy and algorithmic bias when using AI. A future-ready curriculum will not only prepare students to use AI responsibly but also to question and enhance the tools.

AI comes with challenges and opportunities. The risk of bias, data quality and security issues, risk of over-reliance, AI relying on historical rather than real-time data, and lack of transparency in decision-making processes are some of the limitations. Still, AI has a vast potential to augment healthcare and health professions’ education as discussed above. AI should augment clinical decision making, and not replace. Ethical considerations, including patient consent, data security, and accountability, must remain central to any AI integration in healthcare practice.

In summary, AI has huge potential to enhance the strategies implemented in medical education to promote lifelong learning in medical undergraduates. The users should be aware of the limitations of the technology, and incorporate it cautiously to harness the maximum benefit of the technology in the process of transforming our undergraduates to better clinicians and lifelong learners.

Notes on Contributors

NL conceptualised the article, created the first draft, and revised subsequent versions. In addition, approved the final version of the article for submission.

HSC conceptualised the article, revised the draft versions, and approved the final version of the article for submission.

CTY conceptualised the article, revised the draft versions, and approved the final version of the article for submission.

Funding

We did not receive any funding for this publication.

Declaration of Interest

We do not have any conflicts of interest, including financial, consultant, institutional, or other relationships that might lead to bias or a conflict of interest.

References

Luke, W. N. V., & Hooi, S. C. (2024). The role of artificial intelligence in knowledge management for medical students and doctors. Medical Teacher, 1–2. https://doi.org/10.1080/0142159x.2024.2336065

Maggio, L. A., Costello, J. A., Norton, C., Driessen, E. W., & Artino, A. R., Jr. (2020). Knowledge syntheses in medical education: A bibliometric analysis. Perspectives on Medical Education, 10(2), 79–87. https://doi.org/10.1007/s40037-020-00626-9

Roschelle, J., & Teasley, S. D. (1995). The construction of shared knowledge in collaborative problem solving (pp. 69–97). Springer eBooks. https://doi.org/10.1007/978-3-642-85098-1_5

Terblanche, N., Molyn, J., De Haan, E., & Nilsson, V. O. (2022). Comparing artificial intelligence and human coaching goal attainment efficacy. PLoS ONE, 17(6), e0270255. https://doi.org/10.1371/journal.pone.0270255

*Nathasha Luke
2 Medical Drive, MD 9,
National University of Singapore, 117593
+6596204104, +6566013506
Email: nathasha@nus.edu.sg

Submitted: 6 February 2025
Accepted: 14 May 2025
Published online: 7 October, TAPS 2025, 10(4), 94-96
https://doi.org/10.29060/TAPS.2025-10-4/II3664

Charlene Tan¹ & Ruth Neo²

¹College of Arts, Humanities and Languages, Life University, Cambodia; ²UNSW Medicine & Health, University of New South Wales, Australia

I. INTRODUCTION

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

II. MENCIUS ON WELL-BEING AND INTERPERSONAL JOY

Well-being is used synonymously or in conjunction with related terms such as welfare, happiness, prudential value, the good life, prudential good life, quality of life, flourishing, self-interest, fulfilment, utility and pastoral care (Fletcher, 2016). Mencius’ approach to well-being is encapsulated in his idea of interpersonal joy, which harmonises personal and communal delight. A representative passage is 7A20.1 in the Mengzi:

Mengzi said, “An exemplary person [Junzi] takes joy in three things, and being King of the world is not one of them. The person’s first joy is that one’s parents are both alive and one’s siblings have no difficulties. The second joy is that looking up one is not disgraced before Heaven, and looking down on one is not ashamed before humans. The third joy is getting assistance and cultivating the brave and talented people of the world. An exemplary person takes joy in three things, and being King of the world is not one of them (Van Norden, 2008, p. 176).

This passage is about a Junzi which literally means ‘son of a noble’. Confucius appropriated this historical term and infused it with moral import, thereby changing its meaning to denote an exemplary person. That the exemplary person embodies Confucian well-being is evidenced by passages in the Mengzi that describe such a person as having “no anxieties” (4B28.7) and experiencing “joy” (7A20.1, 7A21.2).

With respect to 7A20.1, the passage begins by stating that an exemplary person does not derive joy from being King of the world. Mencius is not asserting that holding political power is wrong or detrimental to one’s well-being. On the contrary, he acknowledges in the next passage that an exemplary person, like all rulers, “desires a large territory and numerous people” (7A21.1). Mencius’ point is that Kingship, in itself, does not give satisfaction to an exemplary person; instead, such a person “takes joy in taking one’s place in the middle of the world and making all the people within the Four Seas settled” (7A21.1) (Van Norden, 2008, p. 176). We see here how an exemplary person obtains personal joy by bringing joy to others (“making all the people within the Four Seas settled”).

All people can become exemplary people by developing the four sprouts within them, namely the mind-and-heart of compassion, the shame of evil in oneself and hatred of evil in others, humility and deference, and right and wrong (2A.6). These four sprouts, when consistently cultivated, will grow into the virtues of benevolence, propriety, righteousness and wisdom, all of which contribute to interpersonal joy.  Retuning to 7A20.1, Mencius’ message is that an exemplary person does not obtain pleasures and life satisfaction from prudential desires, which are manifested in egoistic ambitions with little regard for others. Instead, joy is felt when a person immerses oneself in social interactions and builds strong connections with others. An exemplary person also derives delight by treating others well and developing their potential for the common good. The end result is “making all the people within the Four Seas settled” (7A21.1) (Van Norden, 2008, p. 176).

To sum up, Mencian well-being is indicated by interpersonal joy which integrates individual and collective happiness, as demonstrated by the exemplary person. Communal joy engenders collective well-being, illustrated by the King “sharing the same delight as the people” (1B1.4) (Van Norden, 2008, p. 16).

III. RECOMMENDATIONS FOR MEDICAL EDUCATION

A major implication of Mencian well-being is for medical schools to promote interpersonal joy in the curriculum and assessment. Two suggestions are elaborated in this section: a shift from summative assessment and competition to formative assessment and collaboration; and the introduction of a wellness curriculum that pivots on interpersonal joy.

First, medical schools need to review their curriculum and assessment so as to remove any hindrances to the realisation of interpersonal joy in their students. A specific recommendation is to replace summative assessment and competition with formative assessment and collaboration. Mencius’ call for collective well-being is difficult to achieve if students are fixated with outperforming one another due to the pressures of high-stakes exams. Kachel et al. (2020) report that “during medical school interpersonal skills linked to being an active member of an institution are underrepresented in curricula” (p. 11). It is a challenge for medical students to care for the well-being of others and be open about their mental health needs if they are circumscribed by a culture of competition, distrust and judgement (Canadian Federation of Medical Students, 2021). Cooperation and interdependence can be enhanced by reducing or removing pen-and-paper examination and norm-referenced assessments, and introducing (more) collaborative projects and criterion-referenced assessments. The assessment mode for the cultivation of interpersonal joy should be formative, where students are given continuous feedback and find enjoyment in learning and sharing.

A pedagogical approach to foster interpersonal joy is group projects, where students collaborate for shared success. Anchored upon the principles of cooperation and harmony, group projects foreground interpersonal joy and competencies that are underrepresented in the curricula (Kachel et al., 2020). Termly group projects nurture communication and teamwork skills, spanning a wide range of topics from the basic clinical sciences to medical ethics and public health. The group projects can be evaluated via negotiated assignment, where students develop their own research questions and set their own assessment criteria that are aligned with the course themes. The goal is to foster student-driven learning that gives students the opportunity to explore common topics of interest beyond the confines of standard, end-of-course examinations. A related pedagogical approach is encouraging students to participate in service learning, community involvement as well as local and overseas volunteer projects, so as to generate communal interactions and bonding. By serving others, the students’ sprout of compassion is cultivated and manifested through empathy, beneficence and concern for others (Van Norden, 2008).

The second recommendation is for medical schools to enact a wellness curriculum that pivots on interpersonal joy. Medical schools could adapt the wellness curriculum for medical students in a Canadian university; students there were asked to “define their core values and beliefs while respecting those of others, and apply them in the context of their developing physician identity and that of the medical profession” (Canadian Federation of Medical Students, 2021, p. 22). Mencian ideas can be integrated into the before-mentioned wellness curriculum through reflective questions such as: What does an exemplary person (junzi) mean to me? How can Mencian interpersonal joy be part of my core values as a medical professional? How can I obtain interpersonal joy through interacting with and serving others? The self-reflection activity can be undertaken in various formats such as group discussions, journalling and multi-media presentations.

Mencian ideas of well-being and related suggestions may face challenges in medical schools where individualism and competition are often culturally entrenched. In this regard, Mencian well-being may be more appropriate for medical education in Confucian heritage cultures. Significantly, studies have shown that Asian adolescents experience a strong sense of well-being when they partake in collective activities; in contrast, adolescents in Anglo-American societies typically enjoy higher well-being when they engage in more individualistic activities (Chue, 2023). Relatedly, Mencian well-being’s focus on moral cultivation sets it apart from two dominant models in Anglophone societies, namely Seligman’s PERMA (Positive emotions, Engagement, Relationships, Meaning & Accomplishment) and Ryff’s six aspects of psychological well-being, which are autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. As noted earlier, Mencius advocates for the development of our innate goodness in the form of the four sprouts, which in turn contributes to interpersonal joy. In contrast, the theories of Seligman and Ryff generally de-emphasise moral education.

