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

Suryanti Chan¹, Hamzah Hamzah² & Insan Sosiawan Tunru³

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

I. INTRODUCTION

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

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

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

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

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

II. APPROACH TO SYNTHESIS

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

III. GLOBAL TRENDS SHAPING MEDICAL EDUCATION

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

A. Globalisation and Medical Education

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

B. Technological Advancements

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

C. Accreditation and Quality Assurance

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

D. Outcome-Based Education

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

IV. CONCLUSION

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

Notes on Contributors

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

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

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

Ethical Approval

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

Acknowledgement

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

Funding

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

Declaration of Interest

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

References

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

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

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

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

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

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

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

Han Ting Jillian Yeo & Dujeepa D. Samarasekera

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

I. INTRODUCTION

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

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

II. DEVELOPING A GUIDE

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

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

III. IMPLEMENTATION

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

IV. LIMITATIONS AND FUTURE DIRECTIONS

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

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

V. CONCLUSION

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

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

Notes on Contributors

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

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

Ethical Approval

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

Funding

No funding sources are associated with this paper.

Declaration of Interest

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

References

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

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

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

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

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

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

Sulthan Al Rashid

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

I. INTRODUCTION

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

II. INTEGRATION OF AI TOOLS IN MEDICAL EDUCATION

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

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

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

A. WhatsApp in Medical Education

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

B. MS Word in Medical Education

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

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

IV CONCEPT MAPPING

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

A. Expanding on AI-driven Tools for Concept Mapping

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

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

V. EXTENDED CLASS HOURS FOR ACTIVE ENGAGEMENT

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

VI. IMPLEMENTATION CONSIDERATIONS

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

VII. FUTURE DIRECTIONS & CONCLUSION

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

Notes on Contributors

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

Acknowledgement

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

Ethical Approval

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

Funding

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

Declaration of Interest

The author asserts that he has no conflict of interest.

References

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

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

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

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

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

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

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

Prabanjini Rajkumar & Lucy Victoria Everett Wilding

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

I. INTRODUCTION

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

II. METHODS

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

III. RESULTS

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

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

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

Faculty of Medicine, University of Moratuwa, Sri Lanka

I. THE EARLY CLINICAL EXPOSURE PROGRAM

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

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

II. DESIGN OF THE PROGRAM

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

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

III. DELIVERY OF THE PROGRAM

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

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

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

IV. DISCUSSION

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

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

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

V. CONCLUSION

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

Notes on Contributors

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

Ethical Approval

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

Acknowledgement

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

Funding

The project is funded neither by any person nor institute.

Declaration of Interest

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

References

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

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

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

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

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

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

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

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

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

I. INTRODUCTION

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

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

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

II. THE FRUSTRATIONS AND OUR ARGUMENTS

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

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

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

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

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

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

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

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

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

III. OUR PROPOSALS

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

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

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

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

IV. CONCLUSION

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

Notes on Contributors

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

Funding

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

Declaration of Interest

The author declares that there is no conflict of interest.

References

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

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

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

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

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

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

Submitted: 6 May 2024
Accepted: 23 September 2024
Published online: 7 January, TAPS 2025, 10(1), 59-61
https://doi.org/10.29060/TAPS.2025-10-1/CS3339

Kye Mon Min Swe¹, Amit Bhardwaj² & Hnin Pwint Phyu³

¹School of Medicine, Newcastle University Medicine Malaysia, Malaysia; ²Department of Orthopaedics, Sengkang General Hospital, Singapore; ³M Kandiah Faculty of Medical and Health Science, University Tunku Abdul Rahman, Malaysia

Table 1. The Challenges and Benefits When Conducting Virtual Follow-up Home Visits

IV. DISCUSSION

Although the experiences of VF visits are challenging, medical students found the experiences valuable. The students found the importance of VF for chronic illness, which made them aware of the challenges and benefits of telemedicine. The challenges were similar to the studies from literature, such as technological difficulties, lack of familiarity with telehealth platforms, lack of access to internet or devices and sufficient internet connection speed, especially with patients with low socioeconomic status, which hinder effective communication and assessment. Moreover, patients with physical, cognitive, and language disabilities may find it hard to use the technology. Another challenge was the inability to perform an in-person clinical examination, and the students found less confidence in evaluating patient conditions through a screen, which impacted the quality of care delivered (Cheng et al., 2022; Pathipati et al., 2016).

