Abstract

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

Introduction: This article explores the dynamic relationship between the Scholarship of Teaching and Learning (SoTL) and the well-being of students and educators within the context of medical education.

Methods: The author critically reviewed the salient views and knowledge at the intersection of SoTL, well-being, and resilience. By critically examining literature, insights from various studies were synthesised, offering a detailed overview of the current state of knowledge in this field. This review guided the identification of key practices and recommendations.

Results: SoTL emerges as a transformative force, enhancing well-being for both students and educator through evidence-based practices and innovative teaching methods. The article explores the crucial role of SoTL in fostering resilience, not only among students but also among educators. Despite promising evidence, challenges in implementing SoTL for well-being persist, requiring strategic approaches to overcome traditional paradigms. The discussion extends to the global implications of SoTL, emphasising the need for collaborative efforts to foster better educational practices and establish inclusive learning environments.

Conclusion: As we assess the evidence for transformative change, a call-to-action echoes, urging global collaboration, research endeavors, and institutional support to realise the full potential of SoTL, ultimately creating environments where both learners and educators thrive.

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

Introduction: Despite significant efforts to address gender equality in medical education, the issue persists. The narrative review aimed to address the research question: What are the strategies implemented to address issues of gender inequality in medical education and what were their outcomes?  

Methods: Seven major electronic databases of CINAHL, Embase, ERIC, PsyInfo, PubMed, SCOPUS and Web of Science were reviewed. Search phrases used were (Medical education) AND (Gender equality) OR (Gender bias) OR (Gender diversity) OR (Gender discrimination). Original research articles were included, together with systematic reviews with outcomes reporting on strategies to address gender equality.

Results: Articles unrelated to medical education (e.g. allied health and nursing education) and non-English articles were excluded from the study. A total of 1248 articles were identified, and 23 articles met the inclusion criteria. Training programs (n=14; 60.8%) for medical students and faculty have successfully increased awareness on the issues of gender equality and boost confidence in handling cases on gender inequality, yet implicit bias remains with leadership continuing to be associated more strongly with males.

Conclusion: Leadership bodies in Institutions of Higher Education and policymakers would be in an ideal position to address these issues through shaping policies and provision of training for hiring bodies and faculty.

Keywords:           Medical Education, Gender Equality, Strategies

Abstract

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

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

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

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

Abstract

Introduction: This study aims to explore the development of nurse prescribing and identify nurse prescribing implementation and challenges in China.

Methods: Conducted as a systematic review adhering to the PRISMA, this study involved a comprehensive literature search across various databases. A timeline mapping and a region mapping were conducted.

Results: A total of 28 articles from databases were included in the study. The growth of nursing education and research, the emergence of specialty nurses, and the establishment of nurse-led clinics have contributed to the advancement of nurse prescribing in China. Presently, approximately half of the 34 regions in China are either actively researching or preparing for nurse prescribing involving medication.

Conclusion: Based on the findings, several tasks have been identified for the implementation of nurse prescribing in China. Firstly, it is imperative to elevate the overall level of nursing education and revise the existing curriculum to equip nursing students with the necessary knowledge and skills required for prescribing. Secondly, it is crucial to establish a systematic qualification system for prescribing nurses, defining the roles of specialty nurses and advanced practice nurses. Thirdly, the development of nurse prescribing includes scope of nursing practice and prescribing protocols are essential. Lastly, extension of the geographic reach of legislation and pilot projects is needed to realise the nationwide implementation of nurse prescribing.

Keywords:           Nursing, Health Professional, Prescribing

Abstract

Introduction: COVID-19 pandemic disruptions to medical educational programs have been felt worldwide. However, little is understood about the experience of Low to Middle Income Countries’ (LMIC) and the impact of ensuing disruptions on medical education. We aimed to develop a collective understanding of this through the perspectives of individual LMIC educators, exploring how they continued to deliver undergraduate and postgraduate medical education in the context of pandemic barriers, by reflecting on their successes and shortcomings.

Methods: A phenomenological study was conducted with ten purposefully recruited educators involved in medical education from mainly the Asia-Pacific region. In-depth interviews via web-conferencing were conducted, and data analysed using Braun & Clarke’s (2006) framework. 