In individualistic societies, interpersonal joy can complement the existing wellness frameworks by underscoring collaborative learning, such as group projects and service learning (Bourcier et al., 2021). Staff development is also critical, where faculty members are introduced to Mencian principles and practical ways to promote them, such as organising service learning and designing wellness curricula. Ultimately, the successful implementation of interpersonal joy necessitates faculty development, which should be strategically incorporated into the staff training programmes (Canadian Federation of Medical Students, 2021).

IV. CONCLUSION

Mencius’ approach to well-being is encapsulated in his idea of interpersonal joy, which harmonises personal and communal delight. Mencian well-being supports collective well-being by twinning self-interests and other interests. This paper has also suggested that medical schools revamp the curriculum and assessment modes to shift from summative assessment and competition to formative assessment and collaboration. Medical schools should also explore pedagogical methods that incorporate Mencian idea of interpersonal joy into the curriculum.

Notes on Contributors

Charlene Tan conceptualised the topic, provided philosophical ideas and drafted the manuscript. Ruth Neo gave inputs that pertained to medical student well-being and co-drafted the manuscript.

Ethical Approval

Ethical approval is not relevant as this is a conceptual paper that does not involve human participants and/or animals.

Acknowledgement

The authors thank the anonymous reviewers for valuable suggestions to earlier drafts.

Funding

The authors did not receive support from any organisation for the submitted work.

Declaration of Interest

No potential competing interest was reported by the authors. The authors have no relevant financial or non-financial interests to disclose.

References

Canadian Federation of Medical Students. (2021). Canadian federation of medical students wellness curriculum framework. https://www.cfms.org/files/wellness-resources/CFMS-Wellness-Curriculum-Framework_FINAL.pdf

Chue, K. L. (2023). Cultural issues in measuring flourishing of adolescents. In R. B. King, I. S. Caleon, & A. B. I. Bernardo (Eds.), Positive psychology and positive education in Asia: Understanding and fostering well-being in schools (pp. 329-342). Springer.

Fletcher, G. (Ed.). (2016). The Routledge handbook of philosophy of well-being. Routledge.

Kachel, T., Huber, A., Strecker, C., Höge, T., & Höfer, S. (2020). Development of cynicism in medical students: Exploring the role of signature character strengths and well-being. Frontiers in Psychology, 11(328), 1-16. https://doi.org/10.3389/fpsyg.2020.00328

Van Norden, B. W. (2008). Mengzi. With selections from traditional commentaries. Hackett Publishing Company, Inc.

*Charlene Tan
Life University, Phreah Sihanouk,
Sihanoukville, Cambodia
Email: chptan@u.nus.edu

Submitted: 9 October 2024
Accepted: 25 July 2025
Published online: 7 October, TAPS 2025, 10(4), 90-93
https://doi.org/10.29060/TAPS.2025-10-4/II3539

Shigeki Matsubara

Department of Obstetrics and Gynaecology, Jichi Medical University, Japan; Department of Obstetrics and Gynaecology, Koga Red Cross Hospital, Japan; Medical Examination Centre, Ibaraki Western Medical Centre, Japan

I. INTRODUCTION

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

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

Medical meetings consist of the audience, presenter, chairperson, and organizers. While some publications focus on how to deliver an effective presentation (Nundy et al., 2022), it is crucial to recognize that the top priority should be the audience (Matsubara & Matsubara, 2024a). A previous report suggested that presenters and chairpersons could activate audience-friendly meetings (Matsubara & Matsubara, 2024a). However, practical suggestions for the audience remain relatively scarce. Some literature merely advises: “Be an active learner; ask questions” (Fisher & Trautner, 2022). To my knowledge, there is limited evidence on whether “active learning and active asking” are truly lacking in real-world settings, and if so, what barriers may underlie this. If the absence of “gamification” factors partly contributes to these barriers, then the present proposal may become more reasonable and persuasive. That said, this proposal is not primarily based on such reasoning. But indeed, publications on active learning and active asking from the viewpoint of “gamification” are lacking, and senior staff are less likely to provide practical advice. Thus, audience members, especially younger generations, may receive little guidance on how to participate effectively in scientific meetings.

I propose a new way of how audiences actively participate in medical meetings. Based on my decade-long experience, I focus on two elements: “listening” and “asking”. These two actions are, I believe, the essence of audience participation. My proposal is to incorporate the concept of “gamification” into personal “listening and asking” activity.

II. “LISTENING”: EFFECTIVE KNOWLEDGE ACQUISITION AT MEDICAL MEETINGS

When I was younger, I took notes on everything and tried to memorise the data presented. For example, I wrote down, “Methotrexate 50 mg cured ectopic pregnancy”. While this approach might work for some, I found that for me, this classroom-like method was neither effective nor reliable. It exhausted my physical and mental energy, sometimes leading to the retention of inaccurate information.

Around 30 years ago, I changed my style. I began to approach meetings as if they were a “game”, the concept now acknowledged as “gamification”. The night before the scientific or medical meetings, I quickly glanced through the program listing titles of the presentations (and abstracts, if available) to form a rough idea of the topics, ignoring details. Before the session starts, I read the presentation titles, for example, “Methotrexate for ectopic pregnancy,” and came up with some likely scenarios (A, B, or C) that the presenter might discuss, akin to forming a hypothesis. If the presenter confirmed scenario A, I thought, “Got it!”. After the presentation, I created a one-line conclusion based on my interpretation, which might align with or differ from the presenter’s. Importantly, this conclusion should always be in my own words (Tip 1 and Additional Notes in the Appendix).

I always did this and made it a routine for medical or scientific meetings. It was useful to skim the titles or abstracts beforehand to become familiar with the field. This enabled me to predict what the presenter might say. Afterwards, I summarised the presentation in my own words. This process mirrors manuscript writing, where I gather general knowledge, form a hypothesis, and craft a key message—essential steps for completing a successful paper (Matsubara & Matsubara, 2024b). Thus, listening to presentations served as practice for writing manuscripts. This procedure changed my attitude toward scientific meetings, and even improved my paper productivity. I began to look forward to the next meeting, anticipating the new ideas I might encounter. I became an active audience member. The one-line conclusion made me continue contemplating whether my interpretation was correct. Even after the meetings, I repeatedly glanced at it, and sometimes a new idea or concept emerged from that single line, which triggered me to write some papers. Thus, this “gamification” concept in listening was effective not only during the scientific meeting but also afterwards. As described, “gamification” has now been widely discussed as an effective measure in medical education (Lee et al., 2025). Here, I propose that involving the concept of “gamification” at a personal level may enhance active participation in scientific meetings, and thereby support life-long learning.

Why not view medical meetings as a “game” rather than a mere duty? This perspective helped me stay relaxed and engaged throughout the session. It renewed my knowledge base and offered a chance for manuscript-writing practice.

III. VALUABLE QUESTIONS AND COMMENTS TO ACTIVATE MEETINGS

Asking questions not only deepens one’s understanding, but also helps activate the meeting itself. The following suggestions may be particularly useful for senior attendants, including meeting leaders, but they are equally relevant to the general audience, including the younger generation.

Valuable questions can:

1. help clarify knowledge for the audience and enhance their understanding,
2. increase the significance of the study being discussed. Here, “questions” can also refer to general remarks about the presentation.
   
   

Some studies present an incorrect message regarding treatment recommendations, which less-experienced doctors may apply without question. Ask questions to clarify. Some presenters may refrain from stating a clear conclusion. Ask for a tentative conclusion. These kinds of questions may also be considered, in a broader sense, a form of “gamification”: such questions can open further discussion and, in that sense, the questioner could act as a “game changer”.

Questions often increase the significance of a study. For example, ask if there’s another relevant interpretation of the data, if similar studies exist that the presenter might not be aware of, or if there are historical perspectives on the issue. Cross-disciplinary perspectives are often useful. For example, perspectives from fields like neurosurgery, gastroenterology, or urology can activate discussions in psychiatry, endoscopy, or nephrology meetings, respectively. Please focus on asking questions that relate to the study’s significance, rather than those solely of personal interest. This approach is akin to how a chairperson should handle the question-answer sessions (Matsubara & Matsubara, 2024a) (Tip 2 and Additional Notes in the Appendix).

Questions can complement presentations much like correspondences enrich published articles by offering additional perspectives. Good questions prompt the presenter and audience to recognise further significance in the presentation. This benefits everyone—the questioner, the presenter, and the general audience. This situation mirrors how good correspondence enriches all parties involved in the academic discussion.

IV. CONCLUSION: PASSING ON THE EXPERIENCE TO THE NEXT GENERATION

I propose a change in perspective: learning at scientific meetings should be viewed as a game.  “Listening” and “asking” share similarities with writing a paper. Having a bird’s-eye view, crafting a hypothesis, and forming a key message are essential for both “effective attendance to meetings” and paper writing (Matsubara & Matsubara, 2024b). A good question is like a brief, insightful correspondence. Thus, making an effort to be a good audience also nurtures good researchers and writers.

