Background The rapid advancement of digital technologies has transformed healthcare delivery, creating an imperative for medical education to integrate digital health (DH) competencies into undergraduate training. Despite growing recognition of its importance, progress in embedding DH literacy within formal medical curricula has been uneven and slow.Objective This study examined DH education within an undergraduate medical programme by integrating faculty and student perspectives to identify curriculum development needs and inform evidence-based educational strategies.Design A mixed-methods study was conducted at a Singapore medical school offering a 5-year undergraduate curriculum. Semi-structured interviews were conducted with four faculty members as DH content experts, exploring curriculum design, pedagogical strategies, and competency expectations. A 24-item survey assessing knowledge, attitudes, and usage of DH tools was administered to students across pre-clinical and clinical training, with 131 responses from 848 eligible participants. Qualitative data were analysed using grounded theory-based thematic analysis, whilst survey data were analysed using descriptive statistics.Results Faculty interviews identified three key themes: curriculum gaps requiring more practical and clinically-oriented DH teaching, structural barriers including time constraints and rapid technological change, and complex stakeholder ecosystem influencing curriculum development. Student survey results revealed a persistent theory-practice gap across DH domains. Students reported high self-perceived knowledge in DH applications and artificial intelligence (AI) but consistently lower confidence in practical application, particularly in electronic health records (EHR) and telemedicine. Clinical students paradoxically rated their EHR knowledge lowest despite greater clinical exposure. Students expressed strong interest in programming, data analytics, and hands-on AI, favouring applied DH skills with direct clinical relevance.Conclusions Medical curricula struggle to translate DH conceptual knowledge into practice, reconcile divergent competency expectations between students and faculty, and remain current amid rapid technological change. Tiered competency models, coupled with experiential learning approaches and continuous faculty development, represent a promising strategy for preparing future physicians for digitally enhanced healthcare delivery.Clinical trial number Not applicable.
Introduction Disability inclusion in residency is essential to building a diverse and equitable physician workforce. Recent Accreditation Council for Graduate Medical Education requirements mandate that programs maintain formal disability policies and provide reasonable accommodations. However, residents with disabilities continue to face barriers, including stigma, complex documentation processes, and limited institutional infrastructure, challenges that differ from medical school settings. Specialty-specific data are necessary to identify gaps in inclusion, especially given that national data show higher rates of disability among trainees entering pediatrics. This pilot study reports the prevalence and accommodation practices of four pediatric residency programs.Methods In collaboration with the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network, we conducted the first pilot survey examining disability prevalence, disclosure patterns, and accommodation use among pediatric residents. The survey was distributed to four programs between April and October 2024. Data were analyzed descriptively, with Fisher’s exact tests used to examine group differences.Results Of the sixty-nine respondents, 36% self-identified as having a disability, more than triple the national average for residents with disabilities. ADHD, chronic health conditions, and psychological disabilities were the most reported. Fear of stigma and lack of documentation issues emerged as barriers to requesting accommodations. First-generation college graduates were significantly more likely to be unsure of their disability status.Discussion This pilot study provides preliminary and important insights into disability prevalence, disclosure, disability uncertainty, and accommodation use in pediatric residency programs. While these findings suggest encouraging rates of accommodation receipt among disabled residents, they also highlight stigma and uncertainty around disability identity and disclosure. Findings should be interpreted in the context of the small sample size, the self-selected participation of programs, and potential response bias.
