Submitted: 14 April 2025
Accepted: 19 August 2025
Published online: 7 April, TAPS 2026, 11(2), 134-136
https://doi.org/10.29060/TAPS.2026-11-2/II3751

Dexter Chai Yih Haur¹, Lee Shuh Shing², Yeo Su Ping², Goh Zi Qing² & Han Ting Jillian Yeo²

¹School of Humanities and Interdisciplinary Studies, Ngee Ann Polytechnic, Singapore; ²Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

I. INTRODUCTION

Surveys/ Questionnaires are one of the most commonly used tools in data collection, enabling researchers to analyse different patterns or trends and ultimately, contribute to the advancement of evidence-based educational practices (Wilson et al., 2023). However, conducting surveys presents several challenges that can compromise data quality and reliability of data collected. This paper draws on our institutional experience in conducting educational surveys, sharing both successes and challenges. We aim to explore the factors influencing survey participation, strategies adopted to address them, and emerging opportunities in survey design.

II. CHALLENGES AND FACTORS IMPACTING SURVEY RESPONSE RATES

Despite their utility, surveys face challenges that can be broadly categorised as participant-related and survey structure-related. Participant-related challenges include response bias, low motivation, and incomplete or inaccurate answers, all of which can compromise data validity, reliability, and representativeness (Phillips et al., 2017). Low response rates further increase the risk of non-response bias. Survey structure-related issues, such as poorly framed questions or excessively lengthy surveys, can reduce engagement and completion rates. Technical barriers and survey fatigue further contribute to low response quality.

This contention aligns with the scholarly discourse presented by Saleh and Bista (2017), elucidating the multifaceted nature of factors influencing survey response rates. Drawing upon the theoretical framework of social exchange theory, which posits that human behaviour is directed by the anticipation of reciprocation, Saleh and Bista (2017) explained that survey response rates hinge upon an array of factors which includes the following: (a) incentives (rewards in increasing survey participants), (b) authority (credibility of the agencies which conducted the survey), (c) survey design (length and types of the question in the survey) and (d) ethical considerations (data privacy, and anonymity).

III. INSTITUTIONAL STRATEGIES TO MITIGATE CHALLENGES

In the past year, Centre for Medical Education (CenMED) conducted multiple educational research involving surveys. Guided by an understanding of response rate determinants, we focused on improving two key domains: design and administration. We prioritised brevity, targeting surveys that could be completed within 10–15 minutes. A mixture of open and closed-ended questions – multiple choice, sliders, ranking, etc. – kept respondents engaged while minimising cognitive load. We limited the number of items to under 50 to avoid fatigue. Questions were concise and clearly worded. Surveys were hosted on Qualtrics with no identifiable data collected, and ethical standards were upheld with Internal Review Board approval before administration.

To improve reach and uptake, we enlisted key faculty members to disseminate the surveys and framed invitation emails to highlight the relevance and value of participation. Despite these measures, we continued to observe lower-than-expected response rates. Deeper examination revealed that survey fatigue – exacerbated by repeated requests and overlapping topics – reduced participant enthusiasm. Generic email blasts lacked the personal engagement necessary to motivate participation.

To circumvent survey fatigue and improve perceptions of surveys, the Centre collaborates with the Dean’s Office to streamline administration process and prevent topic overlap. Recognising the influence of authority figures, key faculty members such as medical educationalists, Vice Dean (Education) or Phase Coordinators, were enlisted to encourage participation during face-to-face sessions. This approach provided a direct personalised appeal to enhance the perceived importance and value of the survey. Additionally, to further facilitate the survey participation, the team provided protected time and space during face-to-face session for respondents to complete the survey.

With this, the team successfully boosted response rates to a satisfactory level. Other than participant-related, and survey structure-related challenges, organisations-related challenges could be one of the contributing factors to low response rates especially in a highly research-focused university. Streamlining processes to eliminate redundancy in survey administration helps improve perceptions of surveys and reduce survey fatigue.

IV. EMERGING OPPORTUNITIES IN SURVEY DESIGN

A. Artificial Intelligence (AI)

One significant area of innovation lies in the use of Artificial Intelligence (AI) to support various stages of the survey lifecycle. AI can facilitate the development of adaptive questionnaires that adjust in real time based on a respondent’s previous answers, thereby improving relevance and reducing cognitive fatigue. Natural language processing capabilities allow for more efficient analysis of open-ended responses. Predictive analytics can help researchers identify trends in responses and patterns of dropout or incomplete data. As described by Paduraru et al. (2024), this enabled for better allocation of resources (e.g. manpower) as AI agents will be able to facilitate the process of questionnaire development, data collection and survey data analysis.

B. Open Data Sharing

Open data sharing in research refers to the practice of making research data freely accessible to other researchers and the public. Open data sharing in research not only enhances collaboration and transparency but also plays a crucial role in improving survey responses. By making survey data openly accessible, researchers can build upon existing datasets, reducing the need for repetitive surveys and minimising respondent fatigue. This approach allows for more robust meta-analyses, enabling a deeper understanding of trends without overburdening participants with multiple survey requests. Additionally, shared data fosters greater trust and engagement among respondents, as they see their contributions being utilised effectively to drive meaningful research outcomes.

C. Social Media

Social media platforms offer a powerful avenue for survey administration, enabling researchers to reach diverse and geographically dispersed populations efficiently. Platforms like Facebook, Twitter, LinkedIn, and Instagram allow for targeted survey distribution through organic posts, paid advertisements, and community groups. Features such as polls, direct messaging, and embedded survey links enhance accessibility and engagement, encouraging higher response rates. Additionally, social media analytics provide real-time insights into respondent demographics and engagement patterns, allowing for adaptive survey strategies. By leveraging these platforms, researchers can improve outreach, increase participation, and gather timely data while minimising costs.

D. Gamification

Gamification can enhance survey administration by incorporating game-like elements to increase engagement and response rates. Features such as points, badges and progress bars make the survey experience more enjoyable, reducing respondent fatigue and encouraging completion. Personalised challenges, leaderboards, and instant feedback can further motivate participation, especially in longer surveys. By integrating storytelling and immersive design, researchers can create a more engaging environment that keeps respondents interested while maintaining data quality. Gamification not only enhances the user experience but also helps mitigate dropouts, making it a valuable strategy for improving survey administration.

V. CONCLUSION

Survey questionnaires remain vital tools in medical education research. Yet, the challenges surrounding participation demand thoughtful design and contextual strategies. Our institutional experience highlights the importance of reducing respondent burden, personalising outreach, and integrating surveys into existing workflows.

Looking ahead, innovations in AI, open data sharing, and social media offer promising avenues for improving data collection. Importantly, while our strategies have shown success within our context, we acknowledge they may not be directly transferable to other institutions. Adaptation to local contexts remains essential. Ultimately, survey success lies in balancing methodological rigour with human-centred design – facilitating meaningful research that benefits both educators and learners.

Notes on Contributors

Dexter Chai drafted the first manuscript and subsequently, the manuscript was edited by Lee Shuh Shing, Yeo Su Ping, Goh Zi Qing and Han Ting Jillian Yeo.

Ethical Approval

Ethical approval is not required for this article as no human participant data was collected/presented.