Finally, I would like to add that, medical meetings provide opportunities not only to gain knowledge, but also to engage in face-to-face communication. Making acquaintances there may broaden future research opportunities, which is especially important for younger physicians. A positive meeting atmosphere encourages such communication. I believe that good “listening” and thoughtful “asking” contribute to this. Active listening and well-considered questions benefit all participants in three ways: deepening understanding for those who ask, helping everyone grasp the presentation’s significance, and fostering a welcoming atmosphere.

Having participated in numerous meetings, I’ve developed this perspective. It’s unclear whether some hierarchical or systemic influences hinder “natural” listening and asking, especially among younger generations. If so, how best to address them should be studied. Regardless, we, as meeting participants, should cultivate the sensitivity to recognise a question that sparks a game-changing moment. I believe the present description offers a way to fully engage in medical and scientific meetings by viewing them as a “game”. This approach has helped me grow as a researcher-physician, contributing to the publication of over 600 PubMed-indexed papers. Thus, for me, this method is time-tested. I believe seasoned doctors like myself have a responsibility to pass on their experiences to the next generation. I invite you to try my perspective, and hope that it serves as a platform for further discussion.

Notes on Contributors

Shigeki Matsubara reviewed the literature, made the concept, wrote and edited the manuscript.

Acknowledgement

I thank Professor Shinya Ito (University of Toronto, Canada), Professor Yasushi Matsuyama (Jichi Medical Univeristy, Japan), and Teppei Matsubara (Harvard Medical School, USA), for their critical reading of this manuscript.

Funding

There are no funding sources for this paper.

Declaration of Interest

Shigeki Matsubara has no conflict of interest to declare.

References

Fisher, J.W. & Trautner, B.W. (2022). Maximizing the academic conference experience: Tips for your career toolkit. Journal of Graduate Medical Education, 14(2), 144-148. https://doi.org/10.4300/jgme-d-21-00943.1

Lee, C.Y., Lee, C.H., Lai, H.Y., Chen, P.J., Chen, M.M., & Yau, S.Y. (2025). Emerging trends in gamification for clinical reasoning education: A scoping review. BMC Medical Education, 25(1), 435. https://doi.org/10.1186/s12909-025-07044-7

Matsubara, S., & Matsubara, D. (2024a). An audience-friendly medical meeting: A good presentation and chairpersonship. JMA journal, 7(3), 406-409. https://doi.org/10.31662/jmaj.2023-0219  

Matsubara, S., & Matsubara, D. (2024b). A checklist confirming whether a manuscript for submission adheres to the fundamentals of academic writing: A proposal. JMA journal, 7(2), 276-278. https://doi.org/10.31662/jmaj.2023-0201

Nundy, S., Kakar, A., & Bhutta, Z.A. (2022). How to give an oral presentation? In Nundy S., Kakar A., & Bhutta Z.A. (Eds.), How to practice academic medicine and publish from developing countries?: A practical guide (pp. 357-366). Springer Nature.  https://doi.org/10.1007/978-981-16-5248-6

*Shigeki Matsubara
Department of Obstetrics and Gynaecology,
Jichi Medical University
3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
Email: matsushi@jichi.ac.jp

Submitted: 24 September 2024
Accepted: 14 May 2025
Published online: 7 October, TAPS 2025, 10(4), 84-89
https://doi.org/10.29060/TAPS.2025-10-4/II3528

Seema Tanaji Methre¹, Ramya Jayakumar¹, Sugata Sunil Jadhav¹, Chhaya Anil Saraf ², Rajkumar Sansarchand Sood¹ & Ashwini Namdeorao Patil³

¹Department of Physiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, India; ²Department of Physiology, Vydehi Institute of Medical Sciences and Research Centre, India; ³Department of Physiology, Symbiosis Medical College for Women, Symbiosis (International) (Deemed University), India

I. INTRODUCTION

Soft skills help a person to boost his or her own performance. They are necessary for professional development. Effective communication and decision making are an integral part of good clinical care. Introduction to soft skills during undergraduate training helps students to appreciate and learn effective interpersonal communication with patients and their families. Soft skills training was not a part of academic curriculum in formal traditional medical training. (Sancho-Cantus et al., 2023).

However, since 2019, AETCOM module was added in medical profession in India, in which students need to learn attitude, ethics and communication (Medical Council of India [MCI], 2018). In addition to verbal communication, non-verbal communication including body language, eye contact, facial expression, touch and gestures are equally important in building trust in doctor-patient relationships. In order to inculcate these soft skills in their future profession, students need to practice these skills again and again.

Various professional bodies and medical students have revealed the need for soft skills training in the curriculum (Modi et al., 2016). Integrating these soft skills with clinical skills training is a big challenge. The concept of role play has been widely used to introduce soft skills in medical profession. Role play promotes active learning among the students and motivates them to work as a team. In contrast to lectures, students get completely involved while performing the act during the role play. This enables them to retain and remember the concepts for longer duration. Role play helps the students to have an in-depth understanding of the topic at hand as they are made to think, script and act out the complete scenario on their own. (Goothy et al., 2019). Role play promotes better understanding and leaves an impact not only amongst the participating students but also in peers who are observing them (Rønning & Bjørkly, 2019). The current study aimed to evaluate effectiveness of role play in nourishing various soft skills in the first-year medical students.

II. METHODS

An interventional study was conducted at a teaching medical institute in Western Maharashtra, India. Ethics clearance from the Institutional Ethical Committee was taken before the commencement of the study (Reference Code: I.E.S.C./159/2022). Selection of participants was purely on a voluntary basis.

A. Pre-Role-Play Self-Assessment of Skills

Topics for role play were given 15 days prior to role play. Five students gave verbal consent for this study. The study procedure was explained to the participants. Topics were given as shown in Appendix 2. They wrote their own script for the role play. Pre-test was conducted through Google form which included following types of questions related to various skills like communication, interpersonal, intellectual, self-management and learning. Pre-validated questionnaire was adapted from the website of College of Physiotherapists of Ontario which was modified and rectified by senior faculties as per the need of our study.

This questionnaire allows students to self-assess their own skills so that they know where they may need to improve. Each question has 3 columns as A, B & C. Each column should be filled per the instructions given below as shown in supplementary table (Appendix 1).

1. Column A

How important is the skill for the participant that he/she thinks should possess/acquire? Need to write the number as per the scale given below:

6 – very important
5 – important
4 – slightly important
3 – slightly unimportant
2 – unimportant
1 – very unimportant

2. Column B

Where does participant see himself/herself in already possessing the following skills (i.e., his/her self-assessment of present skill level)? Need to write the number as per scale given below:

6 – Expert, no need for further training
5 – Expert, needs self-training
4 – Good, needs occasional training from experts
3 – Average, needs frequent training
2 – Poor, needs regular training
1 – Bad, needs handholding and training

3. Column C

Participants need to subtract column B number from column A number (column A – column B). The highest number in this column C shows a major disparity between what he/she thinks about the importance of a particular skill and its current expertise level. These are the skills where participants need to improve whenever she gets opportunity in future.

B. Role Play Enactment Sessions (Intervention)

A total of 3 role plays were enacted by the participants focusing on-bad followed by good 1) attitude, 2) behavior and 3) communication of doctor with patients as per topics given to them (Appendix 2).

C. Post-Role-Play Self-Assessment of Skills

Post-test was conducted for participants using the same questionnaire.

1. Statistical Analysis

Scores of pre-test and post-test were copied into excel sheet and data was analysed by paired t -test using Primer of Biostatistics software, version 7.0.

III. RESULTS

Present study showed self-assessed improvement in communication skills, interpersonal skills and self–management skills due to role play in the participants which was highly significant. Intellectual skills and learning skills also improved significantly in this study. Role play promotes active learning. Participants write scripts on their own, think about the characters, plan for acting and do rehearsal also. Role play helps to build leadership qualities and teamwork amongst participants (Goothy et al., 2019). In order to provide good quality health care, soft skills training is necessary to strengthen these skills in professional training. Improvement in soft skills like communication, interpersonal, intellectual, self-management & learning skills enhances academic performance as well as overall professional development of the student (Sancho-Cantus et al., 2023). Cognitive and psychomotor skills are also enhanced through such activities (Goothy et al., 2019). Such soft skill training also improves coping abilities during disturbances as seen in COVID 19 pandemic and also reduces the incidence of anxiety and depression (Sancho-Cantus et al., 2023).

Only five students volunteered to participate in this study. Improvement in these skills was based on self-assessment. Due to small sample size, social desirability bias and self-report bias, statistical significance may vary and might affect the generalisation of the findings. But this pilot study can be extended with large sample size for getting more appropriate results. Focus group discussions, direct observations and reflective essays might give more in-depth information in future studies.

V. CONCLUSION

Soft skills like communication skills, interpersonal skills and self–management skill may be improved along with Intellectual skills and learning skills by the role play in students of medical profession. Role play can be used as an effective tool to enhance soft skills in the students. Such studies should be facilitated in larger population.