Background Assessing and fostering social empathy among medical students is crucial for advancing health equity. While education on the social determinants of health (SDH) has become increasingly important in medical curricula, its impact has been evaluated mostly through qualitative approaches. Quantitative assessment tools that assess social empathy remain limited in medical education. The Social Empathy Index (SEI) is a self-report instrument designed to assess interpersonal and social empathy and may have relevance for medical education.Objectives This study aimed to examine the psychometric properties of the Japanese version of the SEI (SEI-J) among medical students and explore its potential application in medical education in Japan.Methods A total of 414 medical students from three academic years at a private medical school in Tokyo completed the SEI-J and a self-developed sociodemographic questionnaire. Confirmatory factor analysis was conducted to examine structural validity based on the original SEI framework. Internal consistency was assessed using McDonald’s omega coefficients. Known-groups validity was examined using one-way analysis of variance.Results Of the participants, 279 completed the survey (response rate 67.4%); 230 responses were included in the final analysis. Confirmatory factor analysis provided partial support for the original multidimensional structure of the SEI-J, and McDonald’s omega coefficients indicated acceptable to high internal consistency across subscales. Higher SEI-J scores were associated with female gender, volunteering or study-abroad experience, interest in the arts or literature, people-oriented specialty preference, and greater self-rated understanding of SDH, consistent with prior research.Conclusions The findings demonstrate that the SEI-J is a psychometrically valid and reliable tool for measuring social empathy. This study provides preliminary evidence supporting the applicability of the SEI in a Japanese medical education context, identifies factors associated with the development of social empathy, and offers an outcome measure that supports the evaluation and iterative improvement of SDH- and equity-oriented curricula.
PURPOSE:Gamification is widely adopted in medical education, but recent systematic reviews reveal ambiguous effects on learning outcomes. It remains unclear whether engagement translates to learning or whether game mechanics impose extraneous cognitive load. This quasi-experimental crossover study investigated gamification's impact on student performance and engagement in Team-Based Learning. METHOD:250 first-year MBBS students at a tertiary medical college (2024-2025) participated in two physiology modules (Central Nervous System, Endocrinology) using either traditional or gamified Group Readiness Assurance Tests (GRAT) in a crossover design. Primary outcomes were Individual Readiness (IRAT) and Application Exercise (AE) scores; secondary outcomes were engagement and satisfaction. RESULTS:Primary outcomes (IRAT and AE scores) did not differ significantly between formats. However, learning trajectory analysis revealed a potential mitigating trend: in Endocrinology, traditional groups showed significant IRAT-to-AE decline (-3.3 percentage points, p = 0.030, d = 0.19), whereas gamified groups' decline was non-significant (-1.9 pp, p = 0.124, d = 0.13).During the GRAT intervention phase, traditional teams outperformed gamified teams in Endocrinology (p = 0.006, d = 1.04), but not CNS (p = 0.43). Qualitative feedback was overwhelmingly positive (90% of responses), praising engagement and teamwork, though 13% cited time pressure as stressful. CONCLUSIONS:Gamification may enhance engagement and may provide a motivational buffer against performance decline in challenging content. This suggest gamification is a context-sensitive design choice requiring careful calibration to balance motivational benefits against cognitive costs.
BACKGROUND:As clinical practice provides >50% of medical schools' revenue, research-intensive medical schools often seek to retain fellows with clinical-care interests. Fellows' considerations when deciding whether to stay at research-intensive institutions where they trained remain understudied. We sought to identify experiential factors associated with faculty-position offers and decisions of fellows in training. METHODS:We conducted a mixed-methods study using a survey and semi-structured interview. We invited 471 fellows training in all clinical departments at our institution to complete an anonymous survey between April and June 2021 to examine their level of agreement (strongly disagree [1] to strongly agree [7]) with positive training and mentoring experiences and their academic-medicine career goals in association with being offered a position and, if offered, accepting or declining. After survey completion, we invited fellows for interviews about their decision-making to seek, accept, or decline post-fellowship faculty-positions as well as what our institution could do to encourage fellows to accept offered positions. RESULTS:We analyzed survey data from 168 (35.7%) fellows. Of 48 fellows who were offered faculty positions, 21 accepted and 27 declined; 56 fellows were not offered a position and 64 were too early in training to have received an offer. Fellows who were offered/accepted positions reported higher mean (SD) agreement with positive training (5.9 [1.2]; p < 0.02) and mentoring (6.1 [1.0]; p < 0.001) experiences and having academic-medicine career goals (5.8 [0.8]; p < 0.001) than fellows in other faculty-offer groups. In interviews, 24 fellows reported career goals and institutional resources as influencing decisions. Fellows described institutional opportunities for intervention, especially enhanced communication about institutional priorities and potential positions. CONCLUSIONS:Clear communication with clinical fellows about their academic-medicine career goals and fellowship-training and mentoring experiences can inform decision-making about faculty offers and better equip institutional leaders to retain fellows who align with institutional needs.