Funding

The authors did not receive any funding for this article.

Declaration of Interest

The authors would like to declare that they do not have any conflict of interest.

References

Paduraru, C. I., Cristea, R., & Stefanescu, A. (2024). Adaptive questionnaire design using AI agents for people profiling. International Conference on Agents and Artificial Intelligence, 3, 633-640. https://doi.org/10.5220/0012379600003636

Phillips, A. W., Friedman, B. T., Utrankar, A., Ta, A. Q., Reddy, S. T., & Durning, S. J. (2017). Surveys of health professions trainees: Prevalence, response rates, and predictive factors to guide researchers. Academic Medicine, 92(2), 222-228. https://doi.org/10.1097/acm.0000000000001334

Saleh, A., & Bista, K. (2017). Examining factors impacting online survey response rates in educational research: Perceptions of graduate students. Journal of Multi-Disciplinary Evaluation, 13(29), 63-74. https://doi.org/10.56645/jmde.v13i29.487

Wilson, A. B., Brooks, W. S., Edwards, D. N., Deaver, J., Surd, J. A., Pirlo, O. J., Byrd, W. A., Meyer, E. R., Beresheim, A., Cuskey, S. L., Tsintolas, J. G., Norrell, E. S., Fisher, H. C., Skaggs, C. W., Mysak, D., Levin, S. R., Escutia Rosas, C. E., Cale, A. S., Karim, M. N., … Lufler, R. S. (2023). Survey response rates in health sciences education research: A 10‐year meta‐analysis. Anatomical Sciences Education, 17(1), 11-23. https://doi.org/10.1002/ase.2345

*Dexter Chai Yih Haur
School of Humanities and Interdisciplinary Studies,
Ngee Ann Polytechnic, Singapore
Email: trexed89@gmail.com

Submitted: 6 February 2025
Accepted: 24 September 2025
Published online: 7 April, TAPS 2026, 11(2), 131-133
https://doi.org/10.29060/TAPS.2026-11-2/II3665

Pacifico Eric Eusebio Calderon^1,2,3

¹St. Luke’s Medical Center, ²National Children’s Hospital, Quezon City, Philippines; ³Faculty of Laws, University College London, United Kingdom

I. INTRODUCTION

Artificial intelligence (AI) is now a familiar presence in healthcare. Frequently introduced as a means of augmenting clinical work, it also invites reflection on how the character of medical practice is evolving. AI may influence not only clinical decision-making (Byrne, 2023), but also the production of medical knowledge, the framing of ethical questions, and the assignment of responsibility when outcomes are uncertain, or contested (Aquino, 2023). As these technologies become embedded in the routines of care, they may begin to reshape prevailing conceptions of clinical judgement, moral attentiveness, and professional responsibility.

This article reflects on how the increasing integration of AI into clinical settings may be subtly reconfiguring the ethical landscape of medicine and considers how such shifts might be addressed in ethics education. It critiques three domains in which new tensions emerge: the erosion of space for moral discernment, epistemic injustice within data-driven systems, and the fragmentation of responsibility across increasingly distributed environments.

In place of technical prescriptions, the paper invites educators to reflect on the kinds of moral sensibilities we seek to cultivate in those learning to practise medicine—whether students, trainees, or professionals in continuing formation. How might ethical capacities be fostered in healthcare systems increasingly configured by technologies that clinicians do not design and cannot fully control? What dispositions might be required to remain attentive, critical, and responsive within datafied systems of care?

These questions are pursued through a series of reflections on how AI is reshaping attentiveness, knowledge, and responsibility—and on how ethics education might engage with these shifts with nuance and care.

II. PRESERVING ATTENTIVENESS IN ALGORITHMIC ENCOUNTERS

The clinical encounter between doctor and patient remains foundational to medical practice. Such moments are rarely straightforward. They require not only clinical reasoning but also the capacity to navigate uncertainty, emotional nuance, and what is often unspoken. Ethical significance in these situations is not always immediately visible; it may emerge in a hesitation, a glance, or an absence that nonetheless invites moral attention. Attending to these subtleties requires what might be called moral attentiveness: the ability to notice what might otherwise be missed, and to recognise that ethical meaning is not always legible within procedural norms.

This form of attentiveness finds philosophical resonance in Tronto’s (1993) articulation of care as relational, situated, and responsive to particular needs. On this view, good care cannot be reduced to procedural fidelity or technical adequacy. It involves a willingness to remain present, to slow down, and to engage meaningfully with the lived experience of the person before us.

Yet this space for attentiveness may be increasingly constrained by the integration of AI systems into clinical work (Dalton-Brown, 2020). Many such systems are designed to promote speed, consistency, and institutional efficiency. They may generate clinical suggestions before a patient is even seen, structure how documentation is produced, and guide decisions in ways that encourage adherence to predefined pathways (Byrne, 2023). Whilst these tools may support workflow, their underlying logic can narrow the reflective space needed for ethical discernment. When clinical attention is structured in advance by algorithmic cues, the opportunity to pause, to wonder, or to respond to the unexpected may begin to contract (Dalton-Brown, 2020).

This shift presents a challenge not only for practice but also for pedagogy. If AI systems increasingly shape how care is delivered, then ethics education must consider how to support learners in sustaining forms of attentiveness that resist automation. What pedagogical approaches might preserve interpretive openness in contexts structured around procedural closure? This may call for renewed emphasis on cultivating presence, responsiveness, and moral imagination (Tronto, 1993)—qualities that remain vital to ethical practice but are difficult to codify, even harder to delegate to machines.

III. RECOGNISING EXCLUSIONS IN DATA-DRIVEN KNOWLEDGE

AI systems are often introduced with the promise of improving efficiency, promoting consistency, and mitigating bias or human error in clinical practice (Byrne, 2023). Yet the data on which such systems rely on is rarely neutral. Most are developed in high-resource environments and trained on datasets that reflect the clinical norms, priorities, and assumptions of those contexts. As a result, some experiences of illness are amplified, whilst others are excluded, distorted, or remain unrecognised altogether (Aquino, 2023). These exclusions are not merely technical gaps but carry ethical implications, shaping whose suffering is acknowledged and whose is not.

This form of marginalisation has been theorised by Fricker (2007) as epistemic injustice: harm that arises when individuals or groups are excluded from contributing to shared knowledge, or when their insights are misrepresented, dismissed, or devalued. In healthcare, for instance, this may occur when symptoms presented by certain populations are not recognised by AI systems trained on different demographics, or when non-standard forms of expression—whether cultural context, embodied experience, or vernacular language—are treated as deviations rather than legitimate sources of insight.

For learners, the effects of these omissions may unfold incrementally. What is consistently absent from training tools may come to feel irrelevant; what is frequently represented may appear normative. Over time, these patterns can come to shape how clinicians perceive credibility, construct clinical knowledge, and attend to suffering. The narrowing of epistemic horizons is rarely intentional, but it has moral consequences (Fricker, 2007). Certain voices come to dominate, and some forms of distress remain invisible within algorithmic frames (Aquino, 2023).