Notes on Contributors

Seema Tanaji Methre was involved in conceptualisation, methodology, project administration and supervision, data analysis and writing (original draft and editing).

Ramya Jayakumar was involved in conceptualisation, methodology, project administration and supervision, data analysis and writing (editing).

Sugata Sunil Jadhav was involved in methodology, project administration and supervision, data analysis and writing (editing).

Chhaya Anil Saraf was involved in project administration and supervision.

Rajkumar Sansarchand Sood was involved in conceptualisation, methodology and writing (editing).

Ashwini Namdeorao Patil was involved in conceptualisation, methodology, data analysis and writing (editing).

Ethical Approval

This study was reviewed by the Institutional Ethics Sub-Committee Committee from the Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri, Pune with an exemption from IRB review and the approval to conduct research at institute (Reference Code: I.E.S.C./159/2022).

Acknowledgement

We would like to acknowledge our participants whose efforts were truly appreciable in this study.

Funding

This study was self-funded.

Declaration of Interest

The authors declare no conflicts of interest.

References

Submitted: 11 February 2025
Accepted: 11 July 2025
Published online: 7 October, TAPS 2025, 10(4), 97-99
https://doi.org/10.29060/TAPS.2025-10-4/II3669

Suryanti Chan¹, Hamzah Hamzah² & Insan Sosiawan Tunru³

¹Department of Medical Education, Faculty of Medicine, Universitas Dian Nuswantoro, Indonesia; ²Airlangga Teaching Hospital, Airlangga University, Indonesia; ³Faculty of Medicine, University Yarsi, Indonesia

I. INTRODUCTION

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

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

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

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

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

II. APPROACH TO SYNTHESIS

Drawing on peer-reviewed articles, academic texts, and authoritative reports published over the past decade, this paper explores key international trends influencing medical education curricula. Sources were identified through a purposive review of major databases, such as PubMed, Scopus, and Web of Science, using keywords including “medical education curriculum,” “globalisation,” “technological change in education,” and “outcome-based education.” Selection was guided by relevance, conceptual contribution, and alignment with contemporary educational discourse. Through interpretive synthesis, the emerging themes were organised to highlight the evolving priorities and challenges in curriculum development across diverse global settings.

III. GLOBAL TRENDS SHAPING MEDICAL EDUCATION

Synthesising insights from the existing literature, several key themes emerge, including globalisation, technological advancement, accreditation and quality assurance, and the shift toward outcome-based education, each significantly shaping curriculum design in medical education.

A. Globalisation and Medical Education

Globalisation necessitates the integration of global health perspectives in medical curricula, enhancing students’ cultural competence, global awareness, and adaptability in diverse clinical settings. Imafuku et al. (2021) report that international electives and exposure to various healthcare systems foster a broader understanding of global health challenges. Rukadikar et al. (2022) emphasise embedding cultural competence longitudinally rather than as isolated modules. However, integrating global content can be hampered by linguistic, ethical, and logistical barriers, particularly in low-resource regions. There is also a risk of curricular homogenisation that overlooks local relevance. Initiatives such as the ASEAN Medical Schools Network attempt to address this tension by fostering regional collaboration while maintaining context-sensitive design. Ultimately, globalisation challenges medical educators to balance international standards with localised priorities, cultivating graduates who are both globally minded and locally responsive.

B. Technological Advancements

The digital transformation of medical education, catalysed by the COVID-19 pandemic, has reshaped how knowledge and clinical skills are imparted. Simulation-based learning, virtual patients, high-fidelity manikins, and telemedicine platforms offer realistic, risk-free environments for students to practise complex procedures (Castro et al., 2021). Virtual and augmented reality hold immense promise, especially in underserved areas where traditional clinical exposure is limited (Li et al., 2024). Nevertheless, adoption remains uneven. Barriers such as digital illiteracy, inadequate infrastructure, and resistance to change among faculty hinder optimal implementation. Furthermore, technological integration demands a pedagogical shift towards student-centred, self-directed learning models that not all institutions are prepared to adopt. Addressing these challenges requires systemic investment in digital infrastructure, faculty development, and curriculum redesign to fully harness the potential of educational technology.

C. Accreditation and Quality Assurance

Global accreditation standards, such as those set by the WFME, aim to enhance comparability and mobility of medical graduates by ensuring a baseline of quality and accountability (Bedoll et al., 2021). These frameworks advocate for continuous self-evaluation, peer review, and outcome monitoring. However, rigid adherence to international benchmarks may marginalise unique local needs and strain under-resourced institutions. For example, some Southeast Asian medical schools struggle to meet standards due to shortages in qualified faculty, simulation resources, or research infrastructure. Regional mechanisms like the ASEAN-QA (Asian University Network-Quality Assurance) Framework provide a more flexible model, supporting capacity-building and mutual recognition of quality. Moving forward, accreditation should not be seen solely as a compliance mechanism but as a catalyst for meaningful institutional improvement rooted in contextual realities.

D. Outcome-Based Education

OBE represents a fundamental paradigm shift, placing student competencies at the heart of curriculum design and assessment. Instead of focusing on the amount of content delivered, OBE emphasises the achievement of predefined clinical, ethical, and interpersonal outcomes. The model supports accountability and alignment between educational outcomes and healthcare needs. Ten Cate advocates for the use of Entrustable Professional Activities (EPAs) to operationalise OBE, offering a structured way to assess readiness for clinical practice. However, the practical implementation of OBE remains challenging. Many institutions lack robust tools for assessing soft skills, professional attitudes, and interprofessional collaboration. Furthermore, faculty may be unfamiliar with the principles of formative, feedback-oriented assessment that OBE requires. Successful implementation demands long-term commitment to faculty development, curriculum mapping, and resource allocation, as well as a cultural shift toward continuous quality improvement.

IV. CONCLUSION

The evolution of medical education is shaped by globalisation, technological advancements, accreditation, cultural adaptation, and outcome-based education. These trends emphasise the need for medical curricula that are adaptable, inclusive, and aligned with global healthcare challenges. Moving forward, medical education must remain dynamic and forward-thinking to prepare graduates for both current and future healthcare landscapes.

Notes on Contributors

Suryanti Chan (SC) contributed to the study design, data collection, and manuscript writing. She was responsible for analysing the findings and drafting the discussion.

Hamzah Hamzah (HH) contributed to the study design, literature review, and manuscript revision. He provided insights on the impact of international trends on medical education curriculum, particularly from the perspective of clinical training and healthcare service management in teaching hospitals.

Insan Sosiawan Tunru (IST) contributed to the study design, literature review, and manuscript revision. He provided insights on the impact of international trends on medical education curriculum, particularly from the perspective of accreditation regulation in Indonesia.

Ethical Approval

This manuscript is a literature review based on existing published studies and does not involve any original data collection or interaction with human participants.

Acknowledgement

Authors would like to express their deepest gratitude and appreciation to Prof. Ir Edi Noersasongko, M.Kom, Prof. Pulung Nurtantio Andono, S.T., M.Kom, Dr. Abdul Syukur, M.M, Dr. Hendriani Selina, Sp. A (K), MARS which has supported during this review.

Funding

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

Declaration of Interest

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

References

Bedoll, D., Van Zanten, M., & McKinley, D. (2021). Global trends in medical education accreditation. Human Resources for Health, 19(70), 1­­–15. https://doi.org/10.1186/s12960-021-00588-x

Castro, M. R. H., Calthorpe, L. M., Fogh, S. E., McAllister, S., Johnson, C. L., Isaacs, E. D., Ishizaki, A., Kozas, A., Lo, D., Rennke, S., Davis, J., & Chang, A. (2021). Lessons from learners: Adapting medical student education during and post COVID-19. Academic Medicine, 96(12), 1671–1679. https://doi.org/10.1097/ACM.0000000000004148

Imafuku, R., Saiki, T., Hayakawa, K., Sakashita, K., & Suzuki, Y. (2021). Rewarding journeys: Exploring medical students’ learning experiences in international electives. Medical Education Online, 26(1), 1913784. https://doi.org/10.1080/10872981.2021.1913784

Li, X., Elnagar, D., Song, G., & Ghannam, R. (2024). Advancing medical education using virtual and augmented reality in low- and middle-income countries: A systematic and critical review. Virtual Worlds, 3(3), 384–403. https://doi.org/10.3390/virtualworlds3030021

Rukadikar, C., Mali, S., Bajpai, R., Rukadikar, A., & Singh, A. K. (2022). A review on cultural competency in medical education. Journal of Family Medicine and Primary Care, 11(8), 4319–4329. https://doi.org/10.4103/jfmpc.jfmpc_2503_21

*Suryanti Chan
MD, MPH, MMed, PhD (Health Sciences), FIHFAA
Universitas Dian Nuswantoro,
Pendrikan Kidul Number 184,
Semarang, Central Java Province, Indonesia
(62)851-011-56248
Email: suryanti83@yahoo.com

Submitted: 14 March 2024
Accepted: 13 November 2024
Published online: 1 April, TAPS 2025, 10(2), 91-93
https://doi.org/10.29060/TAPS.2025-10-2/II3264

Han Ting Jillian Yeo & Dujeepa D. Samarasekera

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

I. INTRODUCTION

Assessment is an important component of training in ensuring that graduating students are competent to provide safe and effective medical care to patients. Typically, the passing score is set as a fixed mark, but this approach does not account for the varying difficulty of exams. As a result, students who have achieved the required level of competence might fail if the exam items are particularly challenging (false negative), while students who have not attained the necessary competence might pass if the items are unusually easy (false positive). Hence, deciding on the right pass mark is important for each assessment. To mitigate this issue, criterion referenced standard setting was adopted in medical education (Norcini, 2003). It determines the minimum competence level expected of a candidate and whether a candidate would pass or fail the assessments (Norcini, 2003). The Angoff method is one of the more commonly used standard setting techniques. It is an examinee centred method and requires a panel of judges to estimate the probability that a borderline candidate would get the item correct.