To overcome these challenges, it is essential to provide comprehensive training focused on telehealth skills to familiarise students with virtual platforms and their functionalities. Additionally, implementing a mentorship programme or clinical attachment with telehealth practitioners guiding medical students during VF visits can foster confidence and communication skills. Encouraging regular feedback sessions will allow students to improve their techniques and address specific concerns in real-time.

As medical education shifts toward integrating telehealth, understanding the challenges students encounter is essential in preparing the next generation of healthcare professionals. The study identified a range of challenges, including technological barriers, such as unfamiliarity with telemedicine platforms, as well as issues related to patient engagement and communication. Medical students reported difficulties building rapport with patients, which is essential for effective follow-up, and expressed concerns regarding their ability to conduct comprehensive assessments virtually.

By documenting these challenges, this study contributes to the existing literature by highlighting medical students’ specific hurdles in the VF context. While experiencing the challenges, the VF visits allowed students exposed to various acute and chronic patient cases to learn about a holistic approach to managing chronic illness, work with teamwork, and have the opportunity to communicate with the patient and their family members. (Cheng et al., 2022; Iancu et al., 2020).

The findings inform educators and curriculum developers of the need for enhanced training programmes focusing on telehealth competencies. Physical follow-up visits have resumed following the pandemic, and a hybrid approach has been embraced to nurture telemedicine concepts and overcome challenges. It recommended medical institutions integrate telemedicine into curricula, ensuring today’s students are prepared for the evolving landscape of medical practice.

V. CONCLUSION

In conclusion, challenges exist in conducting virtual follow-up visits for chronic illness patients, targeting educational strategies to mitigate these difficulties. By equipping medical students with the necessary skills and support, healthcare institutions can enhance the effectiveness of virtual follow-ups, ultimately improving patient care and outcomes in a digital healthcare environment.

Notes on Contributors

Dr Kye is the corresponding author for this paper. She designed the study, analysed the data, and prepared the manuscript, working with the co-author.

Dr Amit and Dr Hnin contributed substantially to the final manuscript’s design, editing and preparation.

Ethical Approval

The research study was approved by Universiti Tunku Abdul Rahman Scientific and Ethical Review Committee on 20^th April 2021 (Approval number: UTAR/SERC/92/2021).

Acknowledgement

We would like to acknowledge the Year 4 medical students of UTAR (Academic Year 2020/2021) for voluntary participation in this study. 

Funding

There was no funding for this research study.

Declaration of Interest

The authors declare no conflicts of interest, including financial, consultant, institutional or other relationships.

References

Aron, J. A., Bulteel, A. J. B., Clayman, K. A., Cornett, J. A., Filtz, K., Heneghan, L., Hubbell, K. T., Huff, R., Richter, A. J., Yu, K., & Weil, H. F. (2020). A role for telemedicine in medical education during the COVID-19 pandemic. Academic Medicine, 95(11), e4-e5. https://doi.org/10.1097/ACM.0000000000003572

Cheng, C., Humphreys, H., & Kane, B. (2022). Transition to telehealth: Engaging medical students in telemedicine healthcare delivery. Irish Journal of Medical Science, 191, 2405-2422. https://doi.org/10.1007/s11845-021-02720-1

Iancu, A. M., Kemp, M. T., & Alam, H. B. (2020). Unmuting medical students’ education: Utilizing telemedicine during the COVID-19 pandemic and beyond. Journal of Medical Internet Research, 22(7), e19667. https://doi.org/10.2196/19667

Pathipati, A. S., Azad, T. D., & Jethwani, K. (2016). Telemedical education: Training digital natives in telemedicine. Journal of Medical Internet Research, 18(7), e193. https://doi.org/10.2196/ jmir.5534

Waseh, S., & Dicker, A. P. (2019). Telemedicine training in undergraduate medical education: Mixed methods review. JMIR Medical Education, 5(1), e12515. https://doi.org/10.2196/12515

*Dr Kye Mon Min Swe
Newcastle University Medicine Malaysia,
No 1, Jalan Sarjana 1,
Kota Ilmu, Educity@Iskandar,
Nusajaya, 79200, Johor, Malaysia
601115133799
Email: drkyemonfms@gmail.com

Submitted: 13 May 2024
Accepted: 26 August 2024
Published online: 7 January, TAPS 2025, 10(1), 62-64
https://doi.org/10.29060/TAPS.2025-10-1/CS3346

Daniel Ardian Soeselo^1,2, Rennie Yolanda³, Gisella Anastasia¹, Dwi Jani Juliawati¹ & Natalia Puspadewi¹