Ethics education might respond by fostering what could be described as epistemic humility: an awareness that all systems of knowledge, however advanced, can be partial and situated. This involves not only recognising what is missing but also cultivating the capacity to dwell with uncertainty and remain attentive to the margins of representation. Especially in global or resource-constrained settings—where imported AI systems may misrepresent local realities—this disposition is not only prudent, but also pedagogically essential. The task is not to reject such tools outright, but to approach them with critical distance, sustained attentiveness, and moral care.

IV. NAVIGATING RESPONSIBILITY IN DISTRIBUTED SYSTEMS

The deeper integration of AI into medical work is also reshaping how professional responsibility is perceived. AI is often viewed as a form of support—something that augments rather than replaces the clinician (Byrne, 2023). Yet in practice, the distinction between assistance and authority may be far from straightforward. When outputs appear confident and their reasoning opaque, clinicians may feel compelled to defer, even in the presence of doubt.

Efficiency is frequently presented as the primary feature of such tools. Yet efficiency is rarely neutral. It tends to reflect the priorities of institutions—throughput, documentation, predictability—rather than the relational demands of ethical care. The logic of efficiency that underpins many AI systems often aligns with these institutional imperatives. In doing so, it may shift the moral orientation of practice away from responsiveness to particular needs and toward standardised procedures. As Tronto (1993) reminds us, responsibility is not simply the performance of tasks; it involves attentiveness to needs that unfold slowly or resist resolution. When time saved is redirected toward institutional metrics, the more reflective dimensions of medical work may be compromised.

Within such systems, responsibility can become fragmented and elusive. Clinical decisions often arise through a convergence of human reasoning, algorithmic suggestion, and organisational structure (Aquino, 2023). Yet when outcomes are contested, accountability frequently reverts to the individual clinician. For learners, this may create a disorienting professional ethical terrain. They are expected to exercise moral judgement in contexts that may increasingly constrain their agency.

In response, ethics education might offer more than abstract principles. It can support learners in reflecting on what it means to assume responsibility in conditions where control is partial and in navigating situations where the line between autonomous professional judgement and systemic compliance is blurred. Discernment—understood here as the capacity to act with care in the face of uncertainty, complexity, or constraint—becomes central to this pedagogical task. It is perhaps not a matter of identifying the right answer, but of cultivating the sensitivity to decide well when clarity is elusive.

V. CONCLUDING REFLECTIONS

The discussion has traced how the integration of AI into clinical practice may be reshaping the moral contours of medicine—not through sudden rupture, but through subtler shifts in how clinicians attend, decide, and take responsibility. It explored three such developments: the narrowing of interpretive space in clinical encounters; the exclusions embedded in data infrastructures; and the dispersal of professional responsibility across distributed systems. These changes do not call for rejection, but for careful recalibration—one that sustains moral attentiveness, epistemic humility, and ethical discernment within systems increasingly structured around speed, efficiency, and procedural logic. Each domain also opens space for pedagogical reflection, prompting us to ask not only how we teach ethics, but what kinds of moral sensibilities we hope to preserve.

What forms of teaching might support the cultivation of these capacities? How might empirical inquiry illuminate the lived ethical consequences of AI integration across diverse institutional and cultural contexts? And how can educators, ethicists, clinicians, and curriculum designers engage in shared dialogue about the values we wish to uphold amid technological transformation? Much, however, remains unsettled. The task ahead may lie in cultivating–in learners, and in ourselves as educators– a disposition to remain with ethical demands that technological systems cannot resolve. Such a pedagogy would rest not on certainty but on reflective presence, epistemic humility, and a sustained attentiveness to the forms of care we still hope to practise in a world increasingly shaped by algorithmic reasoning.

Notes on Contributors

The author solely conceptualised, drafted, and revised the manuscript.

Ethical Approval

As this is a theoretical study, it does not involve human participants or data collection. Accordingly, ethical approval was not applicable.

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 author declares no conflict of interest.

References

Aquino, Y. S. J. (2023). Making decisions: Bias in artificial intelligence and data-driven diagnostic tools. Australian Journal of General Practice, 52(7), 439–444. https://doi.org/10.31128/AJGP-12-22-6630

Byrne, M. F., Parsa, N., Greenhill, A. T., Chahal, D., Ahmad, O., & Bagci, U. (Eds.). (2023). AI in clinical medicine: A practical guide for healthcare professionals. John Wiley & Sons.

Dalton-Brown, S. (2020). The ethics of medical AI and the physician–patient relationship. Cambridge Quarterly of Healthcare Ethics, 29(1), 115–121. https://doi.org/10.1017/S0963180119000847

Fricker, M. (2007). Epistemic injustice: Power and the ethics of knowing. Oxford University Press. https://doi.org/10.1093/acprof:oso/9780198237907.001.0001

Tronto, J. (2020). Moral boundaries: A political argument for an ethic of care. Routledge. https://doi.org/10.4324/9781003070672

*Pacifico Eric Eusebio Calderon
Faculty of Laws, University College London
4-8 Endsleigh Gardens,
London WC1H 0EG
United Kingdom
Email: pacifico.calderon.24@ucl.ac.uk

Submitted: 25 February 2025
Accepted: 9 September 2025
Published online: 6 January, TAPS 2026, 11(1), 79-81
https://doi.org/10.29060/TAPS.2026-11-1/II3679

Gaik Kin Teoh¹ & Darlina Hani Fadil Azim²

¹Department of Psychology and Counselling, School of Psychology and Social Science, IMU University, Malaysia; ²Department of Psychology and Counselling, School of Psychology and Social Science, IMU University, Malaysia

I. WHERE THE STORY STARTED…

Climate change and health tractions have loudly cumulated at the recent Asian Pacific Medical Education Conference, APMEC 2025. This has alerted us, the mental health professionals in Malaysia, to reflect and to wonder what has been put in place to address the mental health issues while climate change is impending in our country. Thus, this paper aims to skim through the websites of global and Malaysian mental health governing organisations and advocates for climate change and mental health information. The keywords used for searching the official websites were “mental health” and “climate change.” The official websites selected were those that discuss and outline action plans for both mental health and climate change.

II. HIGHLIGHTS ON THE GLOBAL STATUS OF CLIMATE CHANGE

According to the Climate Change 2023 Synthesis Report: Summary for Policymakers,

1. About 3.3 to 3.6 billion people live in conditions that are highly vulnerable to climate change.
2. Increasing climate change events have caused millions of people to live with the threat of acute shortages of food and water security. These communities are found in Africa, Asia, Central and South America, Least Developed Countries, small islands and the Arctic. Meanwhile, in developing countries, the current global financial flows for adaptation are lacking.
3. Between 2010 and 2020, the death toll due to floods, droughts and storms was 15 times higher in highly vulnerable areas.
4. In the near term, every region of the world is predicted to face further escalation in climate hazards, increasing multiple risks to ecosystems and humans. The hazards and associated risks are – an increase in heat-related human mortality and morbidity, food-borne, water-borne, and vector-borne diseases and mental health challenges, floods, biodiversity loss in land, freshwater, and ocean ecosystems and a decrease in food production.
5. The choices and actions taken in this decade will influence the situation now and for thousands of years to come. Thus, deep, rapid, and sustained mitigation and accelerated implementation of changes in this decade would decrease future losses and damages. Delayed mitigation will further increase global warming and damage.

