Medical Teacher最新文献

{"title":"Very-short-answer assessments: Beyond aggregate equivalence.","authors":"Zhanglei Mu","doi":"10.1080/0142159X.2026.2737237","DOIUrl":"https://doi.org/10.1080/0142159X.2026.2737237","url":null,"abstract":"","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1"},"PeriodicalIF":4.0,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'You stay quiet, you observe, and that's it': A qualitative study of clerkship students' experiences of debriefing patient deaths.","authors":"Brianna Legere, Paula Cameron, Anna MacLeod","doi":"10.1080/0142159X.2026.2740165","DOIUrl":"https://doi.org/10.1080/0142159X.2026.2740165","url":null,"abstract":"<p><strong>Introduction: </strong>Patient death is a complex and formative experience for medical students. Debriefing can be a powerful support for students during clerkship, when most students encounter patient death for the first time. However, medical educators require better understanding of student debriefing experiences amid patient death, to inform debriefing as a support.</p><p><strong>Methods: </strong>We conducted a focused secondary Reflexive Thematic Analysis (RTA) of longitudinal semi-structured interviews with twelve medical students during the clinical phase of a four-year Canadian undergraduate medical program (<i>n</i> = 48 interviews). Our iterative interpretive analysis explored student experiences of debriefing about patient death.</p><p><strong>Results: </strong>Students described highly variable access to debriefing, with many encounters with patient death occurring without acknowledgement or support. When debriefing was absent, students expressed feelings of loneliness, emotional turmoil, and even disillusionment. However, when debriefing was practiced or even just offered, students described feeling connected, accepted, and safe. Student-identified barriers to debriefing included existing expectations, attitudes, and practices around patient death. Students emphasized the value of debriefing informally with preceptors and near peers.</p><p><strong>Discussion: </strong>Participants desired skills and practices to help them to emotionally process the death of a patient during clinical placements. They perceived offers for debriefing as indications of a safe learning environment, whether students accepted or declined these offers. Missed opportunities for debriefing about death reinforced professional norms that diminish death and devalue emotional experiences in medicine. By introducing and normalizing debriefing as a practice early in medical education and encouraging its use during clinical placements, we can better prepare students to face the deeply impactful experience of patient death.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1-14"},"PeriodicalIF":4.0,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to incorporate theory in qualitative research: AMEE Guide No. 183.","authors":"Renée E Stalmeijer, Lara Varpio","doi":"10.1080/0142159X.2026.2614604","DOIUrl":"10.1080/0142159X.2026.2614604","url":null,"abstract":"<p><p>An important hallmark of rigorous research in Health Professions Education (HPE) research is the use of theory. There are many ways to use theory in qualitative research, and so being a savvy user of theory in such research can be a difficult goal for researchers to obtain. Therefore, this AMEE Guide aims to assist (novice) HPE researchers in navigating theory-use in qualitative research by: (a) articulating what theory is; (b) describing why researchers use theory in a research project; (c) describing how to select a theory to inform a study; (d) adressing when theory can be incorporated into a qualitative study's design; (e) and defining what a theoretical framework is and illustrating how to construct one. Each of these elements is illustrated with an example to help readers follow the implications of their decisions. Then, to support understanding, we present a fictional case and illustrate how two different theories can be applied to inform research addressing the case. We highlight how the two theories identify different research problems, and we highlight how each theory brings different aspects of the case into focus as central to the study, while simultaneously diminishing other aspects.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1621-1636"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-creation of a fit-for-purpose Feedback Toolkit for clinical clerkships.","authors":"Javiera Fuentes-Cimma, Dominique Sluijsmans, Francisca Rammsy, Ignacio Villagran, Lorena Isbej, Arnoldo Riquelme-Perez, Sylvia Heeneman","doi":"10.1080/0142159X.2026.2634062","DOIUrl":"10.1080/0142159X.2026.2634062","url":null,"abstract":"<p><strong>Introduction: </strong>Feedback is a powerful educational intervention in clinical education, yet its effectiveness depends on how it is integrated into teaching and learning activities. Previous studies have shown that productive feedback in clinical education relies on sociocultural factors such as a supportive feedback culture, trustworthy relationships, and student agency. Co-creation is a promising approach for designing educational interventions that are contextually relevant and aligned with the needs of teachers and students. This study aimed to advance both theoretical and practical understanding of co-creation as a design strategy in health professions education, particularly in developing productive feedback processes tailored to undergraduate clinical education.