¹Medical Education Unit and ²Department of Surgery, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Indonesia; ³School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Indonesia

I. INTRODUCTION

Providing comprehensive palliative care is a global challenge, particularly in resource-limited settings like Indonesia (Putranto et al., 2017). Palliative care education in Indonesia is often underrepresented in medical curricula, leading to gaps in understanding and application among future healthcare professionals. This issue is compounded by the dominance of lecture-based classrooms from elementary to high school in Southeast Asia, including most medical education in Indonesia. Implementing a flipped classroom approach, which reverses traditional lecture-based and promotes active learning, could transform the education of healthcare professionals by effectively integrating surgery and palliative care within the Indonesian context (Hew & Lo, 2018).

The flipped classroom has rapidly developed in recent years, proving effective in medical education by enhancing learning performance and student satisfaction (Hew & Lo, 2018). While widely adopted in parts of Asia, particularly in Taiwan, Korea, and China (Ha et al., 2019), it remains less common in Southeast Asia, especially within medical education.

This study introduces a flipped classroom model to promote active learning and better knowledge retention, shifting the focus from traditional lecture-based teaching to student-centered learning. We aim to enhance the comprehension and application of palliative care principles among pre-clinical students.

II. METHODS

This study explores the novel use of a flipped classroom method to teach the role of surgery in palliative care, and assessed using the Kirkpatrick model (Heydari et al., 2019). Participants were preclinical students in the palliative care elective module at the School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia.

In the asynchronous stage, students were divided into four groups and given two medical journals and four trigger questions (Supplementary) one week before the synchronous class. They independently studied the material and discussed the questions in groups, submitting their answers to the facilitator a day before the synchronous session. During the synchronous stage, each group had 15 minutes to present their answers, followed by 45 minutes of interactive discussions with the facilitator using case simulations and videos. The facilitator is an experienced educator in palliative surgery.

Kirkpatrick level 1 evaluates student reactions to the learning experience at the end of class sessions using a questionnaire with a Likert scale and open-ended questions on learning materials (journals and trigger questions), learning time, active participation of students, and facilitators. Kirkpatrick level 2 evaluates student learning outcomes through five multiple-choice questions (MCQs). Questionnaires are available in Supplementary. The flipped classroom effectiveness was assessed based on multiple criteria, specifically the student’s interest in attending classes, encouragement to seek additional knowledge sources, active involvement, and motivation to study the material more deeply.

III. RESULTS

Thirty-three out of 37 students who attended the learning agreed to be included in the study. Each group comprises 9 to 10 people with a similar mean GPA (3.21 to 3.33). We assumed identical average GPA scores to mitigate any bias in the study toward students’ learning abilities. Table 1 shows students’ reactions to the learning experience (Kirkpatrick level 1).

Table 1. Student reactions evaluation (Kirkpatrick level 1) towards the flipped classroom method

*Mean Likert scale
SD = Standard Deviation

Most students spend 1 to 2 hours reading journals (19 students; 57.6%) and discussing in groups (20 students; 60.6%) respectively. Kirkpatrick level 2 evaluation was conducted using five multiple-choice questions administered at the end of the class. The difficulty levels of the questions were assessed, comprising 80% moderate and 20% easy questions. The evaluation results indicated that the average percentage of correct answers was 43.76%, reflecting an unsatisfactory outcome. Specifically, four out of the five questions had correct answer rates below 50%. These results suggest that the learning objectives were not effectively met, highlighting the need for further refinement of the flipped classroom approach and instructional methods to improve comprehension and retention of the material. The data of this study are openly available at https://doi.org/10.6084/m9.figshare.25594335.

IV. DISCUSSION

The flipped classroom method increased student interest in attending classes and deepened their study of the material. The learning materials encouraged students to seek additional knowledge, enhancing understanding and active participation. Most students strongly agreed that the trigger questions helped them understand the material and were satisfied with both the time given and the facilitators. However, active participation in the learning process was scored the lowest (3.90 ± 1.07 SD), with some students citing embarrassment, fear, and difficulty expressing opinions. Additionally, group discussions during the asynchronous stage, which were conducted online, made it difficult for students to unite ideas and draw conclusions from the discussions.

The learning outcome evaluation (Kirkpatrick level 2) revealed that most students answered four of five questions incorrectly, likely due to a lack of clinical experience. Interestingly, question number 2 was the most accurately answered, likely because it aligned with the theoretical principles of palliative learning.