Results: Four major themes were identified: ‘Navigating Change, ‘Altered and Divided Teaching Roles and Spaces’, ‘Curricula Impact’ and ‘Challenges and Affordances of Remote Learning’. Educators described major disruptions to delivering medical education, particularly clinical education. Remote learning was the mainstay of facilitating continued education, often requiring investment into infrastructure that was non-existent pre-pandemic.

Conclusion: LMIC educators’ pandemic response have been robust in pursuit of continued medical education. Necessary adoption of online teaching approaches has provided avenues to close healthcare education gaps by facilitating improved reach and quality of medical education in these regions. Building on this requires strategies that meet LMICs areas of need, focusing on capacity building that sustains and grows new pedagogical practices.  We must ensure educational advances are equitable and accessible for all, identifying and supporting countries and contexts at risk of being left behind.

Keywords:           Low to Middle Income Countries, COVID-19, Medical Education, Remote Learning, Qualitative

Abstract

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

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

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

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

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

Abstract

Introduction: Paediatric practice presents unique challenges for clinical reasoning, including the collection of clinical information from multiple individuals during history taking, often in emotionally charged circumstances, and the variable presentation of signs and symptoms due to the developmental stage of the child. Communication skills are clearly important but the most effective methods of teaching clinical reasoning in paediatrics remains unclear. Our review aimed to examine the existing methods of teaching clinical reasoning in paediatrics, and to consider the evidence for the most effective approaches.

Methods: We performed a scoping review and evidence synthesis drawn from reports found during a systematic search in five major databases. We reviewed 211 reports to include 11.

Results: Students who received explicit training in clinical reasoning showed a significant improvement in their experiential learning, diagnostic ability, and reflective clinical judgement. More specifically, key findings demonstrated frequent student-centered interactive strategies increased awareness of the critical role of communication skills and medical history taking. Real case-based exercises, flipped classrooms, workshops, team-based or/and bed-side teaching, and clinical simulation involving multisource feedback were effective in improving student engagement and performance on multiple outcome measures.

Conclusion: This review provides a structured insight into the advantages of different teaching methods, focusing on the multistep decision process involved in teaching clinical reasoning in paediatrics. Our review demonstrated a relatively small number of studies in paediatrics related to clinical reasoning, underlining the need for further research and curricular developments that may better meet the known unique challenges of the care of paediatric patients.

Keywords:           Clinical Reasoning, Paediatrics, Teaching Methods, Medical Students

Abstract

Introduction: Professional identity formation requires students’ ability to reflect, which can be supported by constructive feedback from teachers. Feedback practice faces many challenges, including those related to sociocultural aspects. Feedback can be optimised by implementing a model suitable to the attributes of students, teachers, and the clinical environment. This study aimed to develop a suitable feedback model and test its effectiveness in promoting reflection.

Methods: The model was designed based on the theoretical framework and identified feedback-related attributes in FMUI. Expert reviews and cognitive interviews were conducted before the model was tested. The model’s effectiveness was tested using a quasi-experimental design involving 74 students in the Paediatric Module. Students were asked to reflect on their mini-CEX experience after receiving feedback from teachers, and the depth of reflection was compared between students in the intervention and control group. The depth of reflection was measured using Kember scoring, and bivariate analysis was conducted using SPSS 20.0.

Results: The model consists of 5 steps including: Rapport building, Acknowledge students’ strengths, Identify aspect(s) that need improvement, Share teachers’ experiences, and Establish a plan to improve. Deep reflection was more frequently found in the intervention group. Mann-Whitney test showed that the difference between groups was statistically significant (Z=2.964, p=0.003), indicating that reflection in the intervention group was deeper than the control group.

Conclusion: The feedback model formulated based on feedback-related attributes in FMUI was named the RAISE model. Upon testing, students receiving the model could reflect more deeply compared to those receiving the standard model.

Keywords:           Feedback, Clinical, Reflection, Sociocultural

Abstract

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

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

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

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

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

Abstract

Introduction: Paediatric milestones provide a structured method for observing and monitoring a child’s progress and should be part of core paediatric curriculum. However, a literature review reveals that primary care physicians and pediatricians feel inadequate about their knowledge and practice of developmental paediatrics, thus exposing the lacunae in training.

