Perspectives on Medical Education最新文献

{"title":"Reducing the Number of Distractors in Multiple-Choice Questions: A Randomized Study in Undergraduate Medical Education.","authors":"Patricia Sunsundegui, Marcos Llorente-Ortega, Felipe Lucena, Nerea Fernández-Ros, Maite Solas, Ana Belén Alcaide, Manuel F Landecho, Jorge Quiroga, Mercedes Iñarrairaegui, José Ignacio Herrero","doi":"10.5334/pme.2583","DOIUrl":"https://doi.org/10.5334/pme.2583","url":null,"abstract":"<p><strong>Background: </strong>Multiple-choice questions (MCQs) are widely used in medical education due to their efficiency and scalability. However, the quality of distractors plays a critical role in item validity. Evidence suggests that reducing distractors may enhance psychometric performance without compromising assessment quality.</p><p><strong>Methods: </strong>We conducted a randomized study involving 198 MCQs used in second-year medical exams at the University of Navarra. Each exam included 50 items with two distractors and 50 with three distractors. Items were analyzed for difficulty index, point-biserial coefficient, low-functioning distractors, item-writing flaws, and overall quality (difficulty index 0.45-0.75 and point-biserial > 0.20). In addition, items were classified as either factual recall or clinical case-based to assess the effect of question type. Univariate and multivariate analyses were performed.</p><p><strong>Results: </strong>No significant differences were found between two- and three-distractor items in terms of difficulty, discrimination, or overall quality. However, items with two distractors presented fewer item-writing flaws (60.2% versus 46%; p = 0.045) and more frequently all their distractors were functional (38.8% versus 18%; p = 0.01). Factual questions were easier and more likely to contain poor distractors, while clinical-case items were more complex and discriminative. Multivariate analyses confirmed that distractor quality, not quantity, was the main factor associated with item performance.</p><p><strong>Conclusions: </strong>Multiple-choice questions with two well-constructed distractors are a valid and efficient alternative to traditional formats. Reducing the number of distractors improves distractor quality and reduces writing flaws, without compromising psychometric standards. These findings support a shift toward more streamlined item formats in medical education assessment.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"372-380"},"PeriodicalIF":3.9,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13109911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Safety in Anticoagulation: Implementing Safety-II and FRAM in the Medical Curriculum.","authors":"Lauren S Baidjoe, Liselotte M van Dijk, Mirjam Simoons, An Tran, Marieke J H A Kruip, Jorie Versmissen, Floor van Rosse","doi":"10.5334/pme.2277","DOIUrl":"https://doi.org/10.5334/pme.2277","url":null,"abstract":"<p><p>Medication safety is a cornerstone of patient care, yet traditional error-focused approaches often limit learning opportunities in healthcare. While Safety-I focuses on identifying the root cause of the problem, Safety-II adds the dimension of adaptability and resilience of health care professionals in complex environments. This paper describes an innovative educational intervention aimed at integrating Safety-II, the Functional Resonance Analysis Method (FRAM) and anticoagulation management into an existing medication safety course within the Erasmus University medical curriculum. The course, designed for master's-level medical students, uses Safety-II to analyze everyday clinical successes and to deepen understanding of anticoagulation processes in perioperative care. Students engage with clinical cases, create FRAM models, and reflect on their experiences during clerkships, which enhances their ability to recognize system strengths and adapt to complex situations. Teaching strategies such as 'flipped classroom' and 'just-in-time teaching' were incorporated, aligned with the medical curriculum, and enhanced active learning. Early implementation cycles led to iterative refinement of the course materials, informed by student and stakeholder feedback, as well as learning analytics. The course was successfully integrated into the medical curriculum, and our vision has since extended beyond the next generation of medical doctors. The Safety-II course has also been implemented into our cross-disciplinary education for healthcare professionals in specialist training. By integrating Safety-II thinking into various healthcare disciplines, we strive to contribute to a culture of safer, more resilient care, ensuring that adaptability and continuous learning are prioritized in all aspects of patient safety.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"1-9"},"PeriodicalIF":3.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13068099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"It's Not Just About the Tools: Emotionally Responsive GenAI Education.","authors":"Anita Samuel, Jerusalem Merkebu","doi":"10.5334/pme.2280","DOIUrl":"https://doi.org/10.5334/pme.2280","url":null,"abstract":"<p><strong>Background & need for innovation: </strong>Generative artificial intelligence (GenAI) is rapidly entering health professions education, yet most training emphasizes tool use and ethical guidelines while neglecting emotional readiness. Educators often experience affective discomfort, such as a fear of obsolescence, uncertainty about the ethical use of GenAI, and threats to their professional identity, which can undermine their engagement with GenAI. Few professional development models offer structured support to address these barriers.