Introduction Dermatologic conditions are frequently encountered in primary care, yet family physicians often lack confidence and up-to-date knowledge in dermatology. Traditional continuing medical education (CME) methods struggle to meet the practical needs of busy clinicians. We aim to describe the development, implementation, and impact of an innovative online dermatology CME program based on Learning-by-Concordance (LbC) for family physicians in Quebec. Methods Eight online modules were created using LbC methodology, presenting clinical vignettes with expert feedback to stimulate clinical reasoning. Modules were accessed asynchronously. Participant feedback was collected through post-module surveys. Results 322 primary care physicians across Quebec completed at least one module. Learners reported increased knowledge, improved diagnostic reasoning, and high satisfaction with the format. Participants noted greater diagnostic confidence and described concrete changes in their patient management. 89% found the content applicable to their practice, and 84% recommended the program for broader use. Discussion This study supports the effectiveness of LbC as a CME format in dermatology. By integrating clinical vignettes, expert feedback, and structured reflection, LbC fosters clinical reasoning in a format that mimics real-life clinical decision making by integrating diagnostic uncertainty. Conclusion The LbC-based dermatology CME program effectively enhances dermatologic competency among family physicians, offering a flexible and clinically relevant educational model.

Introduction:Learning by concordance (LbC) is an educational approach designed to develop expertise, particularly in the field of clinical reasoning (CR) among healthcare professionals. It is based on the script concordance test (SCT) with the addition of feedback based on expert responses. The objective of this study was to map the scientific literature on this rapidly growing learning approach. Methods:A scoping review was conducted following the Arksey and O'Malley framework and the PRISMA-ScR guidelines. A systematic search was conducted in MEDLINE, Embase, CINAHL, Web of Science and Google Scholar up to March 10, 2025. Eligible primary studies had to focus on the LbC approach targeting healthcare learners. Results:Twenty-eight studies met the inclusion criteria: twenty focused on the implementation of the LbC approach and eight on its development. Most of the studies used mixed methods (quantitative and qualitative). The results mainly indicate that learners perceive the LbC approach as engaging and beneficial for decision-making. The articles mention five elements related to the development of LbC that would contribute to its success. Discussion:The LbC approach could be applicable to a wide range of disciplines and learning levels. The variability in the procedures for developing the approach, as well as the variability of the objectives and methodologies of the studies, limit the comparability of the results. Conclusion:LbC is a promising approach for promoting decision-making skills in a variety of uncertain clinical contexts. The concept of standardized development and evaluation frameworks for this approach could improve its applicability, effectiveness and reproducibility.

INTRODUCTION:A learning by concordance (LbC) tool including 33 vignettes was developed jointly by teachers from the Y and the University of X to train undergraduate dental students in paediatric dental traumatology. The aim of this work was to present a learning tool not yet described in the community of dental educators. The method was presented on two different electronic platforms to two groups of students. Different modalities were compared. METHODOLOGY:International panellists were asked to detail their reasoning for resolving ambiguous or complex situations described in clinical vignettes. Two groups were approached: a first group composed of students new to LbC (Y group) and a second group that had already experienced this type of learning method (X group). The modalities of training management differed according to the groups: Y group used the Wooclap platform and responded on a 5-modality Likert scale, while X group used Moodle and a 3-modality Likert scale. Student volunteers were able to complete a qualitative survey about the training. The main indicator used was students' opinions and feelings about different aspects of the tool. RESULTS:The training was completed by 121 students, 53 of whom agreed to give their opinion on the tool. Consistent with current knowledge, we found that novices had difficulty answering a 5-modality Likert scale because of the subtle difference between two close answers. CONCLUSION:This is the first study to introduce a LbC tool in dental education and the results showed a strong interest in this type of pedagogical tool, regardless of the online platform used.