Methods: An intervention was planned amongst final-year medical undergraduate students in Oman during their paediatric rotation. A 90-minute multimodal active learning module incorporating diverse learning orientations was planned and administered as a skill-lab session. Its effectiveness in learner motivation, engagement, and faculty participation was evaluated using a questionnaire based on the ICAP (Interactive, Constructive, Active, and Passive) framework, administered to students at the end of the session.

Results: Responses of the 62 participants indicated a significant association between their overall experience and tasks related to the active, constructive, and interactive elements of the module (p=0.001). The faculty’s role in facilitating the session significantly contributed to students’ overall experience (p=0.000). On linear regression, active, constructive, and interactive components of the module were moderate to high predictors of the participants’ overall learning experience.

Conclusion: It was beneficial to base the teaching module on established learning theories. Active learning strategies proactively fostered student engagement and self-directed learning during the session. Faculty played an important role in planning and customising the content, flow, and delivery to maximise meaningful learning. Such interactive collaboration, especially for theoretical concepts in medicine, enables better student engagement, providing enhanced opportunities for learning, practice, and feedback.

Keywords:           Active Learning, Child Development, Undergraduate Medical Education, Student Engagement, ICAP Framework

Abstract

Introduction: Selection for basic medical training is highly contextual. The use of cognitive aptitude tests, which commonly supplement measures of prior academic achievement in the selection process of medical schools internationally, is rarely reported from resource-constrained settings in South Asia. We report on the psychometric properties of an aptitude test designed based on the UCAT format, administered to first-year medical undergraduates to determine its utility.

Methods: The aptitude test was administered online to first-year medical students shortly after their admission to two medical faculties in Sri Lanka (n=328). The reliability of the test was determined using Cronbach’s alpha. Overall and subtest scores were computed, and the scores of different demographic groups were compared using the t-test. Factor analysis of the subtests was performed.

Results: The internal consistency of the test was 0.63. The difficulty and discrimination indices were within the acceptable range. The mean score of the aptitude test (AT) was 70.9/100 (SD 8.88). The mean score for females was higher than for males (p=0.04). No statistically significant differences in AT scores were observed between different ethnicities or religions. The entry academic scores demonstrated a weak correlation with the overall AT score (Pearson’s correlation coefficient r=0.27), verbal reasoning (r=0.24), the human body (r=0.19), quantitative reasoning (r=0.18), and situational judgement (r=0.128). Factor analysis indicated items that need revision.

Conclusion: The results indicate the potential value of aptitude tests in Sri Lanka and in similar jurisdictions where selection criteria have yet to expand beyond prior academic performance. A way forward in introducing such tests has been outlined.

Keywords:           Medical Student Selection, Medical Student Admission, Selection Criteria

Abstract

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

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

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

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

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

Abstract

Introduction: Factors affecting decision-making duration in MCQs can enhance assessment effectiveness, ensuring they accurately measure the intended objectives and address issues related to incomplete exams due to time constraints. The authors aimed to explore the aspects of medical student’s perspective regarding the factors influencing their decision making on MCQ assessments.

Methods: A mixed-methods explanatory sequential design was utilised. Initial surveys were conducted using percentages, mean and non-parametric analysis obtained via online questionnaires from the sample group: all 2^nd – 5^th year medical students from SUT, Thailand. The validity of the questionnaires was verified by three independent reviewers (IOC=0.89). This was followed by semi-structured group interviews to explore student’s perspective on the factors affecting their decision. Qualitative analysis was conducted to explore detailed information until data saturation was achieved.

Results: Data from the quantitative analysis identified four factors that students believe affect the duration of the exam: the total word count of each question, test difficulty, and images in tests. Meanwhile, the qualitative analysis provided additional insights on factors such as the examination atmosphere affecting their decisions.

Conclusion: This report indicated that data acquired from a comprehensive reading question should be distinguished from those requiring decisive reading. Apart from text length, question taxonomy-such as recall or application- and questions with given images and tables should be considered as factors determining time allocation for an MCQ. Future research based on these results should aim to develop a mathematical formula to calculate exam duration, accounting for question difficulty and length.

Abstract

Introduction: We aimed to determine the extent to which non-technical skills and attitudes acquired during undergraduate interprofessional simulation in an Advanced Cardiac Life Support (ACLS) course translated into clinical work.