</p><p><strong>Methods: </strong>Eight co-creation sessions were conducted with faculty, clinical teachers, students, and researchers. The process was iterative and grounded in feedback design principles informed by the literature. Co-creation led to the development of a prototype of a Feedback Toolkit, which was piloted in two dyads of clinical-teacher students in a seven-week physiotherapy clerkship. Weekly audio diaries were collected from participants and analyzed using content analysis.</p><p><strong>Results: </strong>Data from the co-creation sessions informed the development of a Feedback Toolkit specifically designed for the clinical teacher-student dyad. The toolkit was built upon three design principles: (1) Contributes to a trustful relationship based on continuous mutual support, (2) Envisioned learning opportunities and feedback scaffolding, and (3) Plan the use of feedback. To operationalize these principles, the toolkit included practical materials such as podcasts, infographics, feedback prompts, and a Mini-CEX. The pilot study demonstrated the toolkit's usability and acceptability and highlighted its value in structuring feedback interactions. Challenges included limited time for full implementation and difficulties in providing constructive feedback.</p><p><strong>Discussion: </strong>The co-creation approach enabled the development of a fit-for-purpose feedback toolkit that aligns with the dynamic needs of clinical education. This study highlights co-creation as a feasible strategy for designing feedback processes in workplace-based learning.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1676-1687"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging artificial intelligence to accelerate competency development in diagnostic reasoning of medical students.","authors":"Moushumi Sur, Supaporn Dissaneevate, Araya Yuenyongviwat, Kanokpan Ruangnapa, Winston Liaw, Peter Boedeker, Shelley Kumar, Brian Rissmiller, Satid Thammasitboon","doi":"10.1080/0142159X.2026.2641769","DOIUrl":"10.1080/0142159X.2026.2641769","url":null,"abstract":"<p><strong>Introduction: </strong>Diagnostic errors remain a critical patient safety concern, yet teaching diagnostic reasoning is challenging due to its complex, context-specific nature. Traditional teaching methods emphasize analytical reasoning but often neglect non-analytical, pattern recognition processes that are grounded in script theory. Script theory highlights illness scripts-structured mental representations of diseases-as foundational to diagnostic expertise. Advances in artificial intelligence (AI) offer opportunities to support illness script formulation through personalized, scalable feedback. This study evaluated whether chatbot-enabled instruction and feedback improve medical students' illness script quality compared with conventional instruction techniques.</p><p><strong>Methods: </strong>We conducted a parallel-group randomized controlled trial with 83 medical students at Prince of Songkla University, Hat Yai, Thailand. Participants were randomized to conventional instruction or chatbot-enabled instruction using Microsoft Copilot. Both groups received didactic instruction, followed by illness script formulation tasks at three timepoints: pre-test (T1), immediate post-test (T2), and post-intervention with new cases (T3). Illness scripts were assessed using the validated Illness Script Assessment Tool (ISAT), which evaluates structure, content, richness, and maturity. Data was analyzed using cumulative link mixed-effects models.</p><p><strong>Results: </strong>Baseline illness script quality was comparable between groups. Chatbot-enabled instruction produced significantly greater improvements in script structure (OR 3.7), content (OR 3.3), and maturity (OR 2.9) at immediate post, with gains sustained at transfer testing for structure. Richness scores showed delayed improvement (OR 2.9). Composite ISAT scores confirmed durable improvements (OR 3.2 at T2; OR 2.7 at T3).</p><p><strong>Discussion: </strong>Chatbot-enabled instruction accelerated and enhanced illness script development compared with conventional methods, operationalizing deliberate practice principles and making non-analytical reasoning teachable. By integrating structured pedagogy with scalable AI feedback, this approach reduces educator burden while fostering diagnostic expertise. Future multi-site studies should examine long-term retention, clinical transfer, and AI feedback fidelity to ensure reliability and equity.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1699-1707"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147474544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A winding pathway with hidden barriers: The role of selection in diversity.","authors":"Anouk Wouters, Lianne Mulder, Eddymurphy U Akwiwu, Jos W R Twisk, Andries S Koster, Rashmi A Kusurkar","doi":"10.1080/0142159X.2026.2670560","DOIUrl":"10.1080/0142159X.2026.2670560","url":null,"abstract":"","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1822-1823"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding competence assessment culture: A qualitative study.","authors":"Ugo Caramori, Natália Bortoletto D'Abreu, Leonardo de Andrade Rodrigues Brito, Joana Fróes Bragança","doi":"10.1080/0142159X.2026.2637608","DOIUrl":"10.1080/0142159X.2026.2637608","url":null,"abstract":"<p><strong>Introduction: </strong>Competency-based medical education (CBME) is a global paradigm designed to align training with the needs of the healthcare system. However, its implementation relies on a shared understanding of key concepts, especially competence and its assessment, which may be interpreted differently across settings. This study explores how faculty members understand competence assessment and examines its implications for CBME implementation.