BACKGROUND:Large language models (LLMs) are increasingly used in higher education, but multi-country evidence on dental students' use, verification, and integrity practices is limited. OBJECTIVE:To compare senior dental students' LLM use, perceived time and academic impact, reliability judgements, verification practices, and integrity safeguards across five countries. METHODS:An anonymous cross-sectional online survey was administered to final-year dental students in the United Arab Emirates (UAE), Jordan, Malaysia, Oman, and Brazil. Measures included tools used, frequency and motivations, learning activities, perceived time and academic impact, verification frequency and strategies, guideline awareness, and integrity safeguards. Analyses used Kruskal-Wallis and chi-square tests with Benjamini-Hochberg adjustment, effect sizes, Spearman correlations, and ordinal logistic models. RESULTS:In total, 454 students participated (UAE 160, Jordan 101, Malaysia 75, Oman 62, Brazil 56; mean age 22.9; 74.9% female). ChatGPT predominated (95.9%), followed by Gemini, formerly Bard (18.0%), DeepSeek (16.4%), and Claude (7.4%). Tool diversity varied across country-based cohorts, with Oman showing greater multi-tool uptake. Use was frequent (several times/week 39.2%, daily 28.6%). Key motivations were saving time (73.0%), clarifying concepts (56.9%), and summarising (54.1%). Common activities included understanding complex concepts (75.3%), summarising lecture notes (70.0%), exam preparation (61.5%), and assignment research (53.2%); exam-time assistance was reported by 25.6%. Verification was 'always' 20.0% and 'often' 34.1%, varying across country-based cohorts, with Oman verifying less frequently than other cohorts. Guideline awareness was 40.3% overall (UAE 61.3% vs Brazil 8.3%). Integrity safeguards commonly involved paraphrasing (69.6%), citations (39.2%), and plagiarism checks (38.0%); disclaimers were uncommon (9.2%). LLM-use frequency correlated with broader academic use (ρ = 0.289) but not with integrity concern (OR = 0.963). CONCLUSIONS:LLM use is widespread and heterogeneous across settings, including non-trivial higher-stakes use. Dental programmes should implement explicit training in verification, evidence traceability, and disclosure, supported by clear, enforceable guidance and assessment designs aligned with real-world LLM practices.
Objective Aligning medical education curricula with standardized competency-based assessments is a multifaceted task that requires accuracy and consistency. While generative artificial intelligence (GenAI) models offer potential assistance, their performance compared to that of human subject matter experts remains unclear. This study investigates the consistency, accuracy, and strategies of human- and AI-generated alignments of pharmacological topics with the United States Medical Licensing Examination (USMLE) Step 1 content.Methods A comparative case study examined curricular alignment results produced by GenAI models and human experts. Agreement percentages and pairwise correlation coefficients were calculated to assess consistency and consensus within and between the two groups, highlighting similarities and differences in alignments. We also examined challenges, strategies, and the impact of time constraints on the alignment task.Results GenAIs exhibited higher inter-rater reliability in within-group comparisons, with exact agreement percentages ranging from 60% to 79% and stronger correlations. In contrast, human raters demonstrated greater variability, with exact agreement percentages between 14% and 66% and weaker correlations. While partial agreement improved alignment for both groups, GenAIs maintained higher overall consistency and consensus. On the other hand, only two human raters and all GenAI models exhibited high inter-rater reliability in between-group comparisons. GenAIs generated alignments based on contextual analysis and hierarchical mapping, while humans engaged in iterative refinement using their expertise and reflection. Time constraints had a minimal impact on GenAIs, whereas it was acknowledged as a limiting factor for human performance.Conclusion GenAIs can efficiently provide accurate and consistent alignments of pharmacological content in medical curricula but lack the sophisticated decision-making capabilities of human experts. While human alignments show variability due to human experts' diverse perspectives and backgrounds, trained experts make more contextually informed decisions. A conceptual model of Curricular Human-AI Teaming (Curricular HAT) could combine these complementary strengths to enhance the workflow and outcomes of curricular alignment. The model supports the transparency and scalability of human-AI collaboration while maintaining the responsibility of human judgment and ethical use of GenAI.