Methods: Following ACLS simulation training for final-year nursing and medical students, we conducted a 1-year follow-up survey, when graduates were in clinical practice. We used the Readiness for Interprofessional Learning Scale (RIPLS – higher scores indicate better attitudes to interprofessional practice), and nine contextual questions with prompts for free-form comments. RIPLS scores underwent repeated-measures between-groups (nurses vs doctors) analysis at three timepoints (pre-course, post-course and 1-year).

Results: Forty-two surveys (58% response) were received, demonstrating translation of non-technical skills and attitudes to clinical practice, including insights into the skills and roles of others, the importance of communication, and improved perceptions of preparedness for clinical work. However, RIPLS scores for doctors decreased significantly upon beginning clinical work, while scores for nurses continued to increase, demonstrating a significant interaction effect (reduction of 5.7 points to 75.7 versus an increase of 1.3 points to 78.1 respectively – ANOVA, F(2,76)=5.827, p=0.004). Responses to contextual questions suggested that reductions in RIPLS scores for doctors were due to a realisation that dealing with emergency life support was only a small part of their practice. However, the prevailing work cultures of nurses and doctors in the workplace may also play a part.

Conclusion: We demonstrated the translation of non-technical skills and attitudes acquired in undergraduate simulation to the clinical workplace. However, results are tempered for junior doctors beginning practice.

Keywords:           Work Culture, Translation, RIPLS, Simulation, Advanced Cardiac Life Support, Undergraduate Education, Skills and Attitudes, Patient Safety

Abstract

Introduction: Numerous studies have been conducted on COVID-19, with the majority focusing on interventions involving students and teachers. However, limited research has delved into the pandemic’s impact on the wellness of various stakeholders and how they have adapted to the challenges it presented. This study aims to fill this gap by exploring these neglected areas.

Methods: This study employs a sequential mixed-method approach to study these areas. The quantitative data collection was carried out using a combination of validated surveys (ranging between 63-88 items) for students, faculty and administrators.  Subsequently, qualitative data collection was gathered via semi-structured interview using a convenient sampling method.

Results: Seventeen faculty, 18 administrators and 369 students responded to the survey. The quantitative data indicated faculty (teachers) exhibited the lowest stress levels and the highest resilience during the pandemic. In comparison, administrators and students experienced moderate levels of stress, with students scoring slightly higher on the stress level. The themes that emerged from the qualitative data were personal endurance, emotional reaction, cognitive-behavioural reaction and social support.

Conclusion: Our study highlighted that, apart from personal endurance, the tension arises from emotional and cognitive-behavioural responses of students, teachers, and administrators can be mitigated based on the presence or absence of support mechanisms.

Keywords:           Wellbeing, Change, Stakeholders, Educational Environment, Culture

Abstract

Introduction: The MBBS programme at Fiji National University reduced its teaching weeks from 18 to 14 weeks in 2018. The purpose of this study was to assess student perceptions of learning and teachers following the reduction in the number of teaching weeks from 18 to 14 weeks.

Methods: A questionnaire was created using a modified Dundee Ready Education Environment Measure (mDREEM) tool (23 items). This was comprised of two subscales; Students Perception of Learning (SPL – 12 items) and Students Perception of Teachers (SPT – 11 items). This was circulated to Year 5 MBBS students through an online survey in 2020.

Results: The response rate was 96%. The students regarded their educational environment as positive in both length of teaching weeks, with an overall mDREEM mean score of 63.29 in 18 weeks and 62.03 in 14 weeks. No statistically significant differences were found between 18 week and 14 week scores across mDREEM scores, SPL scores or SPT scores. The highest scoring item over both was ‘teachers are knowledgeable’.

Conclusion: A positive perception was noted for both lengths of teaching weeks. Reducing the teaching weeks from 18 to 14 did not statistically significantly reduce students’ perception of their educational environment. Items identified with low scores will give a window of opportunity for lecturers and to improve these areas. Future studies may explore the use of the five subscales of the DREEM tool and this study can be integrated into further evaluations of educational environment at Fiji National University.

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.