 

The threat of climate change to health has been highlighted by the World Health Organization (WHO) for many years. In 2008, WHO published a comprehensive report on the health impacts of climate change. In 2021, a survey conducted by WHO, among the 95 participating countries, only 9% included mental health and psychosocial support in national health and climate change plans. In 2022, a new WHO policy brief was put in place to underscore the serious risks of climate change to mental health. One of the most concerning mental health outcomes related to climate change is suicidal risk (Chen et al., 2025).

III. GLIMPSES OF CLIMATE CHANGE AND MENTAL HEALTH AMONG THE MENTAL HEALTH ORGANISATIONS IN THE WESTERN DEVELOPED COUNTRIES

On the other side of the coin, the American Psychological Association [APA] (2017) published Mental Health and Changing Climate: Impacts, Implications and Guidance. In 2020, the American Counseling Association’s task force disseminated a Climate Change Fact Sheet, to familiarise counselors to facts, actions and resources that help to address the needs of clients and communities based on climate change. In 2022, the American Psychological Association (APA) published Addressing Climate Crisis: An Action Plan for Psychologists. The British Psychological Society issued two Clinical Psychology Forum within a year and repeating the same theme – the climate and ecological emergency. This indicated the urgency to take actions and to come together to address the issues of climate change. The Australian Psychological Society [APS] (2024) spotlighted that 94% of its members are concerned about the upcoming impact of climate change on mental health. Particularly, psychological distress has risen from 18.4% in 2011 to 42.30% in 2021 among the 15-24 year old, due to climate change. The New Zealand government underscored climate change and well-being in New Zealand’s Environmental Reporting Series: Our Atmosphere and Climate 2020. In 2024, the Ministry of Health of New Zealand launched the Health National Adaptation Plan 2024-2027, where mental health is embedded to be part of the action plan. In Europe, Climate Change Impacts on Mental Health in Europe was published in 2022. This shows that information on mental health issues associated with climate change is apparent among mental health advocates, particularly, from most Western developed countries.

IV. GLIMPSES OF CLIMATE CHANGE AND MENTAL HEALTH IN SOME ASIAN COUNTRIES

In Asian countries, India has called for action plans for climate change and mental health. Japan and Taiwan have established initiatives focused on mental health and disaster management.  Many Asian countries are prioritising net-zero emissions and carbon neutrality. Information and discussions on mental health associated with climate change are not readily available on the official websites of most mental health organisations. Eliciting information from official websites among Asian countries proved challenging due to language differences.

V. CLIMATE CHANGE AND MENTAL HEALTH IN MALAYSIA

Skimming through the websites of the mental health associations in Malaysia, such as the Malaysian Society of Clinical Psychology, the Malaysian Board of Counsellors (Lembaga Kaunselor Malaysia), the International Counselling Association of Malaysia (PERKAMA International) and the Malaysian Psychiatric Association, no information was found pertaining to climate change and mental health.

Although climate change and health were highlighted in NEHAP Malaysia (National Environmental Health Action Plan) official website, mental health was only mentioned in the context of post-disaster recovery and Post-Traumatic Stress Disorder (PTSD). In reality, mental health issues caused by climate change can also manifest in daily activities. The Ministry of Natural Resources and Environmental Sustainability (NRES) published the National Climate Change Policy 2.0 in 2024, but addressing mental health concerns was not stated in the policy.

Mahmood and Guinto (2022) have highlighted the seriousness of the climate crisis in Malaysia, including how mental health associated with climate change can further complicate the nascent mental healthcare systems. Besides, Pandya-Wood et al. (2024) underscored that no study was conducted pertaining to mental health and climate change. Urgent attention and investment into climate change-related studies, particularly equitable initiatives, are urged. The readiness to curb the subtle and looming “2nd pandemic” seems to be dubious.

VI. POSSIBLE ACTIONABLE SOLUTIONS FOR MALAYSIA

Firstly, mental health challenges related to climate change should be integrated into the National Climate Change Policy. In addition to the existing stakeholders (such as the Ministry of Health, the Ministry of Natural Resources and Environmental Sustainability etc), forming new partnerships with the Ministry of Communications and Ministry of Women, Family and Community Development and NEHAP will play a crucial role in enhancing public awareness towards the issue, as well as implementing targeted health initiatives to uphold the safety, health and mental health of the high risk groups (i.e. pregnant, breastfeeding, postpartum and menopausal women, older people, children under 18, outdoor workers, indigenous communities, low-income populations, people with disabilities and chronic medical conditions). In addition to mass media, information on mental health and climate change should be widely disseminated across the websites and digital platforms of health and mental health-related organisations. In other words, mental health should be given equal prominence as physical health in policy planning.  Innovative technology research is crucial for sustainable development; however, there is a pressing need for more community-based research initiatives that actively seek to understand, involve, and empower the public to contribute to sustainable solutions. Nevertheless, more research grants should be offered to directly address the link between mental health and climate change.

VII. CONCLUSION

We acknowledge that the information retrieved is only limited to publicly available website content. We might also have a bias towards what we consider global mental health organisations. Meanwhile, we have observed that the priorities and initiatives to address mental health and climate change differ by country. Mental health concerns could be addressed by various ministries rather than solely mental health organisations. Achieving carbon neutrality is prioritised over solving mental health concerns in many Asian countries, including Malaysia. Rapid, explicit and organised concerted efforts among the governing bodies are pivotal to curb the subtle and approaching pandemic such as climate change. Forthcoming top-down and bottom-up initiatives are imperative, especially the choices and actions we make in this decade will bear enduring effects for years to come.

Notes on Contributors

GKT initiated, conceptualised, analysed the literature and wrote the paper.
DHFA echoed the significance of the issue, conceptualised, cross-checked the literature, and revised the paper.

Ethical Approval

There is no data presented in this paper, and thus ethical approval is not required.

Acknowledgement

We would like to thank the Dean of the School of Psychology and Social Sciences, in IMU University, Professor Haslee Sharil Lim Bin Abdullah, for supporting our participation in this conference. We also would like to thank Professor Nilesh Kumar Mitra for inviting us to participate in conducting the pre-conference workshop.

Funding

IMU University, Malaysia, funded our participation in this conference.

Declaration of Interest

All authors have no conflict of interest to declare.

