Journal of Medical Education and Curricular Development最新文献

{"title":"Bridging Classroom Learning and Clinical Practice: A Model for Teaching Structural Competency in the Clinical Learning Environment.","authors":"Kristina Bridges, Hannah Maxfield, Ashley Glissman, Kalee Kirmer-Voss, Kate Rampon, Wendi Born, Laurel Witt","doi":"10.1177/23821205261450086","DOIUrl":"10.1177/23821205261450086","url":null,"abstract":"<p><strong>Introduction: </strong>: Structural competency is essential for teaching health professional students about the social and structural drivers of health (SSDoH) before they enter practice. While some curricula exist, most are classroom-based, and studies suggest that students also seek opportunities to practice these skills in clinical settings with real patients. This curriculum was developed to provide these opportunities.</p><p><strong>Methods: </strong>: To address this, we developed the Structural Influence of Health Project, an innovative curriculum within the required third-year Family Medicine Clerkship on the Kansas City campus of the University of Kansas School of Medicine. The program combines didactic seminars, interprofessional home visits, and structured faculty-led debriefs, allowing students to apply structural competency in real-world clinical contexts. Medical students (n=125) completed pre- and post-surveys, and 90 students provided written responses on how to improve the training. This sample size was based on the students enrolled in the Family Medicine clerkship in the 2021-2022 academic year.</p><p><strong>Results: </strong>: After being exposed to the curriculum, the students showed a significantly improved ability to identify social and structural contributors affecting patients' health. Students reported experiential learning opportunities, such as patient home visits, as valuable for applying SSDoH concepts in real-world settings. They appreciated the inclusivity of the curriculum but suggested that it should be more patient- and community-centered. Many have advocated for a shift from problem identification to actionable solutions, with practical approaches integrated into clinical discussions. Expanding the curriculum to include topics such as gender-affirming care, rural health disparities, and insurance challenges was recommended. Future directions may include more deliberate faculty development to allow greater skill with these difficult topics.</p>","PeriodicalId":45121,"journal":{"name":"Journal of Medical Education and Curricular Development","volume":"13 ","pages":"23821205261450086"},"PeriodicalIF":2.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professionalism in Practice: A Novel Approach to Integrating Small Doses of Case-Based Professionalism Education Into Monthly Grand Rounds.","authors":"Allison H Taylor, Andrew Caruso, Kelley Arredondo, Ellen M Friedman, Stacey R Rose","doi":"10.1177/23821205261449384","DOIUrl":"10.1177/23821205261449384","url":null,"abstract":"<p><strong>Introduction: </strong>Professionalism is a critical construct across the health professions, though learners and faculty report feeling underprepared to navigate difficult situations; education in professionalism is challenged by the absence of a universal definition, time constraints due to overcrowded curricula, and the lack of consistent messaging to learners and faculty.</p><p><strong>Methods: </strong>Professionalism in Practice (PiP) was developed to provide small doses (∼5 minutes) of case-based professionalism education as part of an existing educational forum (Grand Rounds) to optimize attendance of both learners and faculty. Each vignette highlighted a common professionalism challenge and was aligned with an AAMC professional competency. Sessions were facilitated by learners and faculty in the department, and introduced a consistent framework (i.e., pause, my perspective, other's perspective, collaboration) for navigating difficult situations.</p><p><strong>Results: </strong>Post-session survey respondents (n=153 across 11 sessions) indicated that vignettes were relevant (93% [n = 142/153] agreed or strongly agreed), and that participants intended to change behavior (70% [n = 120/151] agreed or strongly agreed) and use the PiP framework in future practice (90% [n = 45/50] agreed or strongly agreed). Open-text comments revealed specific planned behavioral changes, such as pausing when frustrated or avoiding biased language in documentation.</p><p><strong>Conclusions: </strong>PiP addresses known challenges in professionalism education by adding case-based teaching to an existing educational forum attended by both learners and faculty, and by using a consistent definition of professionalism and framework for approaching common challenges. The initiative is adaptable to other institutions seeking to incorporate small doses of professionalism teaching as part of routine educational practices.