Abstract

Introduction: Career selection is a critical decision influenced by various factors, including media exposure. As a popular genre among adolescents, medical dramas may shape perceptions of the medical profession. This study explores the impact of medical dramas on medical students’ motivation to pursue a career in medicine.

Methods: This study was conducted at the School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, between February and March 2024, using a mixed-method approach. Quantitative data were gathered through a questionnaire, followed by qualitative insights from in-depth interviews. A two-stage sampling strategy was employed, initially identifying first-year students influenced by medical dramas through screening, followed by purposive sampling to select participants for in-depth interviews.

Results: Analysis identified six key motivational aspects through which medical dramas influence students’ decision to pursue medicine. These include the detailed portrayal of doctors’ roles, their daily lives, and the reinforcement of a positive perception of the profession. Notably, emotional engagement- such as inspiring doctor characters- and the realistic depiction of challenges, including the dedication and hardships of becoming a doctor, emerged as significant factors.

Conclusion: Medical dramas play a significant role in shaping students’ motivation and perception of the medical profession. This study highlights six key motivational aspects influencing career decisions, offering new insights into media-driven career choices and their potential implications for medical education.

Keywords:           Medical Dramas, Medical Education, Medical Students, Student Motivation, Career Choice

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.

Abstract

Introduction: To explore the current situation regarding teaching evidence-based practice (EBP) in Indonesian dental schools as a low-middle-income country (LMIC) setting.

Methods: Two nation-wide surveys were administered to all Indonesian dental schools (N=32) to capture the perceived value of the deans about EBP skills and teaching with its resource-related situation, as well as the actual teaching implementation and its challenges by their curriculum teams. The analysis was performed descriptively as national aggregate data.

Results: The response rates were 96.9% and 90.6%, respectively. The deans considered EBP skills to be very important (61.3%) or important (38.7%). However, only 16.1% of deans reported that the implementation of teaching EBP met their expectations. Most schools (75.9%) considered providing training for teachers as the priority plan. Most schools (62.1%) had an independent EBP course in their curriculum, while 86.2% incorporated EBP teaching (also) into other courses. All dental schools employed a lecture strategy for teaching EBP topics, but also used other strategies such as interactive strategies with a wide range of percentages being utilised (10.3 – 89.7%). EBP-specific topics were generally taught with a level of implementation varying from 34.5% to 96.6% in the pre-clinical and from 10.3% to 62.1% in the clinical programme.

Conclusion: The used approach can be considered an effective strategy to provide opportunities for schools to reflect their EBP teaching. This study confirmed the necessity for improvement, especially the need to support faculty development. The deans and their curriculum teams highly value collaborative improvement plans.

Keywords:           National Survey, Evidence-based Practice, Faculty Perception, Low-middle-income Country

Abstract

Introduction: Transitioning from a novice physiotherapist (NPT) to an independent practitioner presents significant challenges. Burnout becomes a risk if NPTs lack adequate support for learning and coping. Despite the importance of this transition, few studies have explored NPTs’ experiences in Singapore. This study aims to investigate the transitional journey of NPTs within this context.

Methods: Conducted as a descriptive phenomenological study, researchers collected data through semi-structured online interviews with eight NPTs from six acute hospitals across Singapore. Simultaneous data analysis during collection allowed for a reflexive approach, enabling the researchers to explore new facets until data saturation. Thematic analysis was employed and complemented by member triangulation.

Results: The challenges NPTs encountered include seeking guidance from supervisors, managing fast-paced work and patients with complex conditions. Additionally, NPTs grappled with fear of failure, making mistakes and self-doubt. They adopted strategies such as assuming responsibility for learning, developing patient-focused approaches, and emotional resilience. However, a concerning trend emerged with the growing emotional apathy and doubts about their professional choice.

Conclusion: This study provides a nuanced understanding of the challenges faced by NPTs during their transition. The workplace should be viewed as a learning community, where members form mutual relationships and support authentic learning. Recommendations include augmenting learning along work activities, fostering relationships, ensuring psychological safety, and allowing “safe” mistakes for comprehensive learning.

Abstract

Introduction: Very Short Answer Questions (VSAQs) minimise cueing and simulate actual clinical practice more accurately than Single Best Answer Questions, as multiple-choice options might not be realistic. Phramongkutklao College of Medicine has developed a Self-Marked VSAQ (SM-VSAQ) for formative assessments. This study determines the validity and reliability of the SM-VSAQs.