Literature have questioned the reliability of the Angoff method. Variations in pass mark have been reported when the different panels of judges were engaged (Tavakol & Dennick, 2017; Taylor et al., 2017). Judges reportedly faced challenges in visualising and defining the knowledge and skills required of borderline students and hence have difficulty estimating the probability that a borderline student would answer an item correctly (Tavakol & Dennick, 2017). A study by Yeates et al. (2019) also reported the complexity judges faced in the standard setting process due to interaction between the environment, individual judgments, and interaction between the judges. Such variations in pass marks might lead to unfairness to students who were meant to pass but did not due to a higher pass mark. It is of a greater concern to patient safety if students who were meant to fail passed the examination due to a lowered pass mark.  To assist the judges, a guide was developed to set standards for medical and health professions examinations using a probability estimate.

II. DEVELOPING A GUIDE

Judges were to rate each item based on three criteria: relevance, frequency, and difficulty. The guide focused on these areas to assist the judges in their evaluations. The relevance of an item was rated on a 5-point scale ranging from “1 – not knowing will not harm a patient” to “5 – not knowing will cause possible death to the patient”. A highly relevant item was one which assessed a foundational knowledge or a core skill. A less relevant item assessed on knowledge or skill which was good to know or acquire but not required for progression to the next level of education. The difficulty of an item was rated on a 5-point scale ranging from “1 – very easy” to “5 – very difficult”. The difficulty of the item was dependent on the ease of understanding the item construction or the difficulty of the disease condition assessed. For instance, the inclusion of multiple comorbidities in the item stem, as opposed to one comorbidity, required the student to synthesise information before responding. The difficulty of the item was also associated with the level of learning that was assessed. Hence, an item which was assessed on application would be more challenging to the student compared to an item assessing recall. The frequency of an item was rated on a 4-point scale from “1 – very rarely seen in practice of a basic doctor” to “4 – seen very often in practice of a basic doctor”. For example, in the local context, influenza is a clinical condition commonly seen in clinical practice while tetanus is a rarer clinical condition.

Judge’s ratings of each criterion were converted into a probability estimate that a borderline candidate would get the item correct ranging from 0 to 100 percent for each item. An item with a low relevance and frequency but a high difficulty would be assigned a probability estimate between 0 to 30 percent suggesting that a borderline candidate was less likely to get the item correct. An item with a high relevance and frequency but a low difficulty would be assigned a probability estimate between 70 to 100 percent suggesting that there was a high probability a borderline candidate would get this item correct. Judges were given the freedom to assign an estimate from the range provided in the guide or to assign a probability estimate based on their own judgement or expertise.

III. IMPLEMENTATION

To date, the guide was shared with judges during the Angoff standard setting sessions for the medical undergraduate assessments. The guide was given at the start of the session when calibrating judges to a similar mental model on what a borderline candidate was. Judges were free to use the guide in the decision-making process when providing a probability estimate for each item. During the calibration phase and discussion phase of the Angoff standard setting session, we observed that judges provided justifications for their probability estimates by referring to the three criteria. This was more prevalent among judges who were new to the Angoff method.  We believed that the well-defined and objective criteria provided in the guide served as a useful framework for judges to develop a mental model on what a borderline candidate was.

IV. LIMITATIONS AND FUTURE DIRECTIONS

Several limitations have been identified. While we have attempted to implement the guide, judge’s ratings remained influenced by their own criteria set by their personal experiences and beliefs which were often deeprooted and independent of the three identified criteria. This is especially so for judges who had prior experience in standard setting with Angoff method and had formed their own set of criteria. We see greater value in the use of the guide for training judges who were participating in Angoff standard setting for the first time.

The guide was developed within a specific medical school in Southeast Asia with its own unique curriculum and learning objectives. Its applicability and effectiveness may be limited in different educational contexts with varying curricula and assessment methods. These limitations highlighted the need for ongoing evaluation and adaptation of the guide and standard-setting methods to ensure they meet the needs of diverse educational settings and provide reliable assessment outcomes. The team is working on validating the use of the guide in our own local context. This would be conducted by quantifying the level of agreement between judges’ ratings, correlating with other standard setting methods and soliciting feedback from judges on the utility of the guide.

V. CONCLUSION

As more medical schools begin to adopt criterion referenced standard setting methods to set a defensible pass mark for assessments and given the complex process judges face when rating items, there is value in the provision of a guide to judges with defined criteria to facilitate the process of rating items.

By focusing on criteria such as relevance, frequency, and difficulty, the guide aimed to provide a structured framework for judges to make more consistent and objective probability estimates of a borderline candidate’s performance. Preliminary observations suggested that the guide has been useful in standardising judges’ evaluations and aligning them with the intended competence levels of a borderline candidate. However, variability in judges’ personal criteria and context-specific development posed potential issues. Pilot testing, inter-rater reliability studies, and expert reviews were essential in evaluating the guide’s impact on the pass marks. Ultimately, a well-validated guide has the potential to improve the fairness and reliability of assessments in medical and health professions education, ensuring that graduating students are competently prepared to provide safe and effective patient care.

Notes on Contributors

Han Ting Jillian Yeo contributed to writing and editing the manuscript.

Dujeepa Samarasekera contributed to the concept and development of the manuscript.

Ethical Approval

No ethical approval was required for this study as no data were collected.

Funding

No funding sources are associated with this paper.

Declaration of Interest

There are no conflicts of interests related to the content presented in the paper.

References

Norcini J. J. (2003). Setting standards on educational tests. Medical Education, 37(5), 464–469. https://doi.org/10.1046/j.1365-2923. 2003.01495.x

Tavakol, M., & Dennick, R. (2017). The foundations of measurement and assessment in medical education. Medical Teacher, 39(10), 1010–1015. https://doi.org/10.1080/0142159X. 2017.1359521

Taylor, C. A., Gurnell, M., Melville, C. R., Kluth, D. C., Johnson, N., & Wass, V. (2017). Variation in passing standards for graduation-level knowledge items at UK medical schools. Medical Education, 51(6), 612–620. https://doi.org/10.1111/medu.13240

Yeates, P., Cope, N., Luksaite, E., Hassell, A., & Dikomitis, L. (2019). Exploring differences in individual and group judgements in standard setting. Medical Education, 53(9), 941–952. https://doi.org/10.1111/medu.13915

*Han Ting Jillian Yeo
10 Medical Drive
Singapore 117597
Email: jillyeo@nus.edu.sg

Submitted: 27 June 2024
Accepted: 14 October 2024
Published online: 1 April, TAPS 2025, 10(2), 94-96
https://doi.org/10.29060/TAPS.2025-10-2/II3451

Sulthan Al Rashid

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

I. INTRODUCTION

In response to the evolving landscape of medical education, this personal view article explores the integration of advanced digital tools into the curriculum for medical students. As the field of medicine continues to advance rapidly, leveraging technologies such as Google Lens, WhatsApp, Microsoft Word (MS Word), Coggle mapping software, and artificial intelligence (AI)-driven assistants like Chat Generative Pre-Trained Transformer (ChatGPT) can significantly enhance the learning experience. This article outlines strategies for creating impactful PowerPoint presentations, developing comprehensive concept maps, and extending class hours to foster active engagement and a deeper understanding of medical concepts. The integration of these digital tools is increasingly recognised as essential in contemporary medical education. Digital tools can offer interactive and personalised learning experiences, providing medical students with innovative ways to grasp complex concepts and apply them in clinical scenarios. For instance, Google Lens can facilitate quick access to medical references and visual aids, while WhatsApp can enable real-time communication and collaboration among students and educators. MS Word is a versatile tool for drafting and organising written content, and Coggle mapping software can assist in visualising and connecting intricate medical concepts. Meanwhile, AI-driven assistants like ChatGPT offer opportunities for interactive learning and immediate support. Contemporary medical education must continuously evolve to effectively harness these technological advancements. Extending class hours and incorporating digital tools can provide students with more opportunities for engagement and learning, thus enhancing their preparedness for modern healthcare challenges. As medical education adapts to incorporate personalised learning and evidence-based practices, it is crucial to integrate these digital tools to navigate complex clinical scenarios effectively (Park et al., 2021). The subsequent sections of this manuscript will delve into the specific ways in which these digital tools can be utilised to improve medical education, ensuring a consistent and impactful learning experience for students.