</p><p><strong>Methods: </strong>This qualitative, exploratory study was conducted at a public medical school in Brazil. Twenty self-selected faculty members participated in semi-structured, online interviews. Data were analyzed using a deductive framework method informed by four theoretical models from the CBME literature, which structured the analytic dimensions guiding coding and interpretation.</p><p><strong>Results: </strong>Most participants articulated an analytic mental model of competence, describing it as composed of discrete components-knowledge, skills, and attitudes-assessed independently. No participant expressed a synthetic approach centered on real-world professional tasks. Assessment was predominantly positioned as certification of learning and described as enacted through multiple, non-integrated methods. Outcomes were primarily framed as serving internal educational stakeholders, with limited reference to patients or the healthcare system.</p><p><strong>Discussion: </strong>The findings highlight how locally situated cultural understandings shape competence assessment within a formally structured CBME context. The gap between assessment practices and real-world readiness raises concerns regarding the legitimacy of certification, especially in settings lacking a structured educational continuum. Advancing CBME requires interpretive engagement and contextual responsiveness. Exploring how faculty members understand competence assessment offers a key entry point for examining culture and encouraging actions that support CBME in fulfilling its social mandate and reaffirming medical education as a public good.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1688-1698"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147317342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the performance of simulated patients: Development and validation of the Lisbon Assessment of Simulated Patients (LASP) scale.","authors":"Paulo Oom, Sandra Oliveira, Leonor Bacelar-Nicolau, João Pereira, Rita Oom, Rodrigo Sousa","doi":"10.1080/0142159X.2026.2641757","DOIUrl":"10.1080/0142159X.2026.2641757","url":null,"abstract":"<p><strong>Introduction: </strong>Effective communication between doctors and patients is crucial for positive health outcomes and patient satisfaction. In medical education, simulated patients (SPs) play a pivotal role in developing these skills. The quality of SPs' performances and the feedback they provide significantly influence the learning process. However, current assessment tools tend to be too lengthy, overlapping or focused solely on either role-play or feedback, failing to differentiate their individual impacts. This study aimed to develop and validate a concise, reliable instrument to assess the performance of SPs in both domains separately.</p><p><strong>Methods: </strong>The Lisbon Assessment of Simulated Patients (LASP) scale was developed with expert input to ensure content validity. Data were gathered through 629 questionnaires completed by 180 medical students and 15 tutors, who assessed 25 SPs. To determine the factor structure and model fit, exploratory and confirmatory factor analyses were conducted on split subsamples. Internal consistency was assessed using Cronbach's alpha and McDonald's omega. Additionally, descriptive statistics and item-domain correlations were analysed.</p><p><strong>Results: </strong>Factor analyses revealed a two-factor structure consisting of Role Play (4 items) and Feedback (6 items), which together accounted for 54% of the variance. The fit indices indicated an excellent model fit, with a CFI of 0.991, TLI of 0.988, and RMSEA of 0.020. The items demonstrated strong correlations with their respective domains, and the scale displayed good internal consistency, with a Cronbach's alpha of 0.82 overall, 0.72 for the Role Play domain, and 0.79 for the Feedback domain.</p><p><strong>Discussion: </strong>The LASP scale is a practical and psychometrically robust tool designed to assess the performance of simulated patients. It evaluates both role-play and the quality of feedback, allowing for targeted improvements in simulated encounters and enhancing the effectiveness of communication training. This concise and validated instrument supports ongoing quality assurance and faculty development in medical simulation programs.