INTRODUCTION:Artificial intelligence (AI) is being widely used by authors, reviewers and editors in the academic publishing process. However, there remains ambiguity about the boundaries of AI use. Amid this growing uncertainty, editors and publishers face an ongoing tension between a desire to advance the academic publishing process and a need to uphold scientific integrity. This study examined advisory and guideline statements about AI use by health professions education (HPE) journals. METHODS:We collected a corpus of texts relating to the use of AI in HPE journals from 22 HPE journals, 6 respective publishers and the Committee on Publication Ethics (COPE) policies in January 2026 relating to the use of AI in academic publishing. The corpus was examined using content analysis. RESULTS:Five main themes were identified from the analysis: 1) Accountable governance, 2) Protection of ethical standards, 3) Safeguarding of research integrity, 4) Maintenance of human oversight, and 5) Balancing of opportunities and risk. DISCUSSION:Overall, HPE journals predominantly frame the use of AI in academic publishing as a risk rather than an opportunity, with the overarching concern being a potential compromise of scientific integrity. Editors need to manage various tensions related to AI use and disclosure, including ensuring that policies keep up with the speed of technological advancement, and potentially broader impacts on the scholarly HPE field. As guidance on AI use continues to evolve, authors, reviewers and editors must ensure that they actively maintain and optimise their policies and practices in response to emerging evidence, including of unintended consequences.
INTRODUCTION:Professional identity formation (PIF) research in medical education has largely examined micro-level dilemmas within relatively stable training environments. Less is known about how macro-social crises destabilizing the profession's public legitimacy shape early PIF. This study explored how first-year medical students narrated the impact of the 2024-2025 doctor-government conflict in South Korea on their professional identity development, using Transformative Learning Theory (TLT) as an interpretive lens. METHODS:We conducted a theory-informed qualitative study using written reflective essays submitted by first-year medical students as a professionalism course assignment upon returning to the formal curriculum. Using Big Q reflexive thematic analysis, we combined deductive use of TLT as a sensitizing concept with inductive latent analysis to examine students' pre-crisis assumptions, disorienting dilemmas, critical reflection, and evolving identities. RESULTS:Students' narratives were interpretable through four TLT-informed phases: pre-crisis frames of reference, disorienting dilemma, critical reflection, and evolving identity. Pre-crisis configurations included idealized, perfectionistic, system-naive, meritocratic, and hierarchical assumptions about medicine. Disorienting dilemmas centered on collapsing trust in the healthcare system, perceived patient harm, moral ambiguity, social rejection, and internal fragmentation within the medical community. Critical reflection involved deconstructing heroic and individualistic views of doctoring, reattributing problems to structural conditions, and renegotiating meanings of responsibility, competence, and solidarity. Many students described reconstructive identity work, culminating in more socially embedded, system-aware, and pragmatically collaborative identities. Others showed defensive retrenchment, reinforcing grievance, distrust, and a sense of professional victimhood. DISCUSSION:Macro-social crisis can function as a collective disorienting dilemma in early medical education, extending PIF and transformative learning beyond micro-level clinical experiences. Identity development during legitimacy shocks is not uniformly growth-promoting; it depends on reflective and relational conditions under which students process disruption. Medical schools should support early identity work through structured dialogue, attention to belonging, and engagement with healthcare policy.