</p>","PeriodicalId":45121,"journal":{"name":"Journal of Medical Education and Curricular Development","volume":"13 ","pages":"23821205261449384"},"PeriodicalIF":2.0,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Hidden Preceptor: How AI Is Already Teaching Our Learners.","authors":"Samita M Heslin","doi":"10.1177/23821205261449662","DOIUrl":"10.1177/23821205261449662","url":null,"abstract":"<p><p>While Artificial Intelligence (AI) is being used increasingly by medical learners for studying and clinical decision-making, the educational impact of AI remains an opportunity for further discussion. This commentary introduces the concept of AI as a \"hidden preceptor\" that influences medical learners' approach to clinical reasoning, uncertainty, and professional identity. It draws on the concepts of hidden curriculum and clinical reasoning theory. The commentary argues that typically, AI demonstrates characteristics of speed, certainty, and pattern recognition, which can be counterproductive to the educationally desired outcomes of deliberate thinking, mechanical understanding, and reflective practice. Strategies are proposed to assist educators in making AI's pedagogy an explicit part of the educational process, and to enable learners to effectively engage with AI to promote, rather than hinder, their clinical growth and development.</p>","PeriodicalId":45121,"journal":{"name":"Journal of Medical Education and Curricular Development","volume":"13 ","pages":"23821205261449662"},"PeriodicalIF":2.0,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Performance-Based Rubric for Generative AI use in Medical Students' Research Tasks: Development and Initial Psychometric Evaluation.","authors":"Nino Shiukashvili, Mariam Rochikashvili, Vasil Kupradze, Nana Gonjilashvili, Nino Gvajaia, Luka Kutchava, Nona Janikashvili, Nino Tevzadze, Archil Undilashvili, Eka Ekaladze","doi":"10.1177/23821205261442106","DOIUrl":"10.1177/23821205261442106","url":null,"abstract":"<p><strong>Background: </strong>As generative AI becomes embedded in medical training, patient safety depends on graduates' ability to recognize AI limitations and bias, document AI involvement transparently, and verify AI-generated information rather than accept it uncritically. We developed a performance-based rubric to assess observable generative AI (LLM) literacy behaviors within authentic coursework.</p><p><strong>Methods: </strong>In a single-institution evaluation (Spring 2025), third-year medical students (<i>n</i> = 50 submissions) completed a structured research proposal and submitted the corresponding AI chat transcript and an AI-use disclosure. A four-domain rubric was developed through three pilot-revise cycles: AI Use Documentation, Prompt Generation, Verification, and Integration. Each domain was scored 0-3 (total 0-12). Three educators independently scored all submissions. Inter-rater reliability was assessed using ICC (average-measures, agreement). Construct-relevant patterns were examined via domain distributions (floor effects), performance bands (lower 25%, middle 50%, upper 25%), within-submission differences across domains (Friedman with Bonferroni-adjusted Wilcoxon tests), inter-domain associations (Spearman), and correlation with overall GPA (Spearman).</p><p><strong>Results: </strong>Mean (SD) domain scores were: AI Use Documentation 0.67 (1.08), Prompt Generation 1.33 (0.69), Verification 0.41 (0.71), and Integration 1.64 (0.67); total score 4.06 (1.80). Floor effects were substantial for AI Use Documentation (64% scored 0) and Verification (60% scored 0). Inter-rater reliability was high (ICC: Documentation 0.99, Prompt Generation 0.84, Verification 0.93, Integration 0.83). Verification was significantly lower than Prompt Generation and Integration (Bonferroni-adjusted <i>p</i> < 0.008). Inter-domain correlations were weak (<i>ρ</i> -0.206 to 0.310). Total scores showed no significant association with GPA (<i>r</i> = 0.194, <i>p</i> = 0.201).</p><p><strong>Conclusions: </strong>This rubric demonstrated strong scoring reliability and produced initial psychometric evidence consistent with measuring distinct, observable LLM-use competencies. Findings highlight prominent gaps in verification and transparent documentation, reinforcing competency guidance that emphasizes recognizing AI limitations and verifying AI output to protect patient safety. Further multi-site validation and implementation work is warranted.</p>","PeriodicalId":45121,"journal":{"name":"Journal of Medical Education and Curricular Development","volume":"13 ","pages":"23821205261442106"},"PeriodicalIF":2.