References

Australian Psychological Society. (2024, April 24). 94% of psychologists are concerned about the impact of climate change on mental health. https://psychology.org.au/insights/94-of-psychologists-are-concerned-about-the-impact

Chen, D. D., Tu, J. H., Ling, K. N., Jin, X. H., & Huang, H. Y. (2025). Climate change and suicide epidemiology: A systematic review and meta-analysis of gender variations in global suicide rates. Frontiers in Public Health, 12, 1463676. https://doi.org/10.3389/fpubh.2024.1463676

IPCC, 2023: Climate change 2023: Synthesis report, summary for policymakers. Contribution of working groups I, II and III to the sixth assessment report of the Intergovernmental Panel on Climate Change [Core Writing Team, H. Lee and J. Romero (eds.)]. IPCC, Geneva, Switzerland. 1-34. https://doi.org/10.59327/IPCC/AR6-9789291691647.001

Mahmood, J., & Guinto, R. R. (2022). Lessons from climate reports for the Malaysian medical community. The Malaysian Journal of Medical Sciences: MJMS, 29(3), 1-4. https://doi.org/10.21315/mjms2022.29.3.1

Pandya-Wood, R., Azhari, A., Johar, H., Johns-Putra, A., Muhamad, N., & Su, T. T. (2024). Systematic review of climate change induced health impacts facing Malaysia: Gaps in research. Environmental Research: Health, 2(3), 032002. https://doi.org/10.1088/2752-5309/ad6208

*Teoh Gaik Kin
IMU University,
126, Jalan Jalil Perkasa 19, Bukit Jalil,
5700 Kuala Lumpur, Malaysia
60126714766
Email: GaikKinTeoh@imu.edu.my

Submitted: 3 January 2025
Accepted: 14 May 2025
Published online: 6 January, TAPS 2026, 11(1), 82-85
https://doi.org/10.29060/TAPS.2026-11-1/II3600

Sulthan Al Rashid¹ & Pubalan Rajagopalan²

¹Department of Pharmacology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), India; ²Medical Surgical Department, Farrer Park Hospital, Singapore

I. INTRODUCTION

Medical education is transforming to nurture not just clinical expertise and theoretical understanding but also the holistic development of healthcare clinicians. In an era where sustainability in healthcare demands adaptable, resilient, and empathetic professionals, Personal Development Programs (PDPs) have emerged as vital tools. These programs aim to equip healthcare clinicians —doctors, nurses, and allied professionals—with essential skills like communication, empathy, and resilience while fostering lifelong learning and personal well-being. This personal view explores the critical role of PDPs in shaping healthcare clinicians who are prepared to meet the physical, psychological, and social challenges of their roles, thereby contributing to a sustainable future in healthcare. We highlight the benefits, current frameworks, challenges, and strategies necessary for effectively integrating PDPs into medical education to cultivate a holistic, future-ready workforce.

II. THE RATIONALE FOR PERSONAL DEVELOPMENT

The healthcare profession is synonymous with high-pressure work environments that challenge even the most seasoned professionals. As such, equipping healthcare clinicians with resources for self-improvement and mental well-being is not just desirable—it is crucial. Healthcare clinicians regularly contend with issues like burnout, compassion fatigue, and work-life imbalance. The ripple effects of these challenges extend beyond the individual to affect the quality of patient care. Hence, incorporating personal development into medical education is more than a value-added option; it is a foundational component that addresses the holistic training needs of healthcare clinicians.

III. EMOTIONAL INTELLIGENCE AND COMMUNICATION SKILLS

Emotional intelligence (EI) and strong communication skills are essential for effective patient interaction and care. According to research, healthcare clinicians with high EI are more adept at understanding patient concerns, managing personal emotions and potential biases (Webster et al., 2022), and handling complex interpersonal dynamics (Giménez-Espert et al., 2023). Programs focused on EI employ hands-on exercises, role-playing, and workshops that allow healthcare clinicians to develop these skills in real-world scenarios. For instance, simulation labs can recreate patient encounters that test and improve healthcare clinicians’ emotional responses, making them better communicators and more empathetic caregivers.

Moreover, EI training is associated with tangible benefits like higher patient satisfaction and lower medical error rates. In a clinical setting, the ability to manage stress and maintain clear, empathetic communication can significantly affect patient outcomes. Thus, by integrating EI training into the medical curriculum, educators are nurturing a new generation of healthcare clinicians who prioritise both technical precision and human connection.

IV. BUILDING RESILIENCE AND MANAGING STRESS

The healthcare profession is notorious for its physical and emotional demands, making resilience a crucial attribute for survival and success. PDPs that focus on resilience-building often include mindfulness practices, stress management techniques, and guided self-reflection. For example, mindfulness training has been shown to lower levels of burnout among healthcare workers. Programs like these teach healthcare clinicians to manage stress, recover from setbacks, and foster a supportive work culture. This approach benefits both individual well-being and professional performance, ultimately enhancing patient care.

Additionally, stress management workshops can be designed to simulate high-pressure scenarios, helping healthcare clinicians develop coping mechanisms they can use in real clinical environments. Practical training sessions, such as mock emergency simulations, prepare healthcare clinicians to think critically and remain composed under pressure. By equipping future healthcare clinicians with these skills, educational institutions are ensuring that healthcare clinicians can thrive in the demanding healthcare fields.

V. CURRENT MODELS OF PERSONAL DEVELOPMENT IN MEDICAL EDUCATION

A. Reflective Learning and Mentorship

Reflective practices are key components of many personal development programs, allowing healthcare clinicians to analyse their experiences, learn from them, and adjust their behaviour or thinking accordingly. Journaling, in particular, is a powerful tool for self-reflection. By regularly documenting their experiences, thoughts, and emotions, healthcare clinicians can gain a deeper understanding of their learning processes and emotional responses. This habit helps them identify patterns, recognise areas for improvement, and appreciate personal growth over time. Journaling also serves as a therapeutic outlet, reducing stress and fostering self-awareness.

Techniques like case-based discussions and guided reflections complement journaling by encouraging active engagement and peer learning. For instance, healthcare clinicians may write about a challenging patient encounter and later discuss it in a group setting, exploring different perspectives and potential strategies for improvement. These reflective exercises promote a culture of continuous self-improvement and emotional resilience (Hagrass et al., 2023).

Mentorship is another cornerstone of personal development in medical education. Structured mentorship programs provide a platform for healthcare clinicians to discuss both professional and personal challenges. A mentor can offer guidance, emotional support, and career advice, fostering a nurturing relationship that promotes growth and emotional well-being. Through regular discussions, mentees can share insights from their journaling or reflect on professional challenges, receiving valuable feedback and support from experienced practitioners. These mentorship relationships not only guide healthcare clinicians in their academic and clinical journeys but also offer a supportive network that contributes to their overall well-being.

B. Wellness and Achieving Work-Life Balance

Maintaining a healthy work-life balance is vital for healthcare clinicians, who often face long hours and emotionally taxing work (Mitra et al., 2024). Medical education programs that emphasise wellness strategies—such as exercise, nutrition, and self-care—can equip healthcare clinicians with tools to manage stress and sustain their energy levels. Some schools offer wellness electives or modules focusing on self-care and practical life skills, such as time and financial management; for instance, Hackensack Meridian School of Medicine provides a financial wellness elective titled ‘Dollars and Sense for Medical Students,’ which focuses on practical budgeting and saving strategies (Schiavone et al., n.d.).

Practical courses can also prepare healthcare clinicians for the unique challenges of a medical career. Time management workshops, for example, can help healthcare clinicians learn to prioritise tasks and maintain productivity without sacrificing their well-being. Financial literacy courses could teach them how to manage their finances, easing the stress associated with economic pressures during residency and early practice. A holistic curriculum addresses physical, mental, and emotional health, ensuring that healthcare clinicians are well-rounded and resilient.

VI. OVERCOMING CHALLENGES IN IMPLEMENTATION

Despite the numerous advantages of PDPs, integrating them into an already rigorous medical curriculum is fraught with challenges. Heavy academic schedules leave little room for additional content, and there is often scepticism among both faculty and students about the value of PDPs compared to traditional clinical training. However, these hurdles can be surmounted with thoughtful strategies.