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1708-1714"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating real-time voice AI-based virtual patients for authentic communication training.","authors":"Wei Hu, Yi Zuo, Qifeng Wan, Jinyu Zhou, Liqin Yuan, Shalong Wang","doi":"10.1080/0142159X.2026.2645021","DOIUrl":"10.1080/0142159X.2026.2645021","url":null,"abstract":"<p><strong>Introduction: </strong>Effective communication is essential in clinical training, yet opportunities for realistic and interactionally authentic practice remain limited. Standardized patients (SPs) provide realism but are resource-intensive, whereas virtual patients (VPs) offer scalability but have limited capacity to reproduce responsive, interactionally authentic dialogue. Recent advances in generative artificial intelligence (AI), particularly real-time voice models, have opened new possibilities for natural and synchronous dialogue in virtual simulations. To evaluate whether a real-time voice-based virtual patient (RT-VP) can achieve communication performance, perceived realism, and self-efficacy outcomes comparable to SP training, thereby addressing the global challenge of scalable, authentic communication training.</p><p><strong>Methods: </strong>The RT-VP was developed on the Doubao real-time voice generative AI platform, which supports synchronous, bidirectional spoken interaction. In a randomized controlled study, 134 residents were assigned to RT-VP, standardized-patient (SP), or peer role-play (PR) groups. All groups received identical SPIKES-based instruction and practiced in their assigned simulation modality. Outcomes included communication performance, self-efficacy, and perceived realism.</p><p><strong>Results: </strong>Post-training SPIKES scores were highest for SP (26.6 ± 3.0), followed by RT-VP (24.9 ± 2.9) and PR (20.4 ± 4.3) (<i>p</i> < .001). Both SP and RT-VP outperformed PR (<i>p</i> < .001), and the difference between SP and RT-VP did not reach statistical significance (<i>p</i> = .06). Perceived realism generally followed an SP > RT-VP > PR pattern, with RT-VP demonstrating comparable linguistic realism to SP, while SP remained superior in contextual, emotional, and engagement realism.</p><p><strong>Discussion: </strong>This study represents, to our knowledge, the first controlled comparison of real-time voice generative AI-based VPs and SP encounters in communication training. RT-VP simulation approximated SP-level communication performance and perceived authenticity while offering scalability and consistency. Real-time voice simulation offers a scalable means to expand access to emotionally authentic communication training worldwide.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1737-1746"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing costing methodology in Health Professions Education: A state-of-the-art review and research agenda.","authors":"Jennifer Yaros, Mirjam Oude Egbrink, Silvia Evers, Aggie Paulus","doi":"10.1080/0142159X.2026.2697869","DOIUrl":"10.1080/0142159X.2026.2697869","url":null,"abstract":"<p><strong>Introduction: </strong>Despite three decades of research, costing methodology in health professions education (HPE) remains fragmented, limiting the production of consistent, interpretable, and decision-relevant cost evidence. As HPE institutions face increasing pressure to allocate limited resources effectively, robust cost evidence is needed to support cost-conscious decision-making. This study synthesizes persistent methodological challenges in HPE costing and proposes a research agenda to support more transparent, interpretable, and contextually responsive methodology.</p><p><strong>Methods: </strong>A state-of-the-art review was conducted to 1) chart key developments in HPE costing methodology, 2) synthesize recurring methodological challenges across contemporary cost literature, and 3) develop a research agenda. All publication types addressing costs of designing, developing, implementing, and evaluating HPE were eligible if they reflected methodological challenges in cost research. Challenges were synthesized across nine established phases of economic research: study design, perspective, time horizon, identification, measurement, valuation, reporting, comparability, and quality appraisal. Insights from the historical overview and synthesized challenges informed a research agenda.</p><p><strong>Results: </strong>Development of HPE costing methodology has progressed through two parallel streams: domain-specific frameworks and broader conceptual guidance. Limited integration across these approaches contributes to persistent fragmentation. Challenges were identified across all nine phases of cost research, including inconsistent cost definitions, difficulty separating educational and clinical costs, limited data sources, and limited operational guidance for identifying, measuring, valuing, and reporting costs. These findings informed a research agenda outlining priorities to support more transparent, interpretable, and contextually responsive costing methodology.</p><p><strong>Discussion: </strong>Methodological fragmentation in HPE cost research reflects not only uneven methodological development, but also the conceptual, structural, and operational complexities of examining costs across diverse HPE contexts. The resulting research agenda identifies priorities to strengthen methodological foundations through improved transparency, shared methodological resources, and context-sensitive application. Addressing these gaps may support production of rigorous, interpretable, and decision-relevant cost evidence in HPE.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1804-1819"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}