</p><p><strong>Goal of innovation: </strong>To show that emotional readiness is not a secondary concern but the central determinant of GenAI adoption.</p><p><strong>Steps taken for the development and implementation of innovation: </strong>We conducted a six-week, fully online, asynchronous course titled AI in Health Professions Education for healthcare professionals that integrated two core innovations: (1) an emotionally responsive, learner-centered environment and (2) a structured assignment framework, FAIR-Familiarization, Application, Interpretation, and Recalibration. The course prioritized emotional safety, instructor vulnerability, and learner agency to support educators through identity disruption and build reflective engagement with GenAI.</p><p><strong>Outcomes of the innovation: </strong>Three cohorts (N = 40) participated in the course. Pre-course surveys revealed a mix of experience with GenAI and a wide range of emotional responses, including fear, excitement, and apprehension. Thematic analysis of end-of-course reflections showed a shift from anxiety to confidence and from resistance to leadership. Participants reported using GenAI tools in teaching, curriculum design, and faculty development. Six-month follow-up interviews (n = 5) demonstrated sustained tool use and institutional dissemination. Learners described themselves as change agents and expressed a commitment to supporting peers in the adoption of GenAI.</p><p><strong>Critical reflection: </strong>This approach shifted learners from apprehension to leadership, proving emotional safety is key to GenAI adoption. Key pitfalls are the high instructor resource intensity and the entanglement of the FAIR framework and emotional design. We argue that this entanglement is the innovation, and emotional safety is the necessary precondition for the framework's success.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"356-362"},"PeriodicalIF":3.9,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13068100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whose Voice is it Anyway? <i>Artificial Intelligence and the New Crisis of Authenticity in Medical Education</i>.","authors":"Jessica Maher, Anna Byszewski, Heather Lochnan","doi":"10.5334/pme.2265","DOIUrl":"https://doi.org/10.5334/pme.2265","url":null,"abstract":"<p><p>Generative artificial intelligence (AI) has entered the spaces of reflection and narrative learning in medical education, spaces once defined by authenticity, introspection, and human voice. This Eye Opener examines tensions identified through a recent survey of undergraduate medical students and their ePortfolio physician coaches at the University of Ottawa regarding the use of AI in reflective writing. While the student response rate was notably lower (9.6%) than that of coaches (52.9%), this asymmetry prompted consideration of how the evaluative context of reflective writing may influence disclosure of AI use in voluntary surveys. Students who did respond described AI as a scaffold for idea generation and writing support, whereas coaches expressed unease, perceiving even limited AI use as a potential threat to authenticity. The resulting tension between pragmatism and preservation mirrors broader questions in medical education regarding reflective authorship and independent critical thinking. This moment invites reconsideration of reflection not solely as a written product but as a developmental process. Educators may need to move beyond detection toward dialogue that supports psychological safety, transparency, and shared understanding of authorship in the age of digitally assisted writing. Reflection has long been understood as a means of engaging with professional identity formation. The challenge now is determining how this process can remain meaningful as generative tools become increasingly embedded in learners' academic work.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"351-355"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting Basic Psychological Needs in Medical Education: A Patient Best Practice.","authors":"Adam Neufeld, Gregory Guldner","doi":"10.5334/pme.1928","DOIUrl":"https://doi.org/10.5334/pme.1928","url":null,"abstract":"<p><p>Physician burnout remains a pervasive challenge in medical education, with significant implications for both physician well-being and the quality and safety of patient care. Despite growing awareness and interventions, medical educators often lack a cohesive theoretical framework that explains how learning environments can contribute to both burnout and clinical performance. This article highlights Self-Determination Theory (SDT) as a robust, evidence-based lens through which to understand and address these challenges by emphasizing the fulfillment of three basic psychological needs: autonomy, competence, and relatedness. Drawing on foundational and contemporary research across health professions education and healthcare, the authors argue that supporting these needs within clinical learning environments not only enhances learner motivation, engagement, and resilience, but also reduces burnout and its downstream effects on empathy, decision-making, teamwork, and patient outcomes. The authors recommend integrating SDT principles into the structure of medical training through curricular design, assessment strategies, faculty development, and institutional policies that support high-quality motivation. They propose that psychological need support should be regarded as a patient best practice and position SDT not only as a wellness framework, but as a clinical quality framework for strengthening learner development, reducing harm, and promoting safe, compassionate, and effective care. Ongoing research, collaboration, and faculty development will be essential to advancing this work across medical education systems.