II. INTEGRATION OF AI TOOLS IN MEDICAL EDUCATION

AI tools like Google Lens and ChatGPT are transforming how students retrieve, process, and present information in medical education. Google Lens allows students to extract information from textbooks and clinical images, aiding in the understanding of disease pathogenesis. For instance, it can scan textbooks to pull relevant content for study notes or presentations. PowerPoint is effective for delivering concise information (Seth et al., 2010), and its impact can be further enhanced by using AI tools to automate content extraction.” The author’s recommendation of using bold 40-point Calibri font for single-sentence slides is suggested to further improve student engagement and focus during lectures. In addition to ChatGPT, tools like Quizlet and Cortana support personalised learning. Quizlet helps create tailored flashcards based on individual learning needs, while Cortana can assist in scheduling study sessions. IBM Watson for Health further revolutionises education by aiding in the interpretation of clinical data, providing real-time analysis and treatment recommendations. AI-driven tools, such as chatbots and intelligent tutoring systems (ITS), play a crucial role in modernising medical education. Chatbots offer instant support, while ITS create customised learning paths, enhancing outcomes through adaptive learning experiences. Gamification and virtual reality (VR) further boost student engagement by making learning interactive and immersive, allowing for realistic practice in clinical scenarios (Narayanan et al., 2023).

III. ENHANCING MEDICAL EDUCATION THROUGH DIGITAL COMMUNICATION AND WORD PROCESSING TOOLS

Additionally, WhatsApp groups can promote Digital communication platforms like WhatsApp and word processing tools like MS Word have become integral to modern medical education, significantly enhancing content distribution and student engagement.

A. WhatsApp in Medical Education

WhatsApp facilitates structured communication within medical education. For instance, medical schools can create dedicated groups for subjects or cohorts, enabling the exchange of vital information. Faculty can share updates on guidelines, fostering discussions about implications and applications. WhatsApp’s voice messaging and video call capabilities allow for immediate feedback and consultations, enhancing student support awareness of current medical issues. During disease outbreaks, for example, specialised groups can disseminate updates and discuss clinical strategies. Educational challenges, such as a “case of the week,” encourage peer interaction and collaborative analysis, reinforcing learning.

B. MS Word in Medical Education

MS Word is widely used for organised note-taking, which aids students in systematically recording lecture content. For instance, during pharmacology lectures, students can create structured notes with headings for different topics and use bullet points for key concepts. The software also allows for annotating texts and research documents, enabling students to clarify and deepen their understanding.

Furthermore, MS Word supports detailed exploration of medical concepts through documentation and conceptual mapping. Students can create outlines or concept maps, integrating diagrams and linking to additional resources. Custom templates for clinical reports ensure consistency and enhance the overall learning experience.

IV CONCEPT MAPPING

Concept mapping is a powerful tool for visualising relationships between medical topics, facilitating deeper understanding and retention (Baliga et al., 2021). Coggle software is an example of a tool that helps illustrate the connections between risk factors and disease outcomes.

A. Expanding on AI-driven Tools for Concept Mapping

While Coggle is useful, several AI-driven tools offer enhanced features for concept mapping. ChatGPT can generate textual descriptions for relationships, which can then be visualised using software like Coggle. Other platforms, such as MindMeister, Lucidchart, and Xmind, provide advanced functionalities for creating dynamic and interactive concept maps, including collaborative features and automated suggestions.

Detailed examples of concept maps can demonstrate their application in medical education. For instance, a map showing the relationship between lifestyle factors and chronic diseases can visually represent how different elements influence disease progression. Incorporating concept maps at the end of sessions can reinforce key points, aiding retention and comprehension.

V. EXTENDED CLASS HOURS FOR ACTIVE ENGAGEMENT

Extending class hours offers opportunities for immersive learning experiences and practical application of medical knowledge. By increasing lecture durations, students can engage more deeply with content through interactive methods such as case-based discussions and clinical simulations. For example, additional time may be allocated for simulating patient consultations, enhancing both practical skills and theoretical knowledge. Research supports the benefits of extended instruction time, particularly when coupled with a high-quality learning environment, fostering individualised learning essential for mastering complex medical concepts (Rivkin & Schiman, 2015).

VI. IMPLEMENTATION CONSIDERATIONS

Successful integration of digital tools and extended class hours requires meticulous planning and consideration. Ensuring equitable access to digital tools among students and faculty, providing technology through university-provided devices, and offering professional development to enhance faculty digital literacy and instructional effectiveness are crucial. Implementing effective assessment methods to evaluate learning outcomes and measure the impact of digital tools on educational efficacy, such as online quizzes using AI-generated questions simulating clinical decision-making scenarios, is essential.

VII. FUTURE DIRECTIONS & CONCLUSION

Summarising the transformative potential of integrating digital tools and extended class hours in medical education, this section highlights the benefits for medical students in terms of enhanced learning, preparation for modern healthcare challenges, and future career readiness. Equipping medical graduates with skills in digital tool utilisation prepares them for evidence-based practice and lifelong learning in clinical settings. Recommendations for future research focus on advancing AI technologies, conducting longitudinal studies on educational outcomes, and expanding digital integration across medical disciplines. Proposing avenues for further research and development in digital-enhanced medical education, this section explores advancements in AI tools to personalise learning experiences and improve adaptive educational technologies. It discusses potential applications of AI-driven learning modules across medical specialties to enhance interdisciplinary collaboration in patient care and research. Curriculum development should continually evolve to integrate digital tools and extend class hours, framed by ongoing research into their efficacy and impact on medical education.

Notes on Contributors

Sulthan Al Rashid contributed to the concept, scientific content, data collection, and manuscript preparation. 

Acknowledgement

ChatGPT has been employed for manuscript preparation, encompassing tasks such as preparing, drafting, or editing text, without receiving authorship credit.

Ethical Approval

No ethical approval was required for this study as no data were collected.

Funding

The author did not receive any financial support for this study.

Declaration of Interest

The author asserts that he has no conflict of interest.

References

Baliga, S. S., Walvekar, P. R., & Mahantshetti, G. J. (2021). Concept map as a teaching and learning tool for medical students. Journal of Education and Health Promotion, 10, 35. https://doi.org/10.4103/jehp.jehp_146_20

Narayanan, S., Ramakrishnan, R., Durairaj, E., & Das, A. (2023). Artificial intelligence revolutionizing the field of medical education. Cureus, 15(11), e49604. https://doi.org/10.7759/cureus.49604

Park, J. C., Kwon, H. E., & Chung, C. W. (2021). Innovative digital tools for new trends in teaching and assessment methods in medical and dental education. Journal of Educational Evaluation for Health Professions, 18, 13. https://doi.org/10.3352/jeehp.2021.18.13

Rivkin, S. G., & Schiman, J. C. (2015). Instruction time, classroom quality, and academic achievement. The Economic Journal, 125(588), F425–F448. https://doi.org/10.1111/ecoj.12315

Seth, V., Upadhyaya, P., Ahmad, M., & Moghe, V. (2010). PowerPoint or chalk and talk: Perceptions of medical students versus dental students in a medical college in India. Advances in Medical Education and Practice, 1, 11-16. https://doi.org/10.2147/AMEP.S12154

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

Submitted: 21 May 2024
Accepted: 4 February 2025
Published online: 1 April, TAPS 2025, 10(2), 97-100
https://doi.org/10.29060/TAPS.2025-10-2/II3367

Prabanjini Rajkumar & Lucy Victoria Everett Wilding

Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore

I. INTRODUCTION

The transition from pre-university education to medical school marks the first significant change medical professionals face in the medical education continuum, and is deemed as a remarkable stressor (Sá et al., 2021). This paper seeks to explore the experiences of incoming students in further detail, noting that current literature focuses predominantly on the transition from pre-clinical to clinical years instead. These findings may offer valuable insight for medical educators to incite change in the current medical curriculum that would foster a smoother transition.

II. METHODS

This study employed a qualitative approach in obtaining data to capture expressive information. Individual semi-structured interviews were conducted  (Appendix 1) with 11 first-year medical students with voluntary sampling. Informed consent was obtained from all participants to gather information surrounding predetermined questions while also allowing for exploration of new topics, in an individual setting that would allow participants to express themselves freely. Thematic analysis was then used to analyse the transcribed data deductively with the Westerman framework. Other frameworks considered include Tinto’s Model of Student Integration and Mezirow’s Transformative Learning Theory, but these were ultimately not chosen due to their dated nature and lack of direct applicability to the medical context. Furthermore, the Westerman framework uniquely provides clear guidelines on how to incite future change. Westerman’s conceptual framework describes how “novel disruptive elements (first theme) due to the transition from pre-university to undergraduate medical school are perceived and acted on (second theme), and how this directs new medical students’ personal development (third theme)” (Westerman et al., 2010).

III. RESULTS

The themes that surfaced from the data are presented in alignment with the transitional context and the related tasks students encountered (Table 1).