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A National Oncology Fellows' Competition Advancing Clinical Research and Publication.","authors":"Joseph G Kattan, Tala A Najdi, Clarisse J Kattan, Elie F Nemr","doi":"10.1177/23821205261441379","DOIUrl":"10.1177/23821205261441379","url":null,"abstract":"<p><strong>Purpose: </strong>Encouraging research and scientific publication among oncology trainees is a central component of fellowship training, yet opportunities can be limited in resource-constrained settings. The Forum of Research in Oncology (FRON) was established in Lebanon in 2014 to foster clinical research skills, mentorship, and academic output among oncology fellows.</p><p><strong>Design: </strong>Initially held within a single institution, FRON expanded to include 6 medical schools across Lebanon and neighboring countries, thereby promoting national and regional collaboration. The competition's structure includes abstract submission, preselection, presentations, and evaluation by an expert jury.</p><p><strong>Results: </strong>Over the past decade, FRON has demonstrated a substantial positive impact on research productivity, with a marked increase in peer-reviewed publications, higher journal impact factors, and enhanced participation of fellows and students.</p><p><strong>Conclusion: </strong>Beyond measurable academic output, FRON participation has facilitated career advancement and fostered a culture of scientific inquiry by providing a structured, competitive, and mentorship-driven platform.</p>","PeriodicalId":45121,"journal":{"name":"Journal of Medical Education and Curricular Development","volume":"13 ","pages":"23821205261441379"},"PeriodicalIF":2.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ChatGPT-4.0 and Medical Students: A Recognition-Gated Comparative Evaluation on Image-Based Medical Examinations.","authors":"Andreas Sarantopoulos, Zoi Dorothea Pana, Andreas Larentzakis, Sophia Kondylis, Anna Maina, Nikolaos Ziogas, Dimitrios Ntourakis","doi":"10.1177/23821205261449387","DOIUrl":"10.1177/23821205261449387","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI), particularly large language models like vision-capable ChatGPT 4.0, is increasingly shaping medical education. While these systems show promise for automated feedback and adaptive assessments, their performance in visually intensive, image-based disciplines remains insufficiently studied.</p><p><strong>Objective: </strong>This cohort study aims to compare the performance of ChatGPT 4.0 and undergraduate medical students on standardized, image-based multiple-choice questions in Anatomy, Pathology, and Pediatrics. Standardized exams were administered to second-, third-, and fifth-year students, and the same questions were submitted to ChatGPT 4.0 using a two-step deterministic and stochastic protocol. Items with images that ChatGPT 4.0 failed to recognize were excluded. The statistical unit of analysis was the question, and all questions were analyzed as independent question-level observations within each domain. Paired t-tests or Wilcoxon signed-rank tests were used as appropriate, and subgroup analyses were restricted to questions with a discrimination index ≥ 0.1.</p><p><strong>Results: </strong>Of 90 questions, 52 were eligible for the primary comparative analysis after exclusion of items in which ChatGPT 4.0 failed image recognition. ChatGPT 4.0 significantly underperformed students in Anatomy (mean difference = -0.387, p < 0.00001, Cohen's d = 2.10) but outperformed students in Pediatrics (mean difference = +0.174, p = 0.00013, Cohen's d = 0.81); these findings were similar or stronger in discrimination-based subgroup analyses. No Pathology items were eligible for comparative analysis because ChatGPT 4.0 failed image recognition for all Pathology images; therefore, no inference about comparative downstream reasoning can be made for Pathology under this protocol. In the global end-to-end analysis, which scored image-recognition failures as incorrect, ChatGPT 4.0 accuracy was 17.3% in Anatomy, 84.9% in Pediatrics, and 0% in Pathology.</p><p><strong>Conclusion: </strong>These findings demonstrate marked variability in ChatGPT's visual reasoning across medical domains, underscoring the need for multimodal integration and critical evaluation of AI applications before adoption in image-dependent medical education settings.</p>","PeriodicalId":45121,"journal":{"name":"Journal of Medical Education and Curricular Development","volume":"13 ","pages":"23821205261449387"},"PeriodicalIF":2.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Perceived Confidence and Clinical Preparedness in Restorative Dentistry Among Undergraduate Dental Students.","authors":"Hazza A Alhobeira, Ahmed A Madfa, Teflah S Alhudayris, Noor M Alharthi, Abdullah F Alshammari","doi":"10.1177/23821205261449865","DOIUrl":"10.1177/23821205261449865","url":null,"abstract":"<p><strong>Background: </strong>Key goals of undergraduate dental education include developing clinical confidence and preparing students for practice. This is particularly important in restorative dentistry when students transition from preclinical simulation to real clinical procedures. Assessing students' perceptions of their own confidence offers important information about the efficacy of competency-based courses and clinical training.