Methods: Ninety-four third-year pre-clinical students took two occasions of 10-question SM-VSAQ exams regarding cardiovascular drugs. Each question consisted of two steps: (1) clinical vignettes with questions and (2) expected answers with scores, self-marking, and feedback comprehension. Scores ranged from 0.00 to 1.00 in 0.25 increments, though not every increment was applied to all questions. A distribution of the rating agreement between students’ and teacher’s ratings was presented to determine criterion-related validity and inter-rater reliability.

Results: Criterion-related validity revealed 90.64% and 93.19% of the ratings demonstrated exact agreement between students’ and teachers’ ratings, with an inter-rater reliability of 0.972 and 0.977 for the first and second occasions, respectively (p=0.001). The exact agreement was relatively lower on the first occasion for questions with more diverse expected answers (85.11%, r=0.867, p=0.001) and drugs requiring their specific full names for a perfect mark (74.47%, r=0.849, p=0.001). While questions with specific guides do not require complex answers, they received a higher exact agreement.

Conclusion: The SM-VSAQ format effectively combines guided answers with the VSAQ model. The agreement with teacher-rated is excellent. Marking discrepancies rooted in misconceptions underscores the importance of teacher feedback in improving self-grading in formative assessments. Regular self-assessment practice is recommended to enhance grading accuracy.

I. INTRODUCTION

Telemedicine is defined as delivering healthcare services across distances using telecommunication technology (Waseh & Dicker, 2019). It helps ensure continuity of care for vulnerable patients to address the unique demands on our health system, especially in times of crisis, such as the COVID-19 pandemic, via virtual follow-up. It is also helpful in engaging medical students in training and patient care (Aron et al., 2020).

During the pandemic, virtual follow-up (VF) home visits were introduced in the integrated family medicine curriculum for Year 4 students. The family medicine curriculum for Year 4 students highlights the significance of comprehending chronic illnesses within the broader framework of the patient’s family and environment via the Follow-up Study of Patients with Chronic Illnesses programme, traditionally conducted through in-person patient visits. This study investigated the challenges faced while conducting virtual follow-up (VF) patient visits amidst the COVID-19 pandemic.

Abstract

Introduction: Case-Based Learning (CBL) is increasingly used in modern medical schools to improve students’ critical thinking and problem-solving skills. While CBL is established in Western Resource-Structured (WRS) educational settings, its use in Asian-Pacific regions like Myanmar is under explored. This research studied the integration of CBL at the Defence Services Medical Academy (DSMA) in Myanmar, focusing on the perspectives of both students and faculty involved in curriculum reforms.

Methods: This study used constructivist grounded theory to gather data from 24 DSMA participants through four focus group discussions. Twelve students and twelve faculty members, were invited a subgroup of six, and after providing informed consent discussed their experiences of CBL, aiming to assess its effectiveness and relevance in their specific educational and cultural context.

Result: Analysis shows that students valued CBL for enhancing group discussions, reflecting upon real-world situations, and building critical thinking abilities. Faculty members also appreciated CBL for its capacity to create realistic applications and its support for student-centered learning and interpersonal skills development. Both groups acknowledged CBL as an effective method for simulating the complexities of medical practice.

Conclusion: This study found that CBL is well-regarded at DSMA for preparing students competence and confidence for clinical encounters. However, faculty indicated that the extensive time required in preparation of this teaching modality was a significant challenge for the wider adoption of CBL. These insights highlight the adaptability and potential challenges of implementing CBL in non-Western educational settings and suggest possible areas for development for its broader application in the Asia-Pacific region.

Keywords:           Medical Education, Case-based Learning, Perceptions, Grounded Theory, Focus Group Discussion

Abstract

Introduction: This study aimed to identify the emotions experienced by medical students during the quarantine period, explore their coping strategies, and determine whether the pandemic affected their learning behaviours.

Methods: In this descriptive study, data were collected through an online questionnaire. The study included quarantined medical students enrolled in a distance education program at a medical school during the pandemic. The Positive and Negative Affect Scale was used to assess the emotional spectrum of the participants.