Background The integration of artificial intelligence (AI) in medical education is evolving, offering new tools to enhance teaching and assessment. Among these, script concordance tests (SCTs) are well-suited to evaluate clinical reasoning in contexts of uncertainty. Traditionally, SCTs require expert panels for scoring and feedback, which can be resource-intensive. Recent advances in generative AI, particularly large language models (LLMs), suggest the possibility of replacing human experts with simulated ones, though this potential remains underexplored. Objective This study aimed to evaluate whether LLMs can effectively simulate expert judgment in SCTs by using generative AI to author, score, and provide feedback for SCTs in cardiology and pneumology. A secondary objective was to assess students’ perceptions of the test’s difficulty and the pedagogical value of AI-generated feedback. Methods A cross-sectional, mixed methods study was conducted with 25 second-year medical students who completed a 32-item SCT authored by ChatGPT-4o (OpenAI). Six LLMs (3 trained on the course material and 3 untrained) served as simulated experts to generate scoring keys and feedback. Students answered SCT questions, rated perceived difficulty, and selected the most helpful feedback explanation for each item. Quantitative analysis included scoring, difficulty ratings, and correlations between student and AI responses. Qualitative comments were thematically analyzed. Results The average student score was 22.8 out of 32 (SD 1.6), with scores ranging from 19.75 to 26.75. Trained AI systems showed significantly higher concordance with student responses (ρ=0.64) than untrained models (ρ=0.41). AI-generated feedback was rated as most helpful in 62.5% of cases, especially when provided by trained models. The SCT demonstrated good internal consistency (Cronbach α=0.76), and students reported moderate perceived difficulty (mean 3.7, SD 1.1). Qualitative feedback highlighted appreciation for SCTs as reflective tools, while recommending clearer guidance on Likert-scale use and more contextual detail in vignettes. Conclusions This is among the first studies to demonstrate that trained generative AI models can reliably simulate expert clinical reasoning within a script-concordance framework. The findings suggest that AI can both streamline SCT design and offer educationally valuable feedback without compromising authenticity. Future studies should explore longitudinal effects on learning and assess how hybrid models (human and AI) can optimize reasoning instruction in medical education.

Cet article présente les résultats d’une recherche-développement appuyée sur un modèle de leadership pédagogique (Hallinger et Wang, 2015). Nous visions à 1) adapter les principes méthodologiques de la formation par concordance (Charlin et Fernandez, 2016), pour offrir une occasion de développement professionnel à des directions d’établissement scolaire novices, 2) documenter leurs perceptions sur la pertinence de ce type de formation et de ses effets sur la pratique et 3) énoncer certaines indications pour son utilisation. Nos résultats montrent que recourir à la formation par concordance pour les directions d’établissement scolaire est possible et pertinent dans le cadre de leur socialisation professionnelle. Pour les personnes formatrices en gestion scolaire, mais aussi dans d’autres champs des sciences de l’éducation ou domaines (comme les sciences de la santé), utiliser ce type d’approche pédagogique est avantageux et facilité par la disponibilité d’un guide pour les accompagner.

IntroductionDeveloping professionalism notably involves learning how to make professional judgements in ambiguous situations. The Concordance of Judgement Test (CJT) is a learning tool that was proposed to develop professionalism competencies, but it was never performed in dentistry or used with a synchronous methodology. The present study evaluated the feasibility of the use of CJT in the context of dental education, to foster professionalism and stimulate reflexivity and discussion.Materials and MethodsAfter different steps of optimization, a questionnaire presenting 12 vignettes was submitted to 33 Canadian students. Second, after an additional optimization, a questionnaire of 7 vignettes was submitted to 87 French students. An immediate educational feedback was proposed after each vignette to promote reflexivity and discussions during the experience.ResultsThe overall experience of the students was reported as good, thanks to the feedback of real-life situations. This promoted reflexivity and stimulated discussion between students and educators regarding professionalism issues. The students considered CJT as a relevant and well-adapted tool, and reported positive feelings regarding the inter-university aspect of the activity. The mean score of the panel members was close to 80/100 and the mean score of the students was 5 to 10 points lower, which is in agreement with docimological performance.ConclusionThe results suggested that the use of CJT in a synchronous way was a feasible and relevant tool to motivate the students to improve their professionalism, and to stimulate their reflexivity and discussion. The students reported positive experience with CJT, and we believe that this tool can be integrated in the dental curriculum.