BACKGROUND:Serious games and gamification are increasingly used in emergency and critical care training, but the literature is heterogeneous and often overlaps conceptually with digital simulation. For medical education, it remains unclear how these interventions are being designed and how deeply their outcomes are being evaluated. METHODS:We conducted a scoping review following PRISMA-ScR guidance and registered the protocol on the Open Science Framework. PubMed, Web of Science Core Collection, and EBSCOhost (CINAHL Plus with Full Text and ERIC) were searched from inception to 22 February 2026 without language restrictions. We included empirical studies of serious games, gamification, or game-based learning in emergency, resuscitation, trauma, intensive care, and related high-acuity training contexts. Outcomes were mapped to the highest reported Kirkpatrick level. RESULTS:Fifty-two unique studies were included from 669 records, with marked growth in recent years. Interventions were grouped into six primary modality families: digital serious games and virtual-patient environments (27/52, 51.92%), gamification-enhanced teaching or platform-based interventions (9/52, 17.31%), escape rooms (6/52, 11.54%), gamified simulation competitions or deliberate-practice formats (4/52, 7.69%), analogue board or card games (3/52, 5.77%), and virtual reality or augmented reality gamified simulations (3/52, 5.77%). Evaluation remained predominantly proximal: the highest reported Kirkpatrick level was Level 2b in 29 studies (55.77%), Level 2a in nine (17.31%), Level 1 in six (11.54%), and Level 3 in eight (15.38%); no study reported Level 4 outcomes. CONCLUSIONS:The field is expanding rapidly, but most evaluations remain focused on engagement and short-term learning rather than behavioural transfer or downstream clinical impact. In high-acuity health professions education, game-based approaches appear most useful as adjuncts for pretraining, reinforcement, and distributed practice. Future research should improve conceptual clarity and align educational objectives, mechanisms, game mechanics, and outcome measures more explicitly.
INTRODUCTION:This study explored clinical educators' perspectives on their supervision experiences, focusing on successes and challenges, including experiences working with allied health students who underperformed or failed practice placements. METHOD:This study used a convergent mixed-methods design. Universities in Australia and New Zealand (n = 19) that deliver allied health programs (n = 14 professions) were invited to participate. An online questionnaire administered to allied health clinical educators collected quantitative and qualitative data. Quantitative data were analysed descriptively, and content analysis was used to analyse free-text responses. Occupational Adaptation Theory was applied as an interpretative framework. RESULTS:Sixteen universities consented to participate. Data from 66 questionnaires representing clinical educators from 10 professions were compared and triangulated. Constructed themes described that positive placement experiences were shaped by clinical educators' embracing their supervisory roles, having strong professional connections and supportive workplaces. In contrast, negative placement experiences were associated with students lacking foundational skills, learning under pressure, or limited professional readiness. DISCUSSION:Clinical educators reported being equipped to recognise overt student supports but underestimated the impact that environment and educational relationships had on students' capacity to adapt or seek assistance during situations of underperformance. Applying Occupational Adaptation Theory to support data interpretation highlighted that, in addition to supervisory training, mastering their roles and having actionable strategies to support learners in difficulty, requires adequate resourcing and recognition to ensure CEs are equipped to manage every element of student learning.
INTRODUCTION:The complexity of diagnostic reasoning ensures there can be no singular educational intervention to perfect its teaching. The need to flexibly adapt to needs of trainees and learning environments demands deeper understanding of available strategies. Deliberate reflection offers one technique that is central to debate in this area, but the literature remains insufficiently clear about why it can be effective and, hence, what purposes it can serve. By better understanding how deliberate reflection works we can better design learning exercises that guide students toward clinical expertise and better practice. METHOD:Ten pre-clerkship medical students with experience applying deliberate reflection completed a mixed-methods think aloud study. They were asked to verbalize everything that passed through their minds while analyzing clinical vignettes, before and during instruction to apply a deliberate reflection grid. Two cases of varying difficulty were presented. Inductive thematic coding was applied to transcripts with quantification of codes to contextualize when different types of ideas were expressed. RESULTS:Participants' statements suggest that, while using the deliberate reflection grid, medical students shifted away from hypothesis generation toward more explicit hypothesis testing; further, the grid encouraged and supported ongoing reasoning in moments of uncertainty. Each shift altered perceptions of diagnostic likelihood and drew participants' attention to clinical features they did not fully understand. DISCUSSION:Contrary to debate about whether one should teach diagnostic reasoning by emphasizing knowledge gain versus shifting knowledge application strategies, the patterns indicate deliberate reflection to function as a process-oriented scaffold that simultaneously directs people toward additional learning (enabling knowledge gain) and supports retrieval of prior knowledge (de-biasing through procedural direction). Thus, rather than focusing exclusively on correcting cognitive biases or increasing clinical knowledge, educational interventions may be most effective when they guide learners through deliberate and comparative reasoning processes for engaging and building their knowledge base.