Results: The majority of medical students in the sample experienced predominantly negative emotions. Students with higher negative affect scores struggled with stress management and were less able to employ emotional regulation strategies, which adversely affected their learning behaviours.

Conclusion: Emotions should be explicitly addressed in medical education, and students should be supported in managing their emotions as part of their professional development and well-being.

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).

Abstract

Introduction: Virtual reality (VR) has been widely used in medical and health sciences education since the late twentieth century. VR complements the conventional teaching and learning (T&L) approach by providing an engaging and immersive 3D spatial learning environment, especially for understanding the orientation of anatomical structures. Despite these advantages, the usability and student preference of highly immersive head-mounted display-based (HMD) and less immersive desktop-based (DB) VR in human anatomy courses have yet to be determined.

Methods: In a cross-sectional study, 49 Year-2 medical students were recruited through a convenient sampling. The participants were asked to identify 15 skeletal system components using the HMD and DB platform with human anatomy VR application. Both applications’ System Usability Scale (SUS) and preference scores were obtained via a self-administered questionnaire. The data were expressed as median [IQR] and statistically analysed using MATLAB R2022b.

Results: Most participants preferred the HMD over the DB platform (p=0.04), especially the male participants (p=0.01). There was no significant difference in overall SUS scores between both platforms (p=0.14). However, when compared within and between genders, females scored significantly higher in the DB than HMD (p=0.02) and higher than males’ DB SUS scores (p=0.03).

Conclusion: The overall usability of HMD was comparable with the DB platform for learning human anatomy. Although most participants prefer to use the HMD, further exploration of why females prefer the DB is needed. Subsequently, VR application developers must consider gender-related adaptions to promote the equitability and inclusivity of the technology for all users.

Keywords:           Human Anatomy, Virtual Reality, Head-mounted Display, Desktop-based Application, Usability, Preference

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.

Dear Editor,

Comprehensive review articles require more than just gathering information; they require careful synthesis, analysis, and effective communication (Dhillon, 2022). Benjamin Bloom’s Taxonomy offers a systematic framework, guiding authors through remembering, understanding, applying, analysing, evaluating, and creating (Adams, 2015). Leveraging Bloom’s Taxonomy enriches writing, ensuring impactful and thorough reviews.

Abstract

Introduction: Palliative care nursing (PCN) supports individuals with life-threatening illnesses, aiming to improve the quality of life (QoL) for patients and families. The objective was to assess the necessity of establishing an Advanced Certificate Course in PCN at University of Ruhuna, Sri Lanka.

Methods: A descriptive cross-sectional study was conducted among 220 registered nurses (RNs) using purposive sampling, working at National Hospital Galle. A pre-tested, interviewer-administered questionnaire was used, including questions on prior education or training experiences on palliative care (PC), and its principles, services, and management. Descriptive statistics and the chi-square test were used to analyse.

Results: The majority of the RNs were aged 31-40 years (45.2%), females (86.0%), and married (55.7%). A higher proportion of RNs were nursing diploma holders (67.4%), with 55.7% having less than ten years of nursing experience. Only 11.3% of the RNs had formal additional training on PC, such as workshops and a few training hours. Most RNs correctly identified PC aims: improving survival (59.7%), improving QoL of patients and their families (91.4%), providing relief and pain (93.7%), understanding PC (80.1%), etc. The majority (84.6%) had a good attitude toward palliative caregiving, though only 20.4% had average knowledge of PC. Formal PCN training was significantly associated with PC knowledge (p=0.004).

Conclusion: Limited educational exposure, average knowledge levels, and good attitudes toward PC suggest the need for a PCN course for nurses. Providing a special education programme reduces the current gaps in PC by equipping RNs with the respective knowledge, skills, and attitudes to deliver complex management for patients requiring PC.

Keywords:           Palliative Care Nursing, Sri Lanka, Educational Needs, Registered Nurse

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.

Dear Editor,

Abstract

Introduction: The Objective Structured Clinical Examination (OSCE) is a popular method for assessing medical students’ clinical proficiency. Mock OSCEs are often incorporated into medical curricula to help students familiarise themselves with the examination format. While the impact of mock OSCEs on academic performance has been studied, their perceived utility remains less explored. This study aimed to assess the effectiveness of a mock OSCE in preparing medical students for their final examinations.