VII. EFFECTIVE STRATEGIES FOR INTEGRATION

A. Embedding PDPs into Existing Courses

Instead of introducing separate modules, personal development content can be seamlessly integrated into clinical courses. For instance, stress management techniques can be taught as part of clinical skills training, making it easier for healthcare clinicians to apply these lessons in practical settings.

B. Offering Flexible Learning Options

Workshops or online modules provide flexibility, accommodating diverse schedules and learning preferences. This approach ensures that healthcare clinicians can benefit from PDPs, regardless of their time constraints.

C. Leveraging E-Learning Platforms

Online resources can make personal development topics more engaging and accessible. Interactive e-learning modules on resilience, time management, and communication can be tailored to fit into the existing curriculum without overloading healthcare clinicians.

D. Evidence-Based Customisation

Programs should be tailored to the specific needs of healthcare clinicians and backed by research. Continuous evaluation and feedback loops can refine these programs, ensuring they remain effective and relevant. Institutions should commit to ongoing research to evaluate the long-term impact of PDPs on healthcare clinicians’ professional success and personal well-being.

VIII. THE INFLUENCE ON PATIENT CARE

The ultimate goal of medical education is to produce healthcare clinicians who are not only clinically skilled but also compassionate, resilient, and emotionally intelligent. PDPs that focus on active listening, empathy, and teamwork have a direct, positive impact on patient care. Healthcare providers who are emotionally healthy and well-rounded offer more patient-centered care, communicate better, and work more effectively within teams. For example, a healthcare clinician who can manage their own stress is less likely to make hasty decisions, reducing the risk of medical errors.

Emotionally intelligent practitioners are also better equipped to handle complex clinical scenarios, contributing to lower malpractice claims and improved patient safety. Furthermore, a workforce trained in empathy and effective communication fosters a more compassionate healthcare environment, benefiting patients and professionals alike.

IX. LOOKING TO THE FUTURE

As the healthcare landscape evolves, so too must the training of future professionals. Medical educators, healthcare leaders, and policymakers must collaborate to create curricula that prepare healthcare clinicians for the multifaceted realities of medical practice. The future of effective healthcare delivery depends on the well-being of its providers, making personal development programs a vital component of medical education. Research should continue to explore innovative methods to embed personal growth into medical training, measuring the outcomes on both a personal and professional level.

X. CONCLUSION

Integrating personal development programs into medical education is essential for cultivating healthcare practitioners who are not only clinically proficient but also emotionally intelligent and resilient. These programs empower healthcare clinicians to navigate the challenges of their field with empathy, adaptability, and a strong sense of well-being, aligning their personal growth with professional excellence. Medical educators play a pivotal role in shaping a generation of practitioners who prioritise both their own holistic development and the sustainable delivery of compassionate, high-quality care. By embracing this approach, the medical community can ensure a future where healthcare clinicians are equipped to contribute meaningfully to a sustainable and patient-centered healthcare system.

Notes on Contributors

Sulthan Al Rashid was responsible for the conceptualisation, development of scientific content, data collection, manuscript preparation, editing, and proofreading. Pubalan Rajagopalan contributed significantly to drafting the manuscript and provided critical revisions for important intellectual content. He reviewed and approved the final version of the manuscript and agrees to be accountable for all aspects of the work to ensure its accuracy and integrity.

Ethical Approval

Ethical approval is not required as no human participant data was collected.

Acknowledgement

ChatGPT has been utilised in manuscript preparation, including tasks like drafting, editing, and refining text, without being credited as an author.

Funding

The authors did not receive any funding for this study.

Declaration of Interest

The authors declare that they have no conflicts of interest.

References

Giménez-Espert, M. D. C., Maldonado, S., & Prado-Gascó, V. (2023). Influence of emotional skills on attitudes towards communication: Nursing students vs. nurses. International Journal of Environmental Research and Public Health, 20(6), 4798. https://doi.org/10.3390/ijerph20064798

Hagrass, H. M., Ibrahim, S. A. E. A., Anany, R. I. E. S., & El-Sayed, H. A. (2023). Effect of an educational program about mentorship competencies on nurse mentors’ performance: A quasi-experimental study. BMC Nursing, 22, 429. https://doi.org/10.1186/s12912-023-01597-y

Mitra, L. G., Sharma, J., & Walia, H. S. (2024). Improving work-life balance and satisfaction to improve patient care. Indian Journal of Critical Care Medicine, 28(4), 326–328. https://doi.org/10.5005/jp-journals-10071-24689

Schiavone, J., Ambalu, N., Cheriyan, J., & Josephs, J. (n.d.). Financial wellness for medical students: Practical budgeting and saving tips. AAMC. Retrieved April 4, 2025, from https://students-residents.aamc.org/medical-student-well-being/financial-wellness-medical-students-practical-budgeting-and-saving-tips

Webster, C. S., Taylor, S., Thomas, C., & Weller, J. M. (2022). Social bias, discrimination and inequity in healthcare: Mechanisms, implications and recommendations. BJA Education, 22(4), 131–137. https://doi.org/10.1016/j.bjae.2021.11.011

*Mr Pubalan Rajagopalan
Farrer Park Hospital
1 Farrer Park Station Rd Singapore 217562
+6591050751
Email: pubalan83@outlook.sg

Submitted: 14 October 2024
Accepted: 4 March 2025
Published online: 6 January, TAPS 2026, 11(1), 86-88
https://doi.org/10.29060/TAPS.2026-11-1/II3542

Craig Hassed

Department of Medical Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia

I. INTRODUCTION

In this article I will outline some of the personal and clinical challenges faced by medical and allied health professionals. Mindfulness will be proposed as a necessary skill to be taught in under and postgraduate training to address a number of these challenges. To provide some insights into how this can be done effectively, I will share our experience from Monash University where we have successfully integrated the mindfulness-based Health Enhancement Program (HEP) into medical and allied health professional training for over 20 years. The case will be made for why other medical schools around the world can benefit from adopting similar curriculum.

II. DISCUSSION

It is well documented that medical and allied health professionals face many challenges in their working life including high rates of burnout, stress, alcohol and substance use, and poor mental health. Furthermore, in the complex work environments that health professionals work in, they need to make many decisions throughout the day which have major implications for patients’ health. The complexity is further complicated by the fast-paced modern world where the misuse and overuse of technology is leading to high levels of distraction and clinical errors.

The job-ready health professional needs practical skills to help them navigate such challenges. Unfortunately, these skills are often seen as optional ‘soft’ and are rarely part of the core-curriculum, but without these skills being taught in a comprehensive way, history keeps repeating itself.

One generic skill which can help address many specific challenges outlined above is mindfulness. The most widely used definition by Jon Kabat-Zinn is, “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” In its broadest sense, mindfulness is a practice in training attention and attitude. It can be practiced formally as in mindfulness meditation, and informally by being present and engaged as one goes about daily life.

Before introducing such training into the medical and allied health curriculum one needs a rationale for doing it supported by a sound evidence-base. The exponential growth of research into mindfulness for health professionals has confirmed its efficacy in managing stress and anxiety, reducing relapse rates from depression, lowering burnout, and reducing addictive behaviours. Importantly, the modern doctor also needs to be equipped with non-pharmaceutical options or adjuncts for their patients in the management of stress and mental health problems, chronic pain, and coping with chronic illness.