INTRODUCTION:Many medical students incorporate music in their daily lives, however opportunities to engage with music within the curriculum are rare. This mixed-methods study explores the experiences of medical students who participated in a semester-long, performance-focused 'Music for Health' elective at an Australian University, including benefits and challenges perceived by students. METHODS:Data were collected over a three-year period, from six cohorts (2018-2023) of students who participated in the elective during the second year of their medical degree. Twenty-one (21) students who participated in the elective between 2021 and 2023 completed an online survey, from which data were analysed using descriptive statistics and deductive content analysis. Meanwhile, eleven (11) students who participated between 2018 and 2020 granted access to written reflections, which formed the basis for an Interpretative Phenomenological Analysis (IPA). RESULTS:Survey data suggested that most students (>80%) perceived benefits to their mental health and communication and teamwork skills from participating in the elective. Content analysis of 'benefits' and 'challenges' described in survey data supported the validity of six themes identified through the IPA: Therapeutic potential of music; Personal well-being and mental health; Emotions and human connection; Transferable skills; My relationship with music; and Camaraderie through musical collaboration. From themes identified two Global Meaning Units were constructed: (1) Music supports personal and social well-being and (2) Emotional connection through music enhances relationships. DISCUSSION:The results of this study suggest that medical students' participation in curricular music ensemble performance can serve as a medium for teamwork and collaborative problem-solving, developing 'performance skills' such as adaptability and dealing with nerves in a context of peer support. Facilitating student-patient interaction through music can also support students to recognise and value the social and emotional dimensions of medicine practice.
INTRODUCTION:Clinical Competency Committees (CCCs) make high-stakes summative entrustment decisions; however, variability persists when deliberative standards remain implicit and inconsistently applied. We conceptualized this divergence as arising from unstructured evidence-to-judgment processes and misaligned evaluative expectations. This study examined the use of a structured deliberation scaffold to support CCC decision-making in a simulation-based faculty development setting. METHODS:We conducted a theory-informed, simulation-based educational intervention during a national faculty development workshop. Seventy-two faculty members from 32 otolaryngology residency programs reviewed simulated CCC cases and evaluated deliberation quality using the 12-item Objective Structured Clinical Competence Committee Evaluation (OSCCCE) checklist. One scripted video case (Resident B) was designed a priori to represent principle-concordant deliberation. Participants then worked in seven small-group role-play simulations to make summative entrustment decisions across 12 EPAs. Differences in OSCCCE scores and inter-group agreement in entrustment decisions were analyzed. RESULTS:Structured process quality differed significantly across simulated cases. The structured, principle-concordant video case (Resident B) and the actively facilitated role-play simulation (Resident C) received significantly higher OSCCCE scores than the unstructured video case (Resident A) across all domains. Participants also rated collective evaluation processes as more useful in supporting resident development and curriculum improvement. Inter-group agreement in entrustment decisions across the seven simulated CCC groups was substantial for the standardized simulated case (Gwet's AC2 = 0.707, 95% CI 0.566-0.848; p < .001). DISCUSSION:A structured simulation-based approach may help make CCC deliberative processes more explicit and observable in faculty development settings. These findings suggest that process-focused training may support transparency and shared understanding in programmatic assessment, but should be interpreted as preliminary simulation-based evidence rather than proof of improved real-world reliability or decision accuracy. Future work should examine transfer to live CCC settings and longer-term impact on decision stability and feedback quality.