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"343-350"},"PeriodicalIF":3.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning Away from Home. A Qualitative Study of General Practice Trainees' Educational Experiences in Hospitals.","authors":"Tine Lass Klitgaard, Jane Ege Møller, Signe Gjedde Brøndt, Flemming Randsbæk, Søren Prins, Trine Lignell Guldberg, Joachim Frølund Hansen","doi":"10.5334/pme.1981","DOIUrl":"https://doi.org/10.5334/pme.1981","url":null,"abstract":"<p><strong>Introduction: </strong>During general practice (GP) specialist training, trainees typically complete several hospital rotations to develop specific skills and manage a wide range of medical conditions. Previous research indicates that such rotations can also present challenges, including feelings of isolation and risk of burnout. However, little is known about how GP trainees themselves experience and navigate their learning in hospital settings. Understanding these perspectives is essential for designing supportive postgraduate training environments. This study therefore explored GP trainees' experiences of hospital rotations in Denmark.</p><p><strong>Methods: </strong>We conducted a qualitative study combining 38 hours of field observations following nine different GP trainees and ten group interviews with a total of 44 participants. Data were analysed using principles of reflexive thematic analysis.</p><p><strong>Results: </strong>GP trainees regarded hospital rotations as essential for developing competencies needed in general practice, yet they also described them as challenging to navigate. Through our analysis, we developed three overarching themes: 1) Finding meaning away from home; 2) Learning in frequent transitions; and 3) Working and learning at the margins.</p><p><strong>Discussion: </strong>Hospital rotations provide valuable learning opportunities, but their educational impact is shaped by how relevance is made explicit and how transitions are supported. For GP trainees, frequent hospital rotations combined with time away from general practice can create a form of double peripherality, making continuity and belonging fragile. Clear framing of learning objectives, structured rotation planning, and accessible peer and supervisor support are key to ensuring educational value and fostering continuity, belonging, and the development of GP professional identity.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"330-342"},"PeriodicalIF":3.9,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Listen and You Shall Hear: Lessons from Theology and Pastoral Care.","authors":"Lavjay Butani","doi":"10.5334/pme.2052","DOIUrl":"10.5334/pme.2052","url":null,"abstract":"<p><p>Medicine is inherently a spiritual profession; patients and health care professionals both seek meaning and connections beyond just themselves, especially in the context of crises. Yet, the spiritual aspects of care have fallen to the wayside, with the commercialization of the business of health care. In this brief perspective, I integrate lessons from theology and pastoral care into a busy clinical and educational setting to help reclaim the moral dimensions of the care giving relationship.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"308-312"},"PeriodicalIF":3.9,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13025284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embedding Clinical Reasoning into an Undergraduate Medical Curriculum: A Multi-Stakeholder Perspective.","authors":"Martine Chamberland, Isabelle Boulais, Jean Setrakian, Linda Bergeron, Tim Dubé","doi":"10.5334/pme.2448","DOIUrl":"10.5334/pme.2448","url":null,"abstract":"<p><strong>Introduction: </strong>Medical educators agree on the importance of teaching clinical reasoning (CR) at the undergraduate level with a deliberate curricular approach. Despite recent recommendations on how to reach this objective, there are limited empirical data on how it unfolds once implemented. This study advanced the understanding of how a deliberately designed CR curriculum was experienced and contributed to students' CR development. Our study sought to add to the conversation on undergraduate CR curricula by providing data that could be relevant and applicable across other learning contexts.</p><p><strong>Methods: </strong>We conducted a qualitative descriptive study in the context of a competency-based medical program that is interdisciplinary, with spiral integration. Through nine focus groups, we sought the experience of curriculum designers, teachers, and students on how the CR curriculum embedded into the program contributes to students' CR development. Data were analyzed using a thematic approach.