Background Following the change in 2022 of a scored United States Medical Licensing Examination (USMLE) Step 1 to a binary pass-fail grading system, greater emphasis has been placed on the Step 2 Clinical Knowledge (Step 2 CK) exam. Shelf or subject exams offered by the National Board of Medical Examiners (NBME) help prepare students for Step 2CK and therefore deserve the attention of clerkship directors. This paper reviews the literature pertaining to the factors that positively and negatively impact medical students' performance on the shelf exams, including but not limited to performance in the pre-clinical years, clinical exposures, peer learning, active or team-based learning, length of clerkships, and order and number of previous shelf exams.Methods The PubMed database was searched to identify studies describing factors influencing performance on shelf exam scores during medical school and strategies for improving shelf scores. Studies were identified through iterative searches using multiple keyword combinations related to NBME shelf examinations, NBME subject examinations, clerkship performance, academic achievement, and educational interventions. Inclusion criteria consisted of English-language studies published between 2005 and 2025 involving students at U.S. allopathic or osteopathic medical schools. The included studies were reviewed for relevance and methodological rigour, including consideration of study design, sample size, statistical analyses, and reported outcomes.Results A robust pre-clinical education remains vital for success on NBME shelf examinations. Exam scores are also influenced by the number and order of previous exams. Increased clinical exposure, active learning, team-based approaches, and peer review sessions have not consistently shown improvements in performance.Conclusions This review underscores the importance of a foundational understanding of the basic sciences for student success on exams, while acknowledging that clerkship directors must balance their obligation to adequately prepare students for standardized testing with their mission to craft compassionate and competent future clinicians.
Objectives It is critical to identify factors in the work environment that contribute to physician burnout to foster a professional culture that nurtures wellness. This study examined the prevalence of burnout symptoms among a group of Canadian pediatric undergraduate education leaders and explored how membership in a national community (Paediatric Undergraduate Program Directors of Canada, PUPDOC) may serve as a potential mitigating factor.Methods This mixed-methods study involved a survey and subsequent focus groups of PUPDOC members. Survey comprised questions from the Maslach burnout index (MBI) adapted for the educational context. Data were analyzed using descriptive statistics. A qualitative descriptive approach was selected and focus group transcripts were analyzed using content analysis. Themes were generated that relate to PUPDOC’s role in shaping members’ educational and academic work.Results Sixteen members completed the survey (16/23, 70%). On the traditional MBI screen, three of 16 participants scored high-risk for burnout, but none reported high levels of symptoms on the adapted questions. Eighteen members participated in focus groups. Themes were interrelated, and included the significance of a sense of community, strengths and stressors of the job, finding meaning in one’s work, opportunities, and legitimacy associated with belonging to a group.Conclusions Our small group of pediatric undergraduate education leaders demonstrated a relatively low burnout rate compared to published rates in physician colleagues. We propose a sense of community that transcends institutions may help to mitigate burnout. By encouraging membership in such organizations, academic institutional leadership can support resilience and invest in the wellbeing of their education leaders.