INTRODUCTION:Clerkship students encounter ethically significant dilemmas but have limited opportunities to rehearse ethically grounded decision-making and difficult conversations in realistic clinical contexts. We evaluated an immersive, sequential simulation-based clinical ethics education program. METHODS:We conducted an explanatory sequential mixed-methods pre-post study with clerkship students at Kaohsiung Medical University from September 1, 2022, to May 31, 2023. Participants completed a core e-learning curriculum (digital modules/videos) before a two-day immersive simulation. The simulation comprised six longitudinal standardized patient cases, each with four sequential scenarios. Quantitative outcomes included ethical knowledge, ethical sensitivity, vignette-based ethical decision-making, and confidence in managing clinical ethical dilemmas; satisfaction was measured post-intervention. Pre-post comparisons were made using Wilcoxon signed-rank tests. Focus groups were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Findings were integrated using a joint display. RESULTS:Thirty-eight clerkship students participated. Post-intervention ethical knowledge showed gains across all seven assessed domains. Ethical sensitivity increased across three issues, and ethical decision-making improved across all six vignettes. Confidence increased in nine of 11 items, including dilemma awareness, clarifying ethical problems, ethical reasoning, communication to reach consensus, and confidence in ethical decision-making. Satisfaction with simulation education was high. Qualitative integration identified three themes explaining these gains: confidence through enactment, structured ethical decision-making, and voice and consensus under pressure. DISCUSSION:The program was associated with short-term gains in ethics knowledge, ethical sensitivity, vignette-based decision-making, and confidence. Qualitative findings suggested that enactment, feedback, and reflection made ethics learning more practical and increased learners' perceived readiness for challenging clinical encounters. Sequential simulation may help clerkship students connect principle-based ethics teaching with real-time reasoning and communication demands. Controlled longitudinal studies are needed to examine durability, transfer, and workplace-based performance. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT05547893.
INTRODUCTION:Acceptance of teachers' need for pedagogical training to maintain quality in health professions education has grown. However, to enhance interest in becoming a professional teacher, a better understanding of experiences related to initial contact with teaching is needed. The framework of landscape of practice (LoP) offers a perspective highlighting identification processes as academics and clinicians participate in and navigate across familiar and new communities. The aim of this study was to explore how boundary crossing into teaching practices is expressed in educators' narrative constructions of critical incidents from teaching situations at a medical university. METHODS:Teachers' written critical incident analyses (CIA) of teaching situations (N = 69), submitted during two iterations of a faculty development course at a medical university, were collected. The assignments were analysed using qualitative content analysis. RESULTS:One overarching theme, Teaching appears as an individual venture, and four subthemes, Internalised self-blame and external attribution of responsibility; Encountering teaching situations marked by limited control and psychological safety; Relational dynamics and communicative challenges; Pedagogical commitment and professional agency, were identified. The findings mirrored strong reactions, abandonment and isolation, but also engagement and responsibility for high-quality education. DISCUSSION:The findings show that engaging in educational practice, developing a professional identity as a teacher is a complex, often isolated endeavour, sometimes disconnected from primary professional practice. Relating these findings to identification processes described within the framework of LoP, demonstrates a need to support individual processes as well as the connections and collaboration between different communities in a LoP. To address this, three interrelated actions are needed: support from the teachers' primary communities of practice and the wider landscapes of practice; strengthening structural and cultural conditions that recognise education as a scholarly activity and an integral part of the university's LoP; and increased educational awareness and competence at management level.
INTRODUCTION:Although studies have investigated the reliability of entrustment-based rating scales for workplace-based assessments (WBA) with one-off discrete tasks, the same has not been investigated for WBA with multiple longitudinal observations. This study fills this void by investigating the reliability of a milestone-based rating scale format for multisource feedback (MSF). METHODS:At a regional hospital providing Japan's basic postgraduate clinical training programme, an MSF instrument was developed based on a local competency framework (4 domains, 16 subdomains). First-year trainees were assessed using conventional Likert scales in Phase 1. In Phase 2, these were replaced by milestone-based rating scales. The reliability of the MSF was compared between the two phases. RESULTS:Generalisability analyses showed higher Phase 2 dependability (Φ) (univariate Φ: 0.708 vs. 0.846; multivariate Φ: 0.768 vs. 0.895), indicating improved reliability. Univariate decision study results revealed that achieving Φ = 0.767 required 15 raters in Phase 1, whereas six sufficed for Φ = 0.783 in Phase 2. DISCUSSION:Replacing the conventional Likert scale with a milestone-based scale in MSF likely contributed to the higher reliability. Future research should employ a within-subjects design to directly compare both scales.