These findings align with other studies demonstrating the flipped classroom enhances medical students’ learning outcomes and experiences (Nichat et al., 2023). Nichat et al. (2023) found that the flipped classroom promotes active learning by allowing students to study foundational concepts independently during the asynchronous stage and use class time for interactive discussions and collaborative activities, fostering critical thinking and collective analysis.

The challenges observed, such as the low active participation and difficulties in online group discussions, align with findings from Ha et al. (2019). Ha et al. (2019) highlighting that students in flipped classrooms may initially struggle with active engagement and online collaboration due to a lack of experience and confidence. Providing structured guidance during the asynchronous phase, such as online forums and regular check-ins with facilitators, could enhance student participation and collaboration.

The need for clinical experience to answer certain questions suggests that incorporating practical, scenario-based learning activities, such as simulations and role-playing exercises, could bridge this gap. This approach can help students apply theoretical knowledge in a clinical context, improving their readiness for practical evaluations (Hew & Lo, 2018; Nichat et al., 2023).

V. CONCLUSION

The flipped classroom method enhances critical thinking, communication, and reasoning skills, leading to higher student satisfaction and engagement. These findings highlight flipped classroom potential impact in Indonesian medical education. Addressing challenges through targeted interventions, such as clinical simulations and improved online collaboration, can further optimise its effectiveness for preclinical students.

Notes on Contributors

Daniel Ardian Soeselo designed the study, reviewed the literature, analysed the data, and gave feedback during manuscript writing.

Rennie Yolanda participated in data analysis and coding of the qualitative data, reviewed the literature, and wrote the manuscript.

Gisella Anastasia, Dwi Jani Juliawati, and Natalia Puspadewi reviewed the literature, provided input at all stages of the study, and reviewed the manuscript.

Ethical Approval

This research has received ethical approval from the Research Ethics Commission of the Atma Jaya Catholic University of Indonesia No. 13/10/KEP-FKIKUAJ/2022.

Acknowledgement

We would like to thank all the medical students who willingly cooperated in the study.

Funding

No funding was obtained for this study.

Declaration of Interest

All authors have no declaration of interest.

References

Ha, A. S., O’Reilly, J., Ng, J. Y. Y., & Zhang, J. H. (2019). Evaluating the flipped classroom approach in Asian higher education: Perspectives from students and teachers. Cogent Education, 6(1), Article 1638147. https://doi.org/10.1080/2331186X.2019.1638147

Hew, K. F., & Lo, C. K. (2018). Flipped classroom improves student learning in health professions education: A meta-analysis. BMC Medical Education, 18(1), 38. https://doi.org/10.1186/s12909-018-1144-z

Heydari, M. R., Taghva, F., Amini, M., & Delavari, S. (2019). Using Kirkpatrick’s model to measure the effect of a new teaching and learning methods workshop for health care staff. BMC Research Notes, 12(1), 388. https://doi.org/10.1186/s13104-019-4421-y

Nichat, A., Gajbe, U., Bankar, N. J., Singh, B. R., & Badge, A. K. (2023). Flipped classrooms in medical education: Improving learning outcomes and engaging students in critical thinking skills. Cureus, 15(11), Article e48199. https://doi.org/10.7759/cureus.48199

Putranto, R., Mudjaddid, E., Shatri, H., Adli, M., & Martina, D. (2017). Development and challenges of palliative care in Indonesia: Role of psychosomatic medicine. BioPsychoSocial Medicine, 11(1), 29. https://doi.org/10.1186/s13030-017-0114-8

*Daniel Ardian Soeselo
Atma Jaya Catholic University of Indonesia,
Jakarta, Indonesia
+62 813 8193 7250
E-mail: daniel.ardian@atmajaya.ac.id

Submitted: 20 December 2023
Accepted: 22 July 2024
Published online: 7 January, TAPS 2025, 10(1), 53-55
https://doi.org/10.29060/TAPS.2025-10-1/PV3196