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among undergraduate dental students. A standardized, self-administered questionnaire was used to measure students' confidence. It assessed confidence in basic restorative skills, cavity preparation, and performing restorations on different tooth types. It also evaluated confidence in managing various restorative indications. A five-point Likert scale was used to gauge confidence. Descriptive statistics were computed, and Mann-Whitney U, Kruskal-Wallis, and chi-square tests were used to compare academic levels and gender, with significance set at p < 0.05.</p><p><strong>Results: </strong>Students reported high confidence in basic restorative procedures, particularly Class I cavity preparation (mean score >4.4/5). Female students showed greater confidence in controlling tooth coloration (p = 0.048), while no significant gender differences were observed in most procedures (p > 0.05). Confidence was generally higher for anterior than posterior restorations. Sixth-year students demonstrated the highest confidence in radiograph taking (p = 0.043) and local anaesthetic administration (p = 0.017), reflecting increased confidence with academic progression. Confidence in restoring different teeth improved significantly between the fourth and sixth years (p < 0.001). Significant improvements were also observed in complex (p = 0.006) and indirect restorations (p = 0.014). Most students (88.9%) reported that completing more restorative cases increased their confidence.</p><p><strong>Conclusions: </strong>Self-perceived confidence in restorative dentistry increased with advancing academic level and clinical exposure. Lower confidence in posterior and complex restorations indicates the need for additional clinical experience. Enhanced simulation training and structured feedback may help ensure graduates develop competence, confidence, and readiness for independent practice.</p>","PeriodicalId":45121,"journal":{"name":"Journal of Medical Education and Curricular Development","volume":"13 ","pages":"23821205261449865"},"PeriodicalIF":2.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13157581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Outpatient Resident Education Through Precepting Microskills: A Cross-Sectional, Observational Study.","authors":"Kartik Sidhar, Amy Runyon, Marie Claire O'Dwyer, Leigh Morrison, John Holkeboer, Anna McEvoy, Laura Crespo Albiac, Mercy Adetoye, Jenna Greenberg, Laura Lee, Jessica Barnes, Heidi Joshi, Ananda Sen, Jean Wong","doi":"10.1177/23821205261449399","DOIUrl":"10.1177/23821205261449399","url":null,"abstract":"<p><strong>Objective: </strong>Continuity clinics are a cornerstone of family medicine residency. The unpredictable nature of clinic limits the opportunity for formal education during a session. We developed a novel resident-faculty workshop using the 'One Minute Preceptor' model to teach five microskills of precepting. This cross-sectional, observational study evaluated the effectiveness of a single resident-faculty workshop in improving implementation of a systematic method of precepting.</p><p><strong>Methods: </strong>We conducted a 45-minute workshop during a quarterly resident and faculty meeting at a large academic family medicine residency. Faculty members and residents completed pre- and 2-month post-assessments measuring change in the five core precepting microskills over time. Independent T-tests were conducted to assess statistical significance between mean scores related to the core microskills of the pre- and post-group.</p><p><strong>Results: </strong>Post-intervention, participants were significantly (p<0.05) more likely to 'get a commitment' from their learner. The remaining four microskills had numerical improvements in mean scores in the post-intervention assessment but did not achieve statistical significance.</p><p><strong>Conclusion: </strong>This workshop led to improvement in incorporating one of the five microskills of precepting and showed that a brief educational session can be effective as an educational intervention for outpatient precepting.</p>","PeriodicalId":45121,"journal":{"name":"Journal of Medical Education and Curricular Development","volume":"13 ","pages":"23821205261449399"},"PeriodicalIF":2.