Medical Teacher最新文献

{"title":"Development and feasibility of an AI-driven immediate feedback system for observation-based clinical placements: A design-based research study.","authors":"Yuzuru Itoh, Hayato Kedoin, Shun Sugisawa, Takumi Nirengi, Yuji Sato","doi":"10.1080/0142159X.2026.2733152","DOIUrl":"https://doi.org/10.1080/0142159X.2026.2733152","url":null,"abstract":"<p><strong>Introduction: </strong>Reflection is essential for professional development in clinical education; however, students in early-stage observation-based clinical placements may adopt passive learning approaches, while limited supervisory capacity can restrict timely, individualized formative feedback. This study aimed to develop an artificial intelligence (AI)-driven immediate feedback system for daily reflective notes, examine its feasibility, and explore short-term patterns in rubric-based reflective writing.</p><p><strong>Methods: </strong>Using a design-based research framework, we implemented the system with 89 undergraduate students in a judo therapy program during a four-day observation-based clinical placement. Students submitted daily reflective notes, completed rubric-based self-assessments, and received AI-generated rubric scores and feedback within one minute. Feasibility was assessed using system performance, submission and completion rates, and student perceptions. As an exploratory external check, 120 reflective notes from 30 randomly selected students were independently rated by three blinded clinical educators using the same rubric.</p><p><strong>Results: </strong>All 356 system requests were processed successfully. Daily reflective note submission rates exceeded 98%, and self-assessment completion rates exceeded 95% on all days. AI-generated total scores increased from Day 1 to Day 2 and remained at similar levels thereafter. Blinded human ratings showed a moderate rank association (Spearman's ρ = .495) but limited absolute agreement (intraclass correlation coefficient = .399) with AI-generated total scores. The early increase in AI-generated total scores was not reproduced in human total ratings, although human ratings of observational specificity increased from Day 1 to Day 4. Student questionnaire responses indicated favorable perceptions of the system's usability and feedback.</p><p><strong>Discussion: </strong>The system showed stable operation and high student engagement, supporting its feasibility for providing timely, rubric-based formative feedback under clinical educator oversight. However, AI-generated scores should be interpreted as system-internal indicators rather than independent evidence of educational improvement. Further controlled studies using external outcome measures are required.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1-10"},"PeriodicalIF":4.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990560","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":"Shame and its impacts beyond the west: A mixed-methods study of Japanese medical students.","authors":"Hirohisa Fujikawa, William E Bynum, Anthony R Artino, Hirotake Mori, Kayo Kondo, Yuji Nishizaki, Takashi Watari, Hitomi Kataoka, Toshio Naito","doi":"10.1080/0142159X.2026.2733147","DOIUrl":"https://doi.org/10.1080/0142159X.2026.2733147","url":null,"abstract":"<p><strong>Introduction: </strong>Shame is a deeply uncomfortable self-conscious emotion that can influence learning and identity. Empirical evidence on shame in health professions education is largely derived from Western contexts. We aimed to examine the prevalence of shame experiences among Japanese medical students, their associations with key outcomes, and the contextual meanings.</p><p><strong>Methods: </strong>From November to December 2025, we conducted a nationwide, cross-sectional, convergent mixed-methods study across eight medical schools. Shame frequency was assessed with an online survey using the Shame Frequency Questionnaire (SFQ), along with burnout and belongingness using previously published scales with validity evidence, and an open-ended item on leaners' shame experiences and impacts. Descriptive statistics and multivariable regression analyses were conducted, along with inductive content analysis of narrative responses.</p><p><strong>Results: </strong>1030 students provided quantitative data and 533 provided free-text responses. Mean and median SFQ scores were 2.39 and 2.17 of 6, respectively. On adjustment, shame frequency was higher in women than men, and lower in private than national university students. Higher frequency was associated with higher odds of burnout and lower odds of belongingness. Content analysis generated 587 codes, most reflecting shame experiences. Reported shame experiences were most frequently linked to academic performance, particularly examinations, as well as context-specific experiences, including perceived lack of aspiration and past <i>ronin</i> student (i.e. student retaking the entrance exams) experiences. Reported impacts included professional identity formation crisis, sometimes with positive transformation through deliberate self-improvement.</p><p><strong>Discussion: </strong>In this non-Western undergraduate medical education sample, shame experiences were relatively prevalent; varied across learner and institutional characteristics; and were associated with burnout and sense of belonging. Qualitative findings identified examination-centered triggers, Japan-specific experiences, and impacts on developing professional identity. Our findings extend empirical evidence on shame beyond Western contexts and inform future research and educational initiatives to address shame.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1-13"},"PeriodicalIF":4.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983163","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":"From ableist to disability-conscious admissions in medical education.","authors":"Reza Bidaki, Sara Heydari","doi":"10.1080/0142159X.2026.2733146","DOIUrl":"https://doi.org/10.1080/0142159X.2026.2733146","url":null,"abstract":"","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1"},"PeriodicalIF":4.