Galvin Sim Siang Lin¹ & Chan Choong Foong²

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

We are writing to express our strong support for a crucial initiative aimed at improving health profession education, particularly in dental education. Dental education, like all healthcare fields, evolves continuously due to advances in research, technology, and patient expectations (Wong et al., 2020). Dental schools have a pivotal role in shaping the future of oral healthcare professionals, and the absence of such departments may hinder their ability to prepare competent, patient-focused dental professionals. Currently, curriculum development in dental education often faces challenges in keeping pace with the rapidly evolving landscape of oral healthcare. While dental schools are renowned for their rigorous curriculum and comprehensive clinical training, the development of effective teaching methods, curriculum enhancement, appropriate assessment, and faculty development often receive insufficient attention. This can lead to a gap between the skills and knowledge imparted to students and the demands of modern dental practice. Similarly, assessment practices may lack the sophistication needed to adequately evaluate students’ competence in areas beyond technical proficiency, such as communication skills, ethical considerations, and understanding of diversity, equity, and inclusion. Moreover, faculty development initiatives, while crucial for ensuring teaching quality and staying abreast of advancements in educational techniques, may be sporadic and lack a coordinated approach. In most countries, obtaining a professional dental qualification is a prerequisite for becoming a dental lecturer, without the need for an academic qualification in education. Therefore, it is essential to establish dedicated dental education departments with full-time academic members and to define job scopes (Nafea, 2021).

Historically, dental education may have been perceived as a part-time commitment for full-time dental academicians or dental specialists in the teaching fraternities. Some dental schools also established dental education committees comprising representatives from various departments within the dental schools. However, it has become increasingly evident that the dedication to progress within these committees is in jeopardy. This is mainly because each staff member carries their own teaching and administrative duties within their respective dental disciplines. The effective functioning of a dental education department necessitates a multidisciplinary team comprising individuals with diverse expertise and academic qualifications, encompassing dental sciences, educational sciences, and information technology. This diverse team is fundamental to the department’s ability to undertake various responsibilities, including curriculum development, assessment, evaluation, and faculty development. While the responsibilities of dental education departments may involve academic roles such as serving as workshop trainers and providing guidance to dental specialists in module design, it is crucial to distinguish their primarily academic nature from administrative functions. Unlike administrative roles that involve managing events for other trainers or handling paperwork for modules, dental education departments primarily contribute to the academic advancement of dental professionals.

Undeniably, establishing dental education departments within dental schools will foster innovation in teaching and learning methodologies. These departments can serve as hubs for researching and implementing effective pedagogical approaches, ensuring students receive the most up-to-date knowledge and skills. By integrating evidence-based educational techniques, dental schools can improve education quality, encourage active student engagement, and cultivate more competent and compassionate dental professionals. For instance, consider the implementation of team-based and case-based learning in dental education. A specialised department could spearhead research into the effectiveness of this methodology, develop protocols for its integration into the curriculum, and assess its impact on student outcomes. By doing so, the department contributes not only to the enrichment of teaching methods but also to the optimisation of the learning experience.

Furthermore, the dental education department can serve as a cornerstone for supporting faculty development. Recognising the indispensable role of faculty in educational excellence, these departments can facilitate tailored training programs, workshops, and collaborative research endeavours which would have a direct impact on the teaching quality (Irby et al., 2015). They empower educators to stay abreast of the latest teaching methods and scientific advancements. This, in turn, translates into an enriched student learning experience, with educators equipped to effectively inspire and guide the next generation of dental professionals. Consider a scenario where a dental education department collaborates with faculty to implement a novel assessment tool that evaluates not only technical proficiency but also communication skills and ethical considerations. This multidimensional approach not only aligns with the evolving expectations of the dental profession but also contributes to the holistic development of future dental practitioners.

Curriculum development and evaluation represent another critical sphere that stands to benefit profoundly from the establishment of dental education departments. In an era marked by transformative trends, dental schools must adapt to changing healthcare landscapes, incorporating digital dentistry, teledentistry, and cultural competence into their curricula. Dental education departments can lead curriculum reform efforts, ensuring graduates are not only well-versed in traditional dental practices but also adept in navigating the complexities of modern oral healthcare. For instance, envision a dental education department driving the integration of artificial intelligence applications into the dental curriculum. This would prepare students to leverage cutting-edge technologies, ensuring their readiness for a technologically advanced dental landscape (Islam et al., 2022).

In addition, these departments can also play an essential role in assessment and accreditation. In maintaining high education standards and ensuring that graduates are adequately prepared for licensure, dental education departments become custodians of public safety. They serve as a quality assurance mechanism, safeguarding the integrity of dental education and, by extension, the well-being of patients. Consider a scenario where a dental education department collaborates with accreditation bodies to develop robust assessment criteria that encompass not only clinical competence but also ethical considerations, cultural sensitivity, and effective communication skills. This holistic approach not only ensures the competency of graduates but also aligns dental education with the broader goals of promoting patient-centred care.