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Student Learning in an Interprofessional Peer Shadowing Activity Embedded in an IPE Curriculum: An Aotearoa New Zealand Ethnographic Case Study.","authors":"Eileen McKinlay, Julia Myers, Linda Gulliver, Sonya Morgan","doi":"10.1177/23821205261448297","DOIUrl":"10.1177/23821205261448297","url":null,"abstract":"<p><strong>Background: </strong>Shadowing is described as an interprofessional education (IPE) learning activity where a student of one discipline shadows a registered health professional or student of another discipline. To date, research examining the educational effectiveness of the shadowing learning activity has largely focused on students shadowing registered health professionals. This study explores if and what students learn, and the factors that influence their learning, when they shadow students from other disciplines.</p><p><strong>Methods: </strong>This ethnographic, case study observational research used indepth analysis to undertake a fine-grained examination of interprofessional learning gained through student's peer shadowing of each other in a 5-week IPE programme in a rural setting.</p><p><strong>Results: </strong>Both the students who were shadowing and students who were being shadowed were observed to learn in the activity and this learning was multifaceted. It included learning about another discipline's roles, skills and philosophies and the different training programmes, as well as personal and professional concerns and also wider aspects of health care. Peer teaching resulted in active and sometimes reciprocal learning and students were for the most part confident and enthusiastic.</p><p><strong>Conclusions: </strong>Peer shadowing involving senior students of different disciplines where interaction and social engagement occur, promotes meaningful and comprehensive interprofessional learning, including enhancing understanding of interprofessional collaboration as well as other aspects of professional and social practice. It is important for educators to prebrief the students about the goals of peer shadowing and advise them to prepare themselves for the learning activity, but once done, incorporating peer shadowing within IPE curricula provides an effective learning activity in which all students benefit.</p>","PeriodicalId":45121,"journal":{"name":"Journal of Medical Education and Curricular Development","volume":"13 ","pages":"23821205261448297"},"PeriodicalIF":2.0,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13157537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying the Nedelsky Defensible Standard Setting Method in Undergraduate Obstetrics and Gynecology Assessment: A Cross-Sectional Study in a Resource-Limited Context.","authors":"Hieu Anh Bui, Vu Xuan Nguyen, Vy Thanh Thi Tran, Trang Khanh Nguyen Huynh, Hao Trong Nguyen","doi":"10.1177/23821205261447316","DOIUrl":"10.1177/23821205261447316","url":null,"abstract":"<p><strong>Background: </strong>Defensible standard setting is a cornerstone of competency-based medical education. However, many institutions still use arbitrary pass marks such as 50% without empirical justification. This study aimed to apply the Nedelsky method-a defensible, criterion-referenced standard setting approach-to determine the minimal passing score for the final examination of the Obstetrics and Gynecology (OBGYN) course at Pham Ngoc Thach University of Medicine, Vietnam, and to compare it with the conventional Cohen method.</p><p><strong>Method: </strong>A four-step Nedelsky procedure was implemented to establish a defensible passing standard for a 50-item multiple-choice examination administered to fourth-year medical students on December 3, 2022. Three trained assessors independently estimated the number of distractors that a minimally competent candidate (MCC) could eliminate for each question, from which the Minimal Passing Level (MPL) was calculated. Subsequently, a cross-sectional analysis was conducted on 808 students to determine the pass and fail rates using both Nedelsky and Cohen methods. Statistical comparison was performed using the McNemar's test for paired categorical data.</p><p><strong>Results: </strong>The mean MPL derived from three assessors was 65%, corresponding to 33 correct answers as the passing score. According to this standard, 183 of 808 students (23%) passed the examination, while 625 (77%) failed. In contrast, using the Cohen method (cut-off = 55%), 416 students (51%) failed. McNemar's test showed a statistically significant difference between the two methods (χ² = 207.0, p < 0.001), with moderate agreement (Cohen's κ = 0.47).</p><p><strong>Conclusion: </strong>The relative Cohen method underestimated the minimal competency threshold, resulting in a substantial \"failure to fail\" phenomenon. The Nedelsky method provided a more defensible, transparent, and evidence-based approach for setting pass standards in resource-limited medical education contexts. Adoption of defensible standard setting methods such as Nedelsky can enhance fairness, validity, and accountability in competency-based assessments.</p>","PeriodicalId":45121,"journal":{"name":"Journal of Medical Education and Curricular Development","volume":"13 ","pages":"23821205261447316"},"PeriodicalIF":2.0,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}