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148970103","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":"Unknown unknowns in medical education: Artificial intelligence and Jevons' paradox.","authors":"Keith Rui Yi Lee","doi":"10.1080/0142159X.2026.2733142","DOIUrl":"https://doi.org/10.1080/0142159X.2026.2733142","url":null,"abstract":"","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1"},"PeriodicalIF":4.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148970031","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":"Beyond rationality: How postgraduate medical trainees make specialty career decisions-a multi-center Q-methodology study.","authors":"Wei-Chen Chen, Sze-Yuen Yau, Shiuan-Ruey Yu, Chang-Chyi Jenq, Chien-Da Huang, Yu-Che Chang, Chung-Hsien Chaou","doi":"10.1080/0142159X.2026.2718844","DOIUrl":"https://doi.org/10.1080/0142159X.2026.2718844","url":null,"abstract":"<p><strong>Introduction: </strong>Specialty selection is a formative, identity-defining process in early medical careers, yet most studies emphasize demographic and structural predictors while paying less attention to how trainees interpret, prioritize, and integrate competing influences when making specialty decisions.</p><p><strong>Methods: </strong>This multi-center Q-methodology study involved 30 postgraduate year (PGY) trainees from four teaching hospitals in Taiwan. Participants completed Q-sorts of 40 statements and brief post-sort interviews. Principal components analysis with varimax rotation identified shared viewpoints, which were interpreted abductively and examined through the lens of the Trilateral Model of Adaptive Career Decision-Making (rational analysis, intuitive judgment, and career engagement).</p><p><strong>Results: </strong>Three distinct viewpoints were identified: Idealistic Achievers with a Patient-Centered Focus, oriented toward professional meaning and patient impact; Strategic Planners with a Practical Outlook, oriented toward financial considerations and future career opportunities; and Lifestyle-Oriented Realists with a Procedural Interest, who prioritized procedural work alongside work-life balance. Rather than representing separate decision-making processes, each viewpoint reflected a different configuration of rational analysis, intuitive judgment, and career engagement, shaped by both trainees' personal values and the structural realities of the healthcare system.</p><p><strong>Discussion: </strong>Specialty decision-making reflected different configurations of these three processes rather than a single decision-making approach. Recognizing these differences may support more individualized career guidance and postgraduate educational design.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1-12"},"PeriodicalIF":4.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912316","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":"Assessment accuracy and accommodation trustworthiness.","authors":"Lisa M Meeks, Judith Brenner, Joanna Arnold","doi":"10.1080/0142159X.2026.2726819","DOIUrl":"https://doi.org/10.1080/0142159X.2026.2726819","url":null,"abstract":"","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1"},"PeriodicalIF":4.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912043","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 realist review of the remediation of professionalism lapses in undergraduate medical students (RESTORE 3).","authors":"Ross Raymond-Jones, Nicola Brennan, Marie Bryce, Thomas Gale, Tristan Price","doi":"10.1080/0142159X.2026.2718311","DOIUrl":"https://doi.org/10.1080/0142159X.2026.2718311","url":null,"abstract":"<p><strong>Introduction: </strong>Professionalism is a core element of medical curricula worldwide and remains a cross-cutting theme across all aspects of a medical programme. When a medical student fails to demonstrate the expected attributes and behaviours, medical schools have a duty to step in, and where appropriate, offer remediation that aims to facilitate behavioural change. There is sparse explanatory theory on this complex topic, resulting in little evidence-based guidance for medical schools to utilise. This review aims to explain how, why, to what extent and in what circumstances professionalism remediation works for undergraduate medical students.</p><p><strong>Method: </strong>We conducted a realist review that aligns with the RAMESES standards and Pawson's 5 step process. We searched databases (MEDLINE, EMBASE, ERIC and BEI) and carried out forward/backward citation and grey literature searches. Any studies, of any design, from any country that included data related to professionalism remediation of undergraduate medical students was included. Data was extracted and mapped to an existing theory to confirm, revise or refute its context-mechanism-outcome configurations (CMOc's) and devise new CMOcs using a realist logic of analysis.</p><p><strong>Results: </strong>A total of 76 records were included. Publications ranged from 1994 to 2024 and originated mainly from North America and the UK. A realist programme theory was developed, comprising of 27 CMOcs, that explain the remedial cycle from insight to motivation, to sustained engagement and behavioural change, further interacting with three further domains; remediation processes, communication and the integral role of trust/safety.</p><p><strong>Discussion: </strong>This review provides the first theory-driven model of medical undergraduate professionalism remediation. It has highlighted the interconnectedness of the systems surrounding the remediation interventions, their impact on behaviour, including the phenomenon of students 'gaming the system'. We have developed practical and implementable recommendations aimed at supporting those staff involved in facilitating student behaviour change to align with professional standards.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1-16"},"PeriodicalIF":4.0,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906704","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":"The role of medical residents' peer networks in clinical decision making: A constructivist grounded theory study.","authors":"Matthew Clifford-Rashotte, Laura Nimmon","doi":"10.1080/0142159X.2026.2628949","DOIUrl":"10.1080/0142159X.2026.2628949","url":null,"abstract":"<p><strong>Introduction: </strong>The literature exploring how and why medical residents seek clinical advice has centered the formal resident-supervisor relationship, with the informal role of peers remaining underexplored.