BACKGROUND:The recent reform of the second cycle of medical education in France introduced competency-based medical education (CBME) with the incorporation of several pedagogical modalities into undergraduate training and assessment, including objective structured clinical examinations (OSCEs), simulation-based teaching (SBT), and clinical reasoning (CR) instruction throughout the academic year. While these tools are central to preparing competent practitioners, their effective implementation depends on adequately trained educators. We hypothesized that training would be insufficient, notably in the recently introduced pedagogical modalities. METHODS:We conducted a national, cross-sectional survey (June-September 2023) to assess the level and adequacy of training of board-certified physicians practicing in critical care and involved in undergraduate teaching. An anonymous online questionnaire collected demographic data, teaching frequency, training characteristics, perceived adequacy and usefulness of training, preparedness, and barriers. The responses were analyzed descriptively and comparatively. RESULTS:Among the 151 eligible respondents (72% male, median age 41 years, 70% working in teaching hospitals, and 44% holding an academic position), lectures remained the most common teaching modality despite CBME implementation. Only 60% of the respondents reported involvement in OSCEs. Teachers' training rates across pedagogical modalities were low and heterogeneous: 32% for OSCEs, 30% for SBT, 29% for written assessment design, 24% for lectures, and 12% for CR. Training in the SBT was more often practical, longer in duration, and rated as more useful and adequate than training in other modalities. Overall, the respondents reported moderate preparedness and frequent teaching difficulties. Prior training was associated with higher perceived preparedness and fewer difficulties when teaching students. Lack of dedicated time was the most frequently reported barrier to training (69%). CONCLUSION:This national survey revealed insufficient and heterogeneous training of intensivist educators in all pedagogical modalities of the undergraduate curriculum. Trainers report limited preparedness and frequent challenges. Standardized, accessible, and time-protected faculty development programs are urgently needed to support CBME education.
BACKGROUND:Among Hispanic undergraduate students, the association between research-related coursework and research interest remains largely underexplored. This exploratory study examined differences in research interest among undergraduate nursing students according to their exposure to research-related coursework, drawing on Social Cognitive Career Theory. METHODS:A cross-sectional study was conducted with 106 nursing students from a Peruvian university. Participants completed the Interest in Research Questionnaire (IRQ), which demonstrated excellent internal consistency (α = 0.98). Research interest was compared across four academic-semester groupings reflecting proximal and distal exposure to research-related coursework using rank-based nonparametric methods. RESULTS:Significant differences in research interest were observed across groups (Anderson-Darling test = 9.41, p = 0.001), indicating a curvilinear pattern. Students currently or recently exposed to research-related coursework (levels 2 and 4) reported significantly higher research interest than those with more distal exposure (level 3; p < 0.05; medium effect sizes). First-semester students showed research interest levels comparable to those of the proximally exposed groups. CONCLUSION:Research interest may decline in the absence of sustained engagement in research activities, underscoring the importance of early and continuous integration of research experiences throughout undergraduate nursing curricula. The findings also provide initial evidence supporting the use of the IRQ in Spanish-speaking undergraduate contexts.
Background The heart is commonly introduced in early medical education through its structural, mechanical, and electrophysiological roles. Although this framing remains foundational, it may underemphasize the heart’s endocrine functions. Cardiac endocrine signaling, particularly natriuretic peptide physiology, offers a concise structure-function example linking anatomy, histology, cardiovascular physiology, and clinical biomarker interpretation.Objective To synthesize scientific and educational principles of cardiac endocrine function and propose an anatomy-anchored framework for integration into pre-clerkship medical education.Methods A librarian-assisted narrative review was conducted in May 2025 using representative literature from PubMed, Google Scholar, and Scopus, supplemented by historical, molecular, physiological, anatomical, and medical education sources. The search focused on cardiac endocrine function, natriuretic peptides, and medical education and yielded 23 abstracts. The aim was conceptual synthesis rather than systematic or exhaustive retrieval.Results The discovery of atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP) and C-type natriuretic peptide (CNP) established the heart as an endocrine organ influencing renal, and cardiovascular homeostasis. The available medical education literature provides limited explicit guidance on how this topic should be introduced, and reinforced in early curricula. Integration of cardiac endocrine biology aligns with principles of cognitive integration, spiral curriculum design, and authentic learning. ANP and BNP/NT-proBNP are proposed as high-yield teaching examples: ANP links atrial structure and stretch to volume regulation, whereas BNP/NT-proBNP links ventricular wall stress to heart failure evaluation.Conclusions Early integration of the heart’s endocrine function into medical curricula may fortify structure-function reasoning, enhance systems thinking, and support mechanistic clinical reasoning. Rather than adding a separate curricular block, cardiac endocrine signaling can be incorporated through anatomy and histology, then reinforced in cardiovascular physiology, renal physiology, biochemistry, pharmacology, and clinical reasoning. Aligning foundational instruction with modern cardiovascular science can improve learners’ conceptual frameworks and better prepare them for clinical decision making.