Submitted: 30 May 2024
Accepted: 21 October 2025
Published online: 1 April, TAPS 2025, 10(2), 101-103
https://doi.org/10.29060/TAPS.2025-10-2/II3420

Nadhee Peries, Nadeeja Samarasekara, Inuka Gooneratne, Niroshan Lokunarangoda, Ushani Wariyapperuma, Senaka Pilapitiya, Mihara Silva & Nandalal Gunaratne

Faculty of Medicine, University of Moratuwa, Sri Lanka

I. THE EARLY CLINICAL EXPOSURE PROGRAM

According to a large body of research, early clinical exposure and simulation-based learning are beneficial for medical students in many ways, hence the University of Moratuwa has used these concepts together in the MBBS program (Peries et al, 2024). It allows students to develop their thinking, communication, clinical reasoning, and room for trial and error (Krajic, 2003). The faculty has developed a spirally integrated, simulation-based program named Early Clinical Exposure (ECE) for students from 1st year onwards to facilitate step-by-step, yet continuous mastering of concepts and skills of history-taking and examination.

5-year MBBS program of the university consists of three phases: Phase 1 (1^st / 2^nd years), Phase 2 (3^rd / 4^th years), Phase 3 (Final year). During phase 1, students learn basic sciences integrated into body system-based modules; in phase 2, students learn applied sciences integrated into clinical subjects in body system-based modules, simultaneously ward-based clinical training. Phase 3 consists of full-time clinical training. The article describes how the ECE program was designed and exposed students of phase 1 and the early stage of phase 2 to early clinical skill training via various methods, in which, simulation-based history taking, and examination were major components.

II. DESIGN OF THE PROGRAM

The ECE program was pre-tested to see the content, timing, necessity of resources, and efficacy of teaching tools. We identified the limited number of staff as a challenge at the time, and we trained demonstrators to couple with lecturers ensuring the program ran smoothly until more academics were available.  In phase 1, students learned history taking and examination concerning building a rapport and gathering information using communication skills while appreciating patient privacy and concerns. The scenarios were developed and integrated into relevant modules, to cover the applicability of basic sciences in clinical practice and the basics of the ‘clinical method’.

During phase 2 which spanned over 8 weeks, history-taking and examination sessions were revisited where learning outcomes were designed to reach higher skill levels. At this stage, the scenarios were designed to introduce concepts such as identifying problems, critical thinking, and clinical reasoning. Students were taught a holistic approach to medicine and to recognise patients as ‘whole human beings’ rather than health issues/disease entities. These scenarios were developed to ensure students follow a basic history-taking framework and stepwise method to system examination to gather relevant information on symptoms, aetiology, complications, systemic inquiry, compliance, family history, drug history, allergies, co-morbidities, patient concerns, impact on life and fears, etc.

III. DELIVERY OF THE PROGRAM

The program was delivered via small group role-playing between students and lecturers as a series of blended learning activities. The sessions were sequenced just after the relevant basic sciences teaching session to help students understand the relevance and applicability of the knowledge into practice as early as possible. Every student was given adequate time to practice with constructive feedback from teachers and observers.

Furthermore, students were encouraged to relate the most applicable components of the history concerning the patient and his/her presentation appreciating they have different concerns, either related to or not related to the main complaint that needs to be considered. As an example, a scenario developed in the respiratory module on ‘tuberculosis’, allowed students to be involved in a comprehensive information gathering and examination. Further, it also allowed students to evaluate the associated stigma affecting mental status, compliance with drugs, family support, effects on occupation, income, social interaction etc.

At the end of each examination session, videos of body system examinations were posted on Moodle followed by a small discussion forum on common abnormal signs.

IV. DISCUSSION

The ECE program allowed the students to engage in the basics of the ‘clinical method’ at the early stage of their training. It is well noted that early clinical exposure is widely used across Europe (80% of medical schools) (Basak et al., 2009). Even though the medical faculty of the University of Moratuwa is newly developed in a developing country, this program has assisted in targeting high standards in the quality of medical education. 

ECE program also aligned with the MBBS program learning outcomes by teaching; clinical skills, patient management, communication skills, information management, critical thinking, professional values, and attitudes. This is similar to the suggestions given by Ottenheijm et al. (2008), that ECE activities should be well-planned with clear learning goals. Many ECE programs in Europe are unstructured, using real patients in ward settings and observation as the main teaching tool (Basak et al., 2009). In contrast, this program uses simulation patients, blended learning methods, hands-on experience, and direct feedback.

Even though the objectives were achieved, the program is currently in the middle of an evaluation. Therefore, the exact evidence is lacking to claim that this program has achieved the intended learning outcomes. On the other hand, a study done in Iran in 2016 shows, that early clinical exposure has allowed medical students to understand the value and the integration of the subjects they learn during their early years and also has provided an opportunity to get motivated regarding their role as future doctors (Mafinejad et al., 2016). It should be noted that the program needs feedback from students and resource persons to improve it further. Additionally, data should be collected from the students after they have completed the ECE program to investigate whether the program has contributed to achieving program learning outcomes.

V. CONCLUSION

Simulation is used in the Faculty of Medicine, University of Moratuwa to teach skills needed for students to take a proper history and to examine a patient before commencing ward-based learning. This spirally-integrated early clinical exposure with specially selected important case scenarios incorporated into body system-based modules in basic and applied sciences improves student preparedness for ward-based clinical training. It also provides an opportunity to improve soft skills, which contributes to achieving program learning outcomes of the degree. We plan to review and then expand and develop the program in the future with proper feedback taken at different levels.

Notes on Contributors

Nadhee Peries has planned this curriculum component, developed the program, and contributed to executing it. As the first author, she has drafted, edited, and finalised the paper. Nadeeja Samarasekara, Inuka Gooneratne, Niroshan Lokunarangoda, Ushani Wariyapperuma, and Senaka Pilapitiya contributed to developing the program to improve it further with relates to the content. They were involved in planning the program, writing the simulation scenarios, and conducting sessions. They also reviewed and improved the drafted paper. Mihara Silva contributed to arranging logistics at the planning stage and provided inputs on delivery methods. She also supported writing the paper by formatting and proofreading. Nandalal Guneratne was involved as a supervisor who conceptualised the idea of simulation-based learning in our MBBS program and guided the execution of the lessons in several steps: writing up the lesson plan, developing learning outcomes, and executing the teaching-learning method. All the authors have read and approved the drafted paper.

Ethical Approval

Specific ethical approval was not applicable as this was a part of the routine curriculum development process of the MBBS program which was approved and expected to be executed by the faculty. There is no data collection involved.

Acknowledgement

We would like to acknowledge the Faculty Board, Curriculum Development Committee, and the Medical Education Department for the guidance, support, approval, and recognition of the developed activity.

Funding

The project is funded neither by any person nor institute.

Declaration of Interest

There are no conflicts of interest, specially regarding financial, consultant, institutional, and other relationships that might lead to bias or a conflict of interest.

References

Başak, O., Yaphe, J., Spiegel, W., Wilm, S., Carelli, F., & Metsemakers, J.F.M. (2009). Early clinical exposure in medical curricula across Europe: An overview. European Journal of General Practice, 15(1), 4–10. https://doi.org/10.1080/13814780 902745930

Krajic, K. E. (2003). Observation during early clinical exposure – An effective instructional tool or a bore. Medical Education, 37(2), 88–89. https://doi.org/10.1046/j.1365-2923.2003.01421.x

Mafinejad, K. M., Mirazazadeh, A., Peiman, S., Hazaveh, M. M., Khajavirad, N., Edalatifars, M., Allameh, S., Naderi, N., Forounmandi, M., Afshari, A., & Asghari, F. (2016). Medical students’ attitudes towards early clinical exposure in Iran. International Journal of Medical Education, 7, 195–199. https://doi.org/10.5116/ijme.5749.78af

Ottenheijm, R. P., Zwietering, P. J., Scherpbier, A. J., & Metsemakers, J. F.  (2008). Early student-patient contacts in general practice: An approach based on educational principles. Medical Teacher, 30(8), 802–808. https://doi.org/10.1080/01421 590802047265

Peries, N., Samarasekara, N., Gooneratne, I., Lokunarangoda, N., Wariyapperuma, U., Pilapitiya, S., Silva, M., & Gunaratne, N. (2024, January 15-21). Simulated History Taking and Examination as a Part of Early Clinical Exposure in Undergraduate Medical Education of Faculty of Medicine, University of Moratuwa [Conference presentation abstract]. Asia Pacific Medical Education Conference 2024, Colombo, Sri Lanka.

*Nadhee Peries
Department of Medical Education
Faculty of Medicine, University of Moratuwa,
Bandaranayake Mawatha, Moratuwa,
Sri Lanka, 10400
0094772003061
Email: nnperies@gmail.com, nadheep@uom.lk

Submitted: 31 January 2024
Accepted: 3 September 2024
Published online: 7 January, TAPS 2025, 10(1), 56-58
https://doi.org/10.29060/TAPS.2025-10-1/PV3239

Chan Choong Foong¹, Mohamad Nabil Mohd Noor¹ & Galvin Sim Siang Lin²

¹Medical Education and Research Development Unit, Faculty of Medicine, Universiti Malaya, Malaysia; ²Department of Restorative Dentistry, Kulliyyah of Dentistry, International Islamic University Malaysia, Malaysia

I. INTRODUCTION

Contemporary undergraduate medical education is increasingly emphasising the cultivation of student ownership and autonomy, entrusting learners with the responsibility to take charge of their own studies. Across Asian countries, high school graduates embark on their medical education journey at the age of 19 to 20 years, stepping into the realm of adulthood and assuming accountability for their academic pursuits. As the landscape of medical education undergoes transformative shifts propelled by technological advancements and evolving pedagogical approaches, one enduring tradition faces scrutiny: the imposition of compulsory lecture attendance.