Background Based on the involvement of qualified educators in its design, the Learning-by-Concordance tool aims to promote the learning of reasoning in contexts of uncertainty. However, data are still scarce on the experience of educators in terms of sharing and exposing their reasoning processes using this tool. Purpose This study sought to explore the beliefs and experiences of educators when involved in the design of a Learning-by-Concordance tool. Method This research used a descriptive qualitative design. Four dialogue groups were conducted with educators with different roles and responsibilities while designing a Learning-by-Concordance tool. A descriptive interpretative analysis of educators' verbatim quotes was done. Findings A total of 14 participants took part in the study. The results show the discomfort of educators despite their recognized expertise. Three themes emerged: 1- the need to be reassured by the opinions of colleagues; 2-feeling like impostors; and 3- concerns for the quality of instructional supports. Conclusions The role taken by educators for teaching reasoning in contexts of uncertainty is to draw on practical experience where different types of knowledge intersect and are mobilized, to overcome feelings of insecurity, and to engage in close and authentic conversation with learners.

Pharmacists’ roles have evolved substantially from traditional drug compounding and dispensing to encompass patient-centred clinical services. Pharmacist clinical reasoning, though fundamental to these new roles, generally remains implicit and understudied, particularly compared with that of other healthcare professionals, such as physicians. However, teaching and supervising the clinical services provided by pharmacists require a thorough understanding of the reasoning process involved. Several models describing pharmacist clinical reasoning have been developed, but they lack unified mapping.Here, we used an instrumental case study approach to develop a model of pharmacist clinical reasoning during medication review. Our model is adapted from a previously published modelling-using-typified-objects model of physician clinical reasoning in all its cognitive complexity. Our pharmacist model, validated after iterative development and expert consultation, aligns components of pharmacist clinical reasoning with those of physician clinical reasoning. The clinical case contains drug-related problems of variable clinical relevance, as well as numerous key elements (e.g., laboratory results, vital signs) necessary for conducting a medication review. The case serves both as the foundation for model development and as an illustrative step-by-step example within this article.Our model delineates the subprocesses of pharmacist clinical reasoning during medication review, offering a flexible, multipath structure that underscores the dynamic, nonlinear nature of the reasoning. The model might be able to clarify implicit cognitive processes, thus furthering the overarching objective of promoting reflective skill development among learners rather than relying solely on tacit knowledge gained through practice experience.

Background Epistaxis is a recurring cause for referral to emergency departments. Its management can be complex; hence, it is critical to provide appropriate support to Otolaryngology-Head and Neck Surgery (OHNS) residents to develop clinical reasoning skills to manage such cases. Learning-by-Concordance (LbC) is a recently developed educational tool that encourages learners to think through simulated clinical scenarios. A panel of ENTs provides insightful feedback to residents, reflecting a diversity of opinions about practice. Our study aimed to assess LbC's feasibility and perceived value for training OHNS residents in epistaxis management. Methods In this qualitative study, three OHNS surgeons, including two faculty members and one resident, wrote the LbC scenarios. The LbC tool was made available to participants through an online platform. A panel of four OHNS faculty provided feedback on answers to LbC questions. Otolaryngology-Head and Neck Surgery residents participated and provided their opinion on the value of this educational tool through an online questionnaire. Results A total of 10 one-hour sessions were required to create and upload the training tool. To provide insightful feedback embedded in the learning tool, the four panelists needed 60 min each. Of the 37 participating residents, 25 (68%) completed the training. Overall satisfaction was high: 88% appreciated the training method, and 92% wanted to use this type of training again. Most residents felt the training enabled them to improve their clinical reasoning when encountering a patient with epistaxis (92%) and their knowledge about epistaxis (96%). Conclusion Findings suggest that OHNS residents could benefit from clinical reasoning exercises with panelist feedback using the LbC approach for clinical presentations that require complex approaches to manage conditions such as epistaxis.