Objective To explore aspects of professional identity formation in participants of a longitudinal pediatric program for final-year medical students in the US.Introduction Many institutions have specialty-specific courses focused on the transition to residency, typically at the end of medical school. This study examines professional identity formation among participants of a longitudinal fourth-year Pediatric Concentration.Methods Authors used a case study design for this qualitative research study using semi-structured interview questions based on a conceptual model of professional identity formation. Authors used purposeful sampling to identify study participants who were randomly selected from former students who completed the program between 2019 and 2021. Three interviewers independently conducted interviews with individual program participants. Thematic analysis with coder reliability was utilized for data analysis; two investigators independently coded and performed inter-rater reliability (IRR) on three sets of questions from transcriptions. After ensuring acceptable IRR, investigators coded the remaining questions and subsequently identified themes and sub-themes.Findings Eleven former students completed interviews. Following initial independent coding, IRR for three questions was 80%. After coding the 11 interviews, investigators determined that code saturation was achieved. They subsequently identified six main themes: career development, interpersonal connection, personal growth, positive role models, skill-building, and supportive learning environment. Two cross-cutting themes were recognized throughout the data: sense of belonging and gaining confidence toward starting residency.Conclusions Participants in a longitudinal specialty-specific program in the final year of medical school experienced professional identity formation through a supportive learning environment fostering connection and personal growth while building skills, surrounded by positive role models. This community of practice cultivated a sense of belonging and helped participants gain confidence toward their residency and career. This longitudinal, specialty-specific approach to the final year of medical school may enhance professional identity formation for students entering all specialties and could facilitate transition to internship.
INTRODUCTION:Artificial intelligence (AI) is rapidly transforming healthcare systems and clinical practice, increasing the need to prepare future physicians to work effectively with AI technologies in clinical contexts. Despite growing interest in integrating AI into medical education, empirical evidence regarding medical students' readiness to use AI remains limited. This study aimed to assess medical AI readiness among Korean medical students and explore factors associated with their readiness. METHODS:A cross-sectional survey was conducted among medical students enrolled in a six-year medical program at a university in Korea. A total of 204 students participated in the study. Medical AI readiness was measured using the Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS), which assesses four domains: cognition, ability, vision, and ethics. Descriptive statistics, independent t-tests, and Pearson's correlation analyses were performed using SPSS version 27. RESULTS:The overall mean score of medical AI readiness was 4.19 on a 7-point Likert scale, indicating a moderate level of medical AI readiness. Among the subscales, ethics showed the highest mean score (4.69), followed by vision (4.44), ability (4.18), and cognition (3.92). The frequency of AI use was significantly associated with medical AI readiness, whereas the daily duration of AI use was not. No significant gender differences were observed. When students were divided into the low (pre-medical years 1-2) and high (medical years 1-4) groups, the high group showed significantly higher scores only in the ability subscale. CONCLUSIONS:The findings suggest that medical students are not yet sufficiently prepared to utilize AI technologies in clinical practice, particularly in terms of knowledge and practical competencies related to AI. These results highlight the need for structured and longitudinal AI education in medical curricula to better prepare future physicians for AI-integrated healthcare environments.