</p><p><strong>Method: </strong>Using constructivist grounded theory (CGT) methodology, we purposively sampled Internal Medicine/General Internal Medicine residents from a Canadian medical school from April-June 2023. We conducted semi-structured interviews, exploring how and why advice was sought from peers. We analyzed data iteratively, incorporating critical theory into the analysis to attend to the role of hierarchy and agency shaping social processes around peer advice seeking.</p><p><strong>Results: </strong>Ten residents participated. Participants described peer advice seeking as a widespread phenomenon, usually performed without disclosure to supervisors. Peer advice was primarily sought in situations of clinical uncertainty, wherein patient safety was not felt to be immediately threatened. The psychological safety of peers allowed residents to exercise agency in their decision making and maintain credibility with their supervisors.</p><p><strong>Discussion: </strong>Participants in this study frequently seek advice from informal peer networks when navigating clinical uncertainty. Peer advice is used to manage uncertainty and to maintain credibility with supervisors. The ubiquity of peer advice seeking challenges the construct of 'progressive independence.' Future research can identify how supervisors may model and respond to peer advice seeking.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1515-1523"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180651","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":"'I don't know what I don't know': A qualitative study of medical students' self-assessment in a Hong Kong context.","authors":"Binbin Zheng, Qing He, Chin-Hsi Lin","doi":"10.1080/0142159X.2026.2630980","DOIUrl":"10.1080/0142159X.2026.2630980","url":null,"abstract":"<p><strong>Introduction: </strong>Self-assessment (SA), a crucial psychological process in education, involves learners judging whether they meet their own identified standards. SA is a multi-dimensional construct shaped by various factors, including individual, contextual, and cultural influences. This cross-sectional study aims to explore how medical students develop and enact SA across training stages within an East Asian educational context, with particular attention to multilevel influences.</p><p><strong>Methods: </strong>Conducted at a Hong Kong medical school, this study involved one-on-one semi-structured interviews with medical students at different stages of training. Interview focused on students' SA practices and the factors influencing their development across different stages of training. Data were analyzed using thematic analysis, informed by the social ecological model, through iterative coding and interpretation.</p><p><strong>Results: </strong>Interviews with 26 medical students across preclinical and clinical training stages revealed four interrelated levels influencing SA practices: individual level-perceived value, emotional, motivational factors, professional identity, and subconscious reflection; interpersonal level-teacher feedback, peer interaction, and patient feedback; institutional level-curriculum structure, frequency and format of assessments, a supportive environment, and alignment of teaching and learning objectives; and societal level-collectivist cultural norms, humility, and local academic expectations. Additionally, students recognized SA as both a cognitive and emotional regulatory process, shaped by culturally mediated norms around self-evaluation, feedback interpretation, and performance comparison.</p><p><strong>Discussion: </strong>This study demonstrates that medical students' SA practices are shaped by interacting influences across individual, interpersonal, institutional, and societal levels, with cultural norms playing a structuring role rather than a peripheral one. By highlighting how commonly described SA processes operate differently in an East Asian context, these findings extend existing SA and SRL literature and underscore the importance of culturally responsive educational and assessment practices to support students' development of SA and lifelong learning.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1545-1560"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434155","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":"The prompt-powered worksheet: Transforming educators' generative AI trepidation into student learning tools.","authors":"Youngjin Cho, Colleen M Croniger, Maureen W McEnery, Ronaé McLin, Amy L Wilson-Delfosse","doi":"10.1080/0142159X.2025.2558903","DOIUrl":"10.1080/0142159X.2025.2558903","url":null,"abstract":"<p><p><b>What was the educational challenge:</b> Health professions educators face a challenge of leveraging generative AI to enhance learning while preventing passive engagement that undermines the critical thinking essential for patient safety. Faculty express concerns about AI fostering superficial understanding, yet many institutions lack appropriate pedagogical solutions. This challenge is compounded by variations in faculty AI expertise across institutions.<b>What were the solutions and how were these implemented:</b> We developed a prompt-powered worksheet that empowers faculty to create learning tools while preserving critical thinking skills when students use AI for learning. The worksheet guides faculty through sequential steps using predesigned prompts with their chosen chatbot as a brainstorming partner, eliminating the need for complex AI prompting skills while maintaining human expertise in pedagogical design.<b>Lessons learned and next steps:</b> Testing of the prompt-powered worksheet at an international workshop demonstrated the universal accessibility of the strategy regardless of prior AI experience. Educators shifted from viewing AI as a threat to embracing it as a creative collaborator. Our next step is to see if the worksheet helps students maintain critical thinking skills while also improving their learning outcomes when working with AI.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1439-1442"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138023","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}