Because of the enhanced attentional, situational awareness and self-monitoring capacities that mindfulness provides, there is evidence that it enhances clinical decision making, reduces the impact of cognitive biases and helps prevent clinical errors, in part because doctors can learn to be alert to the negative impact of practices like complex multitasking or the distracting effect of technology.

Also important is the evidence from Krasner and Epstein (Krasner et al., 2009) showing that mindfulness not only enhances physician wellbeing but also conscientiousness, emotional intelligence, communication and compassion leading to better clinical interactions with patients.

Mindfulness training has been a part of the core curriculum for medical students at Monash University since 1992. Initially it was on a small scale and then in 2002 the program grew into what we call the Health Enhancement Program. Monash was the first university in the world to integrate mindfulness as core-curriculum and soon after Rochester University introduced a mindfulness program into its curriculum (Dobkin & Hutchinson, 2013).

The HEP is a mindfulness-based healthy lifestyle program delivered in the first semester of the first year of Monash’s five-year undergraduate medical curriculum. It is underpinned by mindfulness training alongside content on lifestyle including the benefits of healthy diet, exercise, environment, connectedness and spirituality, as well as behaviour change strategies and goal setting.

A lecture series providing the evidence and clinical rationale for learning about mindfulness and other elements of the HEP followed by a series of five two-hour tutorials where the students learn to apply mindfulness and lifestyle-focused behaviour change skills in their own lives.

This experiential and deep learning model helps students to foster their own wellbeing, be better manage their stress, and to build an understanding of how these approaches can be used with patients in future medical practice. To assist in the reflective learning approach, students are very actively engaged in group discussions during tutorials. They also keep a weekly reflective journal sharing their reflections, insights, challenges and questions in applying mindfulness and healthy lifestyle change in their own lives. These journals are read by the tutor who provides personalised feedback and encouragement to the students.

The authenticity, credibility and motivation of the tutoring team is crucial for the effectiveness of the program. All tutors are working health professionals – nearly all doctors and psychologists – who personally and professionally use the mindfulness skills they are teaching.

The HEP is core-curriculum and, like any other part of core-curriculum, is assessable and students are required to attend tutorials and learn the content, but we are very clear in communicating to the students that what they practice or apply outside of the tutorial room in their personal life is very much their own personal choice. Students are invited to explore the techniques and apply them in ways that are meaningful for them, but mindfulness is not being imposed on them.

Contextualisation of mindfulness to fit with students’ studies, lives and future work is vital otherwise it won’t be seen as being relevant in the medical curriculum. If this is done well then students receive mindfulness very positively and they apply it in meaningful ways. We have found that over 90% of students report personally applying the formal and informal mindfulness practices in their own lives outside of tutorials (Hassed et al., 2009). If it’s done poorly then the opposite will happen. Contextualisation is further reinforced with mindfulness-based experiments like exploring the effects of complex multitasking, mindful communication, dealing with distractors, and a mindful eating and exercise.

Students need to understand that mindfulness is a transferable skill relevant to their work and life generally, and it is not just seen as a superfluous addition to the ‘serious’ medical curriculum. It is therefore important that mindfulness is horizontally and vertically integrated with other relevant curriculum such as being more present in communication skills training, better focus when learning medical procedures like venepuncture, learning how to manage exam anxiety and, in later years, being more self-aware in clinical decision-making. One method of increasing integration and giving the content a clinical focus is through weekly role-plays similar to the kinds of cases students might meet in OSCE exams.

For the students to take any part of the curriculum seriously and to engage with it, it needs to be assessable. If the mindfulness content is not assessable students will not think it’s important because, in their perception, if it was important, it would be assessed. The journal is marked by the tutors based on the insights students glean and the authenticity and quality of their self-reflection. The knowledgebase and science covered in the HEP lectures is assessed in written exams. Students’ understanding of how to communicate the principles of what mindfulness is about, and what kinds of clinical applications would be appropriate for its use is assessed in OSCE exams. We do not expect the students to reach a point where they could teach mindfulness skills to patients. Further training would be required to reach this objective.

The HEP has become an integral and distinctive part of the Monash medical curriculum. As core-curriculum we have never had the option of performing a randomised control trial on the program outcomes, but we have performed a series of pre-post studies. Our findings that students report improvements in mental health, perceived stress, study engagement, and mindfulness from pre- to post-intervention, even though pre-intervention measures were taken in a low stress period of semester and the post-intervention measures were taken in the period immediately prior to mid-year exams, is very encouraging and counter to evidence showing medical student wellbeing inevitably declines as the semester progresses and students approach assessment (Hassed et al., 2009; Kakoschke et al., 2021).

III. CONCLUSION

Deficiencies in medical education in providing job-ready health professional do not generally lie with a lack of biomedical knowledge and clinical teaching in undergraduate years. The main deficit in training relates to necessary personal skills like attentional control, emotional regulation, stress management, resilience, self-awareness and self-care. One generic skill that has the potential to meet these diverse needs is mindfulness. There is much to be gained by giving all medical and allied health professional students contextualised, relevant, and evidence-based training in mindfulness to help them meet the personal and professional demands that come with increasingly complex and demanding careers in healthcare. A more extensive discussion of the why and how of doing that successfully can be found in a discussion paper in the journal, Mindfulness (Hassed, 2021).

Notes on Contributors

Craig Hassed was the sole author, responsible for the conceptual development and writing of this article.

Funding

There was no funding source for this paper.

Declaration of Interest

The author declares to have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

Dobkin, P. L., & Hutchinson, T. A. (2013). Teaching mindfulness in medical school: Where are we now and where are we going? Medical education, 47(8), 768–779. https://doi.org/10.1111/medu.12200

Hassed, C., de Lisle, S., Sullivan, G., & Pier, C. (2009). Enhancing the health of medical students: Outcomes of an integrated mindfulness and lifestyle program. Advances in Health Sciences Education, 14(3), 387–398. https://doi.org/10.1007/s10459-008-9125-3

Hassed, C. (2021). The art of introducing mindfulness into medical and allied health curricula. Mindfulness, 12, 1909–1919. https://doi.org/10.1007/s12671-021-01647-z

Kakoschke, N., Hassed, C., Chambers, R., & Lee, K. (2021). The importance of formal versus informal mindfulness practice for enhancing psychological wellbeing and study engagement in a medical student cohort with a 5-week mindfulness-based lifestyle program. PloS one, 16(10), e0258999. https://doi.org/10.1371/journal.pone.0258999

Krasner, M. S., Epstein, R. M., Beckman, H., Suchman, A. L., Chapman, B., Mooney, C. J., & Quill, T. E. (2009). Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA, 302(12), 1284–1293. https://doi.org/10.1001/jama.2009.1384

*Craig Hassed
Faculty of Medicine, Nursing and Health Sciences
Monash University
Wellington Road, Clayton,
Victoria, Australia
Email: craig.hassed@monash.edu

Submitted: 28 January 2025
Accepted: 5 July 2025
Published online: 6 January, TAPS 2026, 11(1), 89-91
https://doi.org/10.29060/TAPS.2026-11-1/II3646