Background In team-based learning, students are typically placed in fixed teams based on the idea that stable group membership fosters collaboration: as teammates get to know each other, they share more information, resolve differences and feel motivated to contribute. This rationale had not been tested in a randomized controlled trial.Objective The study compares team-based learning in temporary teams with the default permanent teams regarding individual and team readiness assurance test performance (iRAT, tRAT), reaching team consensus, the learning climate, and intrinsic motivation.Design In a randomized controlled trial, first-year medical students were assigned either to permanent TBL teams or to teams that were re-assigned for each problem. The team readiness assurance test (tRAT) votes, submitted individually and covertly, served as an indirect indicator for team consensus (concordant versus discordant tRAT vote).Results Discordant tRATs (n = 268, 11.8% of all votes) were submitted more frequently in temporary than in permanent teams, both for correct and incorrect majority decisions. The self-rated learning climate was more cooperative in permanent than in temporary teams, while intrinsic motivation and tRAT scores were similar for both types of teams. A poorer learning climate was associated with a higher proportion of discordant tRATs.Conclusion Working in temporary teams does not lead to inferior intrinsic motivation; this was previously also shown for knowledge gain. However, the poorer learning climate, together with reaching a consensus less often, might indicate that at least some members of temporary teams feel not adequately appreciated in the discussion and do not accept the majority decision. With instructional strategies promoting a cooperative learning climate in temporary teams, preclinical TBL courses might serve as an early promoter of the relational team competencies required for subsequent clinical workplace learning in temporary teams.
OBJECTIVE:To assess the mediating role of psychological resilience in the negative association between positive childhood experiences (PCEs) and psychological distress in health professions students (HPS). METHODS:The authors obtained cross-sectional data, including demographic information, the Brief Resilience Scale, and Medical Student Well-Being Index, from a longitudinal survey with circannual waves of data collection in medical, advanced practice provider, (i.e., nursing and physician assistant), and veterinary students at a single institution. The confidential, web-based survey included seven questions about PCEs. The authors conducted a mediation analysis of wave 3 of the data (N = 181) using structural equation modeling, which adjusted for age, gender, underrepresented in medicine (URM) status, and first-generation status. Bootstrap confidence intervals modeled and tested the total and indirect pathways. RESULTS:The path model demonstrated an excellent fit with the data (CFI/TLI = 1.00; RMSEA < .001; SRMR < .001). As hypothesized, PCEs were positively associated with resilience (b = 0.020; p = .049), and resilience was negatively associated with psychological distress (b = -0.815; p = .003). Although PCEs were negatively associated with psychological distress (b = -0.061; p = .003), the indirect path between PCEs and psychological distress through resilience was not significant (b = -0.016; p = .114). CONCLUSION:To our knowledge, this is the first study to examine PCES and resilience in HPS. PCEs and resilience may represent independent predictors of mental well-being in HPS. Our findings underscore the significance of identifying students with fewer PCEs and adopting interventions that support the psychological well-being of HPS, especially those who might be at a higher risk of distress.
INTRODUCTION:Although medical students with pre-medical qualifications (e.g., paramedic training) may enhance diversity within the student body, they have received little attention in international research. Their prior experience may influence study satisfaction through different learning strategies or working alongside their studies. This study investigates how pre-qualifications relate to three dimensions of study satisfaction (content, conditions, and coping with study load) and examines whether deep-processing learning strategies (elaboration and critical thinking) and part-time employment help explain these associations. METHOD:The authors conducted a cross-sectional survey at five German medical schools across different stages of study (3rd, 6th and 10th semester, final year). A structural equation model tested (a) whether pre-qualifications (i.e., academic degree, vocational training in the medical field) moderated the relationship between deep-processing strategies and study satisfaction and (b) whether part-time employment mediated the relationship between pre-qualifications and study satisfaction, controlling for age, gender, undergraduate GPA, semester, and medical school. RESULTS:Associations between deep-processing strategies and satisfaction did not differ by pre-qualifications. Regardless of students' pre-qualifications, elaboration was positively (ß = .51) and critical thinking negatively (ß = -.31) associated with satisfaction with study contents. Students with vocational training or prior academic degree more often worked part-time to finance studies; part-time employment was associated with lower satisfaction with study conditions (ß = -.07) but higher satisfaction with coping with study load (ß = .08). Indirect effects via part-time employment were significant but small. DISCUSSION:The findings suggest that elaboration may be a particularly relevant learning strategy for satisfaction with study contents, regardless of students' prior professional or academic qualifications. The negative association between critical thinking and satisfaction highlights the complexity of students' perceptions of study contents. Although associations involving part-time employment were small, the findings contribute to a better understanding of students with professional and academic pre-qualifications and may inform efforts to support increasingly diverse medical student populations.