Dental education departments can also catalyse interdisciplinary research initiatives, fostering collaboration between dental and other healthcare disciplines. This approach encourages the development of holistic healthcare professionals who can work seamlessly within multidisciplinary teams (Yusoff et al., 2014). For example, the department can initiate research projects exploring the intersection of oral and systemic health, thereby promoting a more comprehensive understanding of the impact of dental care on overall well-being. Establishing these departments also encourages global collaboration with dental institutions, benefiting students and the wider dental community by sharing and exchanging knowledge and best practices. This exchange benefits students and the wider dental community by providing exposure to diverse perspectives and approaches to dental education. For example, international partnerships between dental education departments, lead to collaborative research projects, student exchange programs, and shared educational resources, enriching the educational experience for all involved.

The dental education department can lead educational initiatives by actively engaging in student enhancement programs. Through strategic leadership, the department can orchestrate initiatives beyond dental schools, collaborating with the broader university and healthcare communities to address learning issues among dental students. For instance, the department can organise learning-to-learn or peer-assisted learning workshops, providing diagnostic and interventional programs to academically at-risk students. By forging partnerships with external organisations, dental education departments can contribute to the development of outreach programmes that broaden dental training initiatives. This leadership includes advocating policy changes that prioritise the affective domain of dental training agendas and fostering a more comprehensive and inclusive approach to dentists’ professionalism. Hence, dental education departments not only enhance the visibility of dental training within the community but also contribute significantly to society’s overall well-being.

Nonetheless, establishing dental education departments necessitates collaboration among various stakeholders, including governments, dental associations, and educational institutions. Adequate funding, infrastructure, and faculty support are imperative for the successful realisation of these departments. This is not merely an investment in dental education; it is an investment in the future of dentistry itself. To underscore the urgency and significance of this proposal, it is essential for relevant authorities and stakeholders to engage in earnest deliberations and collaborative efforts. Dental education departments with a multidisciplinary team of full-time and academically qualified members should be considered as a requirement for accreditation. The establishment of specialised dental education departments is not a mere augmentation of existing structures; it is a forward-thinking move towards aligning dental education with society’s changing needs. It represents a collective commitment to nurturing a generation of dental professionals who are not only technically proficient but also adaptable, empathetic, and attuned to the complexities of modern healthcare. By customising dental programmes to include modules such as diversity, equity, and inclusion in dentistry as well as communication skills, this department can instil in future dental professionals a greater understanding of patient experiences, fostering empathy and comprehension within the dental profession.

In conclusion, the establishment of specialised dental education departments within dental schools is a transformative initiative that holds the potential to reshape the landscape of dental education. One approach is to send academic staff within the dental schools for postgraduate training in health profession education. By addressing the nuanced aspects of teaching, curriculum development, assessment, and faculty development, these departments can contribute to the holistic preparation of dental professionals. This is not just a need; it is a strategic imperative for championing progress in dental education and ensuring the delivery of high-quality oral healthcare to communities worldwide.

Notes on Contributors

Galvin Sim Siang Lin conceptualised and wrote the manuscript. Chan Choong Foong edited and revised the manuscript.

Funding

The authors received no financial support for the authorship or publication of this article.  

Declaration of Interest

There is no conflict of interest.

References

Irby, D. M., O’Sullivan P, S., & Steinert, Y. (2015). Is it time to recognize excellence in faculty development programs? Medical Teacher, 37(8), 705-706. https://doi.org/10.3109/0142159X.2015.1044954

Islam, N. M., Laughter, L., Sadid-Zadeh, R., Smith, C., Dolan, T. A., Crain, G., & Squarize, C. H. (2022). Adopting artificial intelligence in dental education: A model for academic leadership and innovation. Journal of Dental Education, 86(11), 1545-1551. https://doi.org/10.1002/jdd.13010

Nafea, E. T. (2021). The dental education specialism in KSA: Are we there yet? Journal of Taibah University Medical Sciences, 16(2), 217-223.

Wong, M. L., Lee, T. W. O., Allen, P. F., & Foong, K. W. C. (2020). Dental education in Singapore: A journey of 90 years and beyond. The Asia Pacific Scholar, 5(1), 3-7. https://doi.org/10.29060/taps.2020-5-1/gp1086

Yusoff, M. S. B., Abdul Rahim, A. F., & Jaa’far, R. (2014). Medical education department roles and initiatives towards achieving APEX agenda. Education in Medicine Journal, 6(2), e1-e7. https://doi.org/10.5959/eimj.v6i2.261

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