Contexte et problématique : La formation par concordance (FpC) est un puissant instrument de formation en ligne, basé sur la théorie des scripts. En éducation médicale, la FpC se présente de manière similaire à un test de concordance de script (TCS) (vignette clinique, hypothèse, nouvelle information, micro-jugement) mais alors que le TCS est destiné à l’évaluation, la FpC est un outil de formation dont l’intérêt repose sur la richesse des rétroactions dont bénéficie l’apprenant à savoir la répartition des réponses des panélistes, l’accès aux brèves explications que les panélistes ont données pour accompagner leurs réponses, et une courte synthèse éducative. Bien que son cadre théorique, la théorie des scripts, soit clair, la conception d’une FpC est complexe. De fait l’opérationnalisation du cadre théorique de la FpC n’a jamais été décrite. Objectif : Le but du présent article est ainsi de proposer un cadre d’opérationnalisation de la création d’une FpC, en utilisant comme socle l’exercice concret, étape par étape, de la création d’une FpC au sujet de la rhumatologie pédiatrique destinée à la formation des médecins de familles et des pédiatres généralistes. Méthodes : En adoptant une technique de groupe nominal, les échanges entre les créateurs de cette FpC (5 médecins pédiatres et/ou spécialistes en éducation médicale) ont permis d’aboutir à un consensus concernant chacun des concepts de la théorie des scripts et leur opérationnalité au regard de la création d’une FpC structurée dans une période de temps optimisé. Résultats : Un cadre opérationnel de création d’une FpC, sous la forme d’une synthèse des opérations conduisant à la création d’une FpC est finalement proposé.

Introduction:Learning-by-concordance (LbC) is an online learning strategy to practice reasoning skills in clinical situations. Writing LbC clinical cases, comprising an initial hypothesis and supplementary data, differs from typical instructional design. We sought to gain a deeper understanding from experienced LbC designers to better support clinician educators' broader uptake of LbC. Methods:A dialogic action research approach was selected because it yields triangulated data from a heterogeneous group. We conducted three 90-minute dialogue-group sessions with eight clinical educators. Discussions focused on the challenges and pitfalls of each LbC design stage described in the literature. Recordings were transcribed and analyzed thematically. Results:We identified three themes by thematic analysis about the challenges inherent in designing LbC that are unique for this type of learning strategy: 1) the distinction between pedagogical intent and learning outcome; 2) the contextual cues used to challenge students and advance their learning and 3) the integration of experiential with formalized knowledge for cognitive apprenticeship. Discussion:A clinical situation can be experienced and conceptualized in many ways, and multiple responses are appropriate. LbC designers use contextual cues from their experience and combine them with formalized knowledge and protocols to write effective LbC clinical reasoning cases. LbC focuses learners' attention on decision-making in grey areas that characterize the nature of professional clinical work. This in-depth study on LbC design, indicating the integration of experiential knowledge, might call for new thinking about instructional design.

RATIONALE AND OBJECTIVE:Learning to interpret thoracic images requires intensive instructor support. Given current cohort sizes at teaching hospitals in North America, instructor availability is rare. A Learning-by-concordance of perception (LbCP) online tool was introduced in a second-year course on lung and oxygenation. The LbCP tool presents thoracic images, students must point or outline abnormal structures directly on the screen and name the lesion. Thereafter, images with correct outline are superimposed on student's work and three key-messages are provided. We aimed to measure student perception of LbCP tool's usefulness and ease of use.MATERIALS AND METHODS:The online tool was developed and implemented for second year students for cohorts in 2016, 2017 and 2018 (n = 296; 303; and 280; N = 879). A survey, comprisingsix questions on a Likert scale was designed to measure perceptions about tool utility and ease of use. An ANOVA analysis was carried out to ensure the normality of the data, and a principal axis factor analysis was used to confirm the presence of the two expected clusters corresponding to our two dimensions.RESULTS:The ANOVA conducted on the combined three year data set revealed an F value of 7.688 (p = 0.001), and principal axis factorial analysis revealed a one factor solution. The percentage of variance explained by the factor was 44.5%, with factor loadings leaning heavily in favor of the tool's perceived utility. A second factor was just shy of the eigenvalue threshold of 1.0 and could provide support for the tool's ease of use.CONCLUSION:The online LbCP tool shows promising impact over three cohorts of students in three consecutive years. Students recognize the pedagogical value of the tool and express their willingness to use more of it in their training.

Introduction Clinical reasoning is a complex task which is generally acquired through years of experience. Learning by concordance (LbC) is an educational reflective tool that fosters clinical decision-making in complex situations. It is widely used and validated in medical education, but is new to dentistry. This presentation aims to familiarize oral pathology educators with LbC, the construction of a LbC activity, and its possible applications in dental education. Materials and Methods LbC activities were created and implemented in the undergraduate oral pathology curriculum at Université de