</p><p><strong>Results: </strong>We identified four overarching themes: 1- Global coherence of the curriculum around the development of CR; 2- Interdisciplinary integration to enhance CR development; 3-Cognitive load of students and pervasive time constraints; 4- Active teaching methods that promote the development of CR.</p><p><strong>Discussion: </strong>From the different stakeholders' perspectives, students acquired various knowledge types in CR domains and applied them to problem-solving. Stakeholders' experiences with the implemented CR curriculum matched the initial intent but presented some challenges as well. These findings underscored both the feasibility and the complexity of embedding CR within an undergraduate medical curriculum. Careful attention is required to support students and teachers.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"313-321"},"PeriodicalIF":3.9,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13025282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Medical Students Negotiate Their Roles in the Figured World of Curriculum Co-Creation: A Longitudinal Qualitative Study.","authors":"Emmanuel Tan, Jennifer Cleland, Jessica Ang, Russell Yap, Siew Ping Han","doi":"10.5334/pme.2538","DOIUrl":"10.5334/pme.2538","url":null,"abstract":"<p><strong>Introduction: </strong>Co-creation, where students and faculty partner to develop curricular materials and learning, is increasingly recognised for its potential to enhance student engagement, ownership, and inclusivity. However, little is known about how students experience and navigate co-creation partnerships. Understanding this process is essential to maximise understanding of, and gains from, student-faculty partnerships. To address this gap, we explored how medical students navigate their roles and boundaries within the process of co-creation.</p><p><strong>Methods: </strong>This is a longitudinal, qualitative study, informed by a constructivist worldview. We conducted 15 semi-structured interviews with five students across three timepoints and collected supplementary data from students' reflective writing. Initial data analysis was thematic and iterative. We then used Figured Worlds theory to explore how co-creation enabled medical students to author identities, negotiate positionalities, and engage in world-making.</p><p><strong>Results: </strong>We identified three main themes. Students wanted to contribute but had to negotiate legitimacy with faculty within the co-creation figured world. They authored new identities as curriculum stakeholders, moving beyond learner advocacy to engage with broader curricular perspectives. They had to navigate tensions at the boundaries between being learners, collaborators, and future doctors, whilst negotiating constraints imposed by institutional structures and power relations.</p><p><strong>Discussion: </strong>Students authored identities as advocates, collaborators and aspirational future doctors, and moved across multiple figured worlds during the co-creation process, negotiating identities and the tensions that emerged through this process.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"322-329"},"PeriodicalIF":3.9,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13025288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Learning Culture Influences the Survivability of an Online Feedback Tool.","authors":"Su Ann Khoo, Yang Yann Foo, Lorelei Lingard, Arif Tyebally","doi":"10.5334/pme.2166","DOIUrl":"10.5334/pme.2166","url":null,"abstract":"<p><strong>Introduction: </strong>Many online tools and innovations exist to support feedback, but their survivability has not been well-studied. This study explores the influence of learning culture on the adoption, utilization and long-term impact of an online written feedback tool among faculty. The study aims to inform strategies for effective implementation of such tools and guide faculty development within the clinical learning environment.</p><p><strong>Methods: </strong>Utilizing constructivist grounded theory, we conducted semi-structured interviews among ten clinical faculty with supervisory roles and experience in giving medical trainees feedback via an online feedback tool. Using an iterative analytic approach, we identified key propositions to derive an in-depth understanding between learning culture (LC) and the \"survivability\" of the online feedback tool.</p><p><strong>Results: </strong>Several socio-cultural factors within the LC have affected the survivability of the feedback tool beyond its development and implementation. Firstly, the lack of a support system exacerbated the burden of clinical teachers. Next, the misapprehension about written feedback and low psychological safety undermined the tool adoption. Lastly, the lack of appreciation towards the importance of a strong feedback loop further reduced the tool's survivability.</p><p><strong>Conclusion: </strong>The development and implementation of online tools in health professions education should take into consideration factors influencing the survivability of the tool. The exploration from a socio-cultural perspective has provided insights to ensure that future online feedback tools and interventions actually survive the test of time and the complexities embedded in the clinical learning environment.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"296-307"},"PeriodicalIF":3.9,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13025158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}