Intriguingly, amid the broader trend toward fostering student autonomy, some Asian medical schools grapple with concerns about low lecture attendance. Rather than embracing the prevailing ethos of adult learning, these institutions respond by adopting autocratic measures to enforce mandatory attendance. This perplexing approach begs the question: Why, in an era of educational evolution and empowerment, do certain medical schools resort to rigid mandates to address the issue of diminished lecture participation?

This article does not engage in a debate about the efficacy of lectures; instead, it delves into the heart of the matter — the compulsory attendance. Considering medical teachers’ dissatisfaction with students’ lecture attendance rates, it becomes imperative to explore the underlying frustrations that lead institutions toward autocratic measures. What lies at the core of this apparent contradiction between the shift toward learner autonomy and the persistence of compulsory lecture attendance?

II. THE FRUSTRATIONS AND OUR ARGUMENTS

1. Some medical teachers may argue that frustration lies in the association between lecture attendance and academic performance.

Our arguments are as follows. First, research data show a mixture of supporting and opposing evidence (Doggrell, 2020b). Second, if this association holds true, it implies that high-achieving students should be afforded the freedom to forego lectures. Alternatively, medical students who acquire lecture content from other media, such as recorded lectures or online resources (e.g. YouTube videos), and offline resources (e.g. reference books) should also have the freedom to skip lectures. Third, it appears more rational to correlate academic performance with students’ active engagement during lectures rather than their mere physical attendance. Students who attend lectures to avoid punishment may be reluctant to become involved. Despite their outward presence, if these students remain preoccupied with internet-connected devices, does their mere attendance satisfy the expectations of medical teachers? The scenario becomes even more poignant when considering the time medical teachers spend managing students who are not engaged in lectures. This time could otherwise have been meaningfully invested in students genuinely seeking to absorb and engage with the lecture content.

2. Some medical teachers contend that the crux of the frustration lies within professionalism, positing that attending lectures is an integral aspect of student professionalism.

Our arguments are as follows. First, a systematic review discussing unprofessional behaviours among medical students does not identify lecture attendance as a dimension of professionalism (mak-Van der Vossen et al., 2017). Second, even if one were to categorise lecture absenteeism as unprofessional, the AMEE Guide No. 61, titled “Integrating professionalism into the curriculum”, does not advocate for compulsory attendance as a prescribed professional solution (O’Sullivan et al., 2012).

Some medical teachers draw parallels by likening student absenteeism to the unacceptable conduct of on-duty medical practitioners. However, this analogy lacks validity. The execution of medical duties by practitioners necessitates a specific venue, such as a clinic, and adherence to fixed working hours. In contrast, medical students can fulfil their learning responsibilities at any time and from any location, exemplified by the ability to engage with recorded lectures. For the analogy to be valid, lectures must be proven irreplaceable in delivering certain medical content.

3. Some medical teachers contend that their frustration lies in low lecture attendance, adversely affecting their morale for teaching (Emahiser et al., 2021).

Our arguments are as follows. First, although low attendance can be upsetting and disappointing, medical teachers should not request compulsory attendance to appease their emotional and moral demands. While commenting on student absenteeism as unprofessional, do these teachers, in turn, project a more professional image by demanding mandatory attendance? Second, the variability in audience size for different lectures or lecturers warrants the teachers’ self-reflections on their teaching methods (Emahiser et al., 2021).  Third, there is perhaps no downside to the teaching styles employed by medical teachers; however, some medical students have preferences for different learning methods (Emahiser et al., 2021). Alternatively, the characteristics of Generation Z learners, marked by a limited attention span and a preference for online learning environments, may not align with the assumptions underlying compulsory lectures. Mandating attendance presupposes a one-size-fits-all approach, and debatably, lectures might not be the panacea for optimal academic performance among medical students.

4. Some medical teachers may argue that the frustration stems from the perception that many Asian high school leavers are not mature enough to make decisions.

Our central argument posits that, irrespective of the potential benefits of lectures, they should not be mandated. How can medical students cultivate maturity if they are not afforded the opportunity to exercise decision-making in the first place? It is ironic that, while Asian medical schools try to promote adult learning principles into their curriculum, they endorse paternalism in conditioning student behaviours. Our stance is not a discouragement of lecture attendance; rather, we oppose the imposition of paternalism in moulding the physicians of tomorrow.

III. OUR PROPOSALS

To address the challenge of low lecture attendance, our proposal for medical teachers is to reconsider the delivery method of lectures. Let us acknowledge the need for our teaching methods to evolve in response to technological advancements and the distinctive learning preferences of Generation Z. Following is an actual reason for absence – “I don’t consider the lecturer adds to the material given on the PowerPoints” and a reason for attending – “It allows for interaction with course staff and/or students” (Doggrell, 2020a). Thus, it becomes imperative for medical institutions to train educators with interactive strategies (e.g., inquiry activities) that complement lectures and motivate students to actively participate in the learning process. Consequently, faculty development programs that are in line with evolving learning science and the changing needs of learners are deemed necessary.

Next, we should reconsider the emotional need to see students physically. Theoretical and empirical evidence suggests that recorded lectures work effectively, as students can pause and play the recordings, which enables them to learn at their own pace. Medical teachers must accept that, with the tremendous amount of available teaching and learning materials online, attending lectures is no longer the sole source of knowledge. Considering flexible attendance policies that accommodate students’ individual needs and recognising the importance of adapting to evolving educational practices and preferences are equally essential.

For medical students, our suggestion is to foster ownership and autonomy in their studies, predicated on an understanding of the potential repercussions on their academic performance. Medical students should be empowered to make informed choices, cognisant that each choice carries consequences. This approach aligns with the principles observed in medicine, where patients retain the autonomy to continue or discontinue treatment at their own risk. If adult learning is deemed fundamental to the future medical curriculum, Asian medical teachers ought to relinquish paternalistic tendencies.

This shift does not imply a cessation of support for student learning. Instead, we shift to help students “learning to learn”, for instance, to promote the understanding of (including but not limited to) andragogy and self-regulated learning. It may not be the lecture attendance that some low-achieving medical students have missed; rather, it could be the cultivation of appropriate mindsets about learning, including aspects like time management and motivation.

IV. CONCLUSION

In conclusion, our scrutiny of compulsory lecture attendance reveals that it neither serves as a panacea for academic performance nor aligns seamlessly with the principles of professionalism or the preferred learning styles of Generation Z. Rather than acting as an antidote, the imposition of compulsory attendance manifests as a form of paternalism within Asian medical schools. This paternalistic approach, rather than nurturing, acts as a toxic element for aspiring medical professionals, hindering the cultivation of autonomy and adult learning principles in the trajectory of futuristic medical education. To remedy this issue, delivery method of lectures should consider state-of-the-art learning science, matched with the changing needs of students.

Notes on Contributors

Chan Choong Foong conceptualised and designed the work, and drafted the manuscript. Mohamad Nabil Mohd Noor conceptualised and designed the work, and drafted the manuscript. Galvin Sim Siang Lin interpreted the findings from past studies for the work, and revised the manuscript critically. All authors have read and approved the submitted manuscript.

Funding

The authors did not receive support from any organisation for the submitted work.

Declaration of Interest

The author declares that there is no conflict of interest.

References

Doggrell, S. A. (2020a). No apparent association between lecture attendance or accessing lecture recordings and academic outcomes in a medical laboratory science course. BMC Medical Education, 20, Article 207. https://doi.org/10.1186/s12909-020-02066-9

Doggrell, S. (2020b). A systematic review of the relationship between lecture attendance and academic outcomes for students studying the human biosciences. International Journal of Innovation in Science and Mathematics Education, 28(1), 60-76. https://doi.org/10.30722/IJISME.28.01.005

Emahiser, J., Nguyen, J., Vanier, C., & Sadik, A. (2021). Study of live lecture attendance, student perceptions and expectations. Medical Science Educator, 31, 697-707. https://doi.org/10.1007/s40670-021-01236-8

Mak-van Der Vossen, M., van Mook, W., van Der Burgt, S., Kors, J., Ket, J. C., Croiset, G., & Kusurkar, R. (2017). Descriptors for unprofessional behaviours of medical students: A systematic review and categorisation. BMC Medical Education, 17, Article 164. https://doi.org/10.1186/s12909-017-0997-x

O’Sullivan, H., van Mook, W., Fewtrell, R., & Wass, V. (2012). Integrating professionalism into the curriculum: AMEE Guide No. 61. Medical Teacher, 34(2), e64-e77. https://doi.org/10.3109/0142159X.2012.655610

*Chan Choong Foong
Medical Education and Research Development Unit,
Faculty of Medicine, Universiti Malaya,
50603 Kuala Lumpur, Malaysia
Email: foongchanchoong@um.edu.my