INTRODUCTION:Emotions arising in clinical care affect both physician well-being and patient care. However, medical curricula provide limited training for students to identify and manage their own emotions and understand their impact. This scoping review identified educational approaches for preparing medical students with the skills to recognize and manage their emotions during physician-patient interactions and in clinical environments. We examined teaching methods, topics, educational purpose, and timing of emotion skills training programs in medical education. METHODS:Following the Joanna Briggs Institute (JBI) methodology for scoping reviews, the systematic search was implemented on February 1st, 2025, across five databases. We focused on training programs delivered before licensing examination. Two independent reviewers screened 7986 articles, with 201 articles included for analysis. RESULTS:The teaching programs had considerable variability, with 46% originating in the U.S. Most programs (46%) implemented emotion skills training during clinical years, primarily addressing emotions in a general context. Teaching methods included group work, case-based learning, simulations, patient experience, and debriefing. Programs were delivered in classrooms (57%), clinical settings (30%) via face-to-face (62%) or online modalities (31%). Emotion-related topics (ET) and their educational purpose (EP) focused on developing students' inner emotional capacity (ET:41%, EP:30%), the emotional identity as a physician (ET:21%, EP:26%), relational emotional capacity (ET:19%, EP:21%), and strategies for sustaining emotional wellbeing (ET:19%, EP:23%). DISCUSSION:Most programs teach emotion skills face-to-face, in classroom settings, during clinical years, with a focus on topics such as reflective emotional capacity or emotion regulation and management, aiming to support the development of students' inner emotional capacity or their emotional identity as future physicians. The findings underscore the increasing recognition of emotion-related skills as critical for patient care and professional development, and highlight elements of training, such as reflection or feedback, which can help reshape medical education to enhance medical students' emotion competence.
INTRODUCTION:In health professions education (HPE), faculty members often combine teaching with patient care and research. Teaching is often perceived as undervalued relative to these other roles, potentially affecting educational quality. Little is known about how faculty members perceive the culture of valuing teaching in their organisation in which competing values, such as being efficient or being flexible, are at stake. The aim of this study is to investigate how the organisational culture of valuing teaching is perceived by faculty members in HPE. METHODS:We conducted a qualitative study in a Dutch university, including 18 semi-structured vignette-based interviews with faculty members combining teaching responsibilities with patient care and/or research. The Competing Values Framework by Quinn was used to investigate the competing values. Interviews were analysed using reflexive thematic analysis, combining an inductive and deductive approach. RESULTS:Three themes were identified. First, although teaching is claimed to be valued by the university, it is not perceived that way at different levels within the organisation by faculty members. Second, faculty members feel that primarily the fulfilling of formal requirements related to teaching is valued, i.e. fulfilling the required teaching hours, with limited focus on valuing teaching quality, teamwork and professional development. Lastly, the culture of valuing teaching is perceived to differ among departments. DISCUSSION:The culture of valuing teaching is perceived to be characterised by a dominant focus on efficiency and formal requirements and limited focus on flexibility and human aspects, which might hamper experimentation and innovations in education. Some departmental leaders are perceived to be able to navigate these competing values of efficiency and flexibility in teaching from the faculty members' perspectives. These findings suggest that valuing teaching requires leadership practices that carefully balance competing values.
ISSUE:Although it has long been present in medicine and medical education, the growth in the number of instances of resistance by medical trainees around the world, the visibility thereof, and the resulting disruption of medical education have made the grounding of professional resistance a critical concern for all involved. POSITION:The authors argue that professional resistance needs to be understood as being subject to the principles of bioethics that underpin medical professionalism: beneficence, non-malevolence, autonomy, and justice. ARGUMENT:The authors consider the implications of this position in terms of three issues: 1) that becoming a professional and pursuing a professional career requires individuals to yield something of themselves, 2) that a profession should aspire to have and to hold to standards that are higher than those required of it, and 3) the issue of the separation of professional and personal lives. CONCLUSION:All acts of resistance by professionals need to align with the foundational ethical principles of their profession to be legitimately considered professional and they cannot simply be set aside when anger or outrage precipitates acts of resistance.
We agree that all acts of resistance by professionals need to align with the standards of the profession. However, we believe that rather than solely residing in the individual, professionalism and professional resistance must be considered as context-dependent and fluid, shaped, or 'bounded" by organizational, cultural, and situational factors. As a result, accountability should not be conceived as a solely an individual matter, but also an institutional and organizational one.