Methods: A prospective study was conducted at a tertiary hospital in Singapore, involving medical students undergoing their Obstetrics and Gynaecology posting. The mock OSCE consisted of five stations and included immediate feedback from examiners. Students completed three questionnaires: pre-mock OSCE, post-mock OSCE and post final examinations, rating the utility of the session and their confidence levels.

Results:  Of the cohort of 147 students, 121 responded to the pre-mock OSCE survey, 132 responded to the post-mock OSCE survey, and 105 to the survey after their final examinations. The percentage of students who found the mock OSCE useful/very useful increased significantly from 97.5% before to 98.5% after the session, and significantly decreased to 96.2% after the examinations. Confidence levels rose significantly from a mean score of 2.34/5 pre-mock to 3.89/5 post-mock, to 4.67/5 post-exam. Qualitative feedback was positive, highlighting the benefit of familiarisation with examination mark schemes.

Conclusion: The mock OSCE was well-received by students and perceived as a valuable tool in preparation for examinations. Despite the limited sample size, these findings support the implementation of mock OSCEs to enhance students’ learning and exam preparedness.

Keywords:           OSCE, Undergraduate, Medical Education, Medicine, Students’ Perception

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.

Whenever I think about student and faculty wellness, I am reminded of two sayings. Firstly, a Taoist saying that recommends we should always “look close, not far” (Wee Kee Jin, personal communication, August 25, 2012). And secondly, William Osler’s saying, “Our main business is not to see what lies dimly in the distance but to do what lies clearly at hand” (Bryan, 1997). Both quotes suggest that the most prudent course of action for students and faculty is to always reflect on one’s own actions and focus on the tasks at hand.

Standard setting is the process of deciding the boundary or standard that separates the candidates into two (e.g. pass and fail) or more groups, based on their ability shown at an assessment. Standard setting methods can be broadly grouped into four clusters (see table below).

When to use which method, though a crucial decision for any Board of Examiners, is inadequately explored in the literature. The following brief guide attempts to bridge this literature gap.

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.

Dear Editor,

The Department of Radiology, Defence Services Medical Academy reports the results on the impact of a 2-week radiology program on year 4 medical students’ perception of radiology. Advances in imaging modalities has led to almost every patient getting a scan prior to any planned management making it essential for medical students to understand the importance of radiology’s role in clinical practice. Limited exposure to radiology can perpetuate negative stereotypes by perceiving radiology as providing no significant contribution to patient care (Grimm et al., 2021). In the academic year of 2020/2021, we piloted a 2-week radiology program for 4^th year medical students and conducted a qualitative, experiential, and phenomenological study design using Focus Group Interviews (FGIs) from January to July 2022 after obtaining ethical approval to find out the effectiveness of exposure to radiology impacts on 4^th year medical students’ opinions and views on radiology. Eighteen out of 20 4^th year medical students volunteered to participate. FGIs can be used to gather rich data through participant exchange of ideas or comments on each other’s views (Stalmeijer et al., 2014). We found that students who were hesitant to express their views individually were willing to do so in small groups.

Since the time of the Flexner report, it has been accepted that science is the foundation of clinical practice (Finnerty et al., 2010; Flexner, 1910; Grande, 2009; Haramati et al., 2024; Lindsley et al., 2024; Slivkoff et al., 2019; Weston, 2018; Woods et al., 2006). However, the methods traditionally used to teach sciences to medical students have been questioned in the post-Flexner era (AAMC-HHMI Committee, 2009; Cooke et al., 2010; Fulton et al., 2012; Slivkoff et al., 2019). For nearly 100 years, the foundational sciences were taught in a discipline-oriented fashion, primarily through passive learning approaches (lectures), and largely separated from clinical practice (AAMC-HHMI Committee, 2009; Flexner, 1910). Consequently, in the pre-clerkship phase, scientific details were often overtaught and disconnected from clinical applications. This approach frequently required students to “re-learn” their foundational sciences in the setting of patient care. The disconnect between science and medicine was further exacerbated in the later phases of medical training by physicians who taught in a manner that emphasized pattern recognition over scientific underpinnings. We have come to understand that these pedagogical approaches to medical education were neither efficient nor optimal.