Darlina Hani Fadil Azim¹, Gaik Kin Teoh¹ & Nilesh Kumar Mitra²

¹Department of Psychology & Counselling, School of Psychology & Social Sciences, IMU University, Malaysia; ²Human Biology Division, School of Medicine, IMU University, Malaysia

I. INTRODUCTION

Sustainability was the key topic at APMEC 2025. However, how can we maintain care quality when patient demands overshadow healthcare workers’ well-being? The mental health challenges faced by medical students and healthcare professionals – including high workload, burnout, and the emotional toll of the second victim phenomenon, which is the emotional and psychological distress healthcare professionals experience after being involved in or witnessing an adverse patient event or medical error – are well-documented yet often insufficiently addressed (Busch et al., 2021). Despite growing awareness, existing institutional policies for managing and monitoring mental well-being remain fragmented and unsustainable (Kuhlmann et al., 2024). In the Conference workshop session, “Promoting Mental Health in HPE and Healthcare: Partnering for Change”, we were able to create a safe space in which sincere and honest experiences were shared among the participants, who were medical doctors, medical educators, and support staff for medical students and they were able to learn from one another. Therefore, the aim of this paper is to share our insights and recommendations that can be helpful for medical educators and policymakers in ensuring that the healthcare workers well-being is maintained for a sustainable future.

II. STRESSORS OF STUDENTS AND RESIDENTS

The participants highlighted in the small group discussions that the stressors among residents are quite different from those faced by medical students. While students tend to be more concerned about academic pressures and uncertainties about their future careers, residents are more concerned about the high workload and challenging work demands, including patient care responsibilities and personal factors such as managing a young family.

The participants also expressed their concerns about providing the necessary support for both students and residents under their care. They have observed that they tend not to reach out for help when they need it, and for those who do, participant X mentioned that “they are not as forthcoming in sharing about the core of the problem and instead tend to keep it at a superficial level”. Several participants hypothesised that this could be due to the stigma surrounding mental health and the limited time to consult with a senior or superior. This is supported by the study by Hawsawi et al. (2024) who also found other factors such as no or minimal access to mental health support, as well as the normalisation of stress and burnout in the medical field.

To address this, participant Y shared his strategy of “approaching students during informal settings such as class break time or lunch breaks” to make the interaction less formal and a more congenial interaction. He also prefers to “just listen and support, instead of trying to change or correct the student”. Another participant who works in a teaching hospital found that “my students were more willing to open up when I shared my own struggles from when I was a junior doctor”. These practices can help encourage more open communications from the medical students and residents.

III. COPING STRATEGIES OF MEDICAL EDUCATORS

To explore the participants’ coping strategies in managing their own stressors, each participant was requested to list both internal and external supports that are available to them and to share with the whole group. Internal coping mechanisms such as turning to religion offer comfort, meaning, and community support. Positive self-talk and acceptance promote self-compassion and reduce negative thinking. Distraction techniques, such as engaging in hobbies, practicing mindfulness, or exercising, provide temporary relief and improve mood. In terms of external support, most of the participants have a strong support system from family, colleagues and mentors who provide emotional support, understanding, and a sense of belonging. Having a safe space to vent frustrations and anxieties without judgment offers crucial emotional release. One participant found this workshop activity of self-disclosure and sharing helped her to see that she is not alone in her own struggles with mental health issues. Interestingly, none of the participants mentioned systemic support as one of the coping factors. Could this imply systemic support is beyond their capacity, or are they not aware of its availability or significance? The participants highlighted that while there are efforts in their institutions to promote mental health and well-being, these tend to be more focused on the students, rather than on staff. Two of the participants also discussed how their institutions have made available third-party digital therapeutics companies that includes access to mental health professionals and also AI chatbots that can provide online support. This could be a more accessible option for those who are hesitant to reach out for help.

IV. PROPOSED SOLUTIONS

Considering the input from the workshop participants, we recommend the following:

1) To reduce the stigma of seeking formal mental health support that are provided by the institutions, incorporate in the medical curriculum the provision of a safe platform for sharing personal stories from senior staff or alumni that showcase their mental health challenges in different stages of their career and how they managed it. This fosters a work culture that powerfully conveys mental health challenges are not signs of weakness, but rather that understanding how and where to seek help is an essential component of professional practice.

2) To further harness the support that staff are already providing informally to their peers and students, a mandatory training programme on Mental Health First Aid focusing on recognising signs of distress, basic active listening skills, motivational interviewing skills and appropriate referral pathways can be implemented. This can be made available to the students as well.

3) To address the perceived lack of systemic support for staff, a mandatory wellness program is recommended. This may include regular and dedicated mental health check-ins with independent mental health professionals who are familiar with the unique stressors and challenges faced by healthcare professionals and students including the second victim phenomenon. These check-ins can be in an informal setting like during coffee breaks or gym sessions to encourage open and non-judgmental conversations, reduce stigma, and normalise seeking psychological support as a routine part of professional well-being. Using AI chatbots could also be an alternative approach. These conversations can provide valuable opportunities to identify early warning signs and offer timely support.

V. CONCLUSION

The format of this APMEC 2025 workshop can serve as a model for fostering collaborative mental health discussions, thus making it a replicable innovation. The insight from the workshop clearly shows that more needs to be done to address healthcare workers’ well-being at the systemic level. This is a direct call to action for HPE institutions to prioritise and implement strong, dedicated mental health support systems. Furthermore, HPEs must equip all staff and students with the essential skills to proactively offer mental health support to their peers and colleagues, fostering a truly supportive academic and professional environment.

Notes on Contributors

DHFA conceptualised the core idea, developed the argument and wrote the paper.
GKT initiated, conceptualised, analysed the literature and revised the paper.
NKM analysed the literature and revised the paper.

Ethical Approval

There is no data presented in this paper, and thus ethical approval is not required.

Acknowledgement

We would like to thank the Deans of the School of Psychology and Social Sciences and the School of Medicine at IMU University, for supporting our participation in this conference.

Funding

IMU University, Malaysia, funded our participation in this conference.

Declaration of Interest

All authors have no conflict of interest to declare.

References

Busch, I. M., Moretti, F., Campagna, I., Benoni, R., Tardivo, S., Wu, A. W., & Rimondini, M. (2021). Promoting the psychological well-being of healthcare providers facing the burden of adverse events: A systematic review of second victim support resources. International Journal of Environmental Research and Public Health, 18(10), 5080. https://doi.org/10.3390/ijerph18105080

Hawsawi, A. A., Nixon, N., Stewart, E., & Nixon, E. (2024). Exploring access to support services for medical students: Recommendations for enhancing wellbeing support. BMC Medical Education, 24(1), 671. https://doi.org/10.1186/s12909-024-05492-1

Kuhlmann, E., Falkenbach, M., Brînzac, M. G., Correia, T., Panagioti, M., & Ungureanu, M. I. (2024). The mental health needs of healthcare workers: When evidence does not guide policy. A comparative assessment of selected European countries. The International Journal of Health Planning and Management, 39(3), 614-636. https://doi.org/10.1002/hpm.3752

*Darlina Hani Fadil Azim
126, Jalan Jalil Perkasa 19, Bukit Jalil,
57000 Kuala Lumpur, Malaysia
+60122846675
Email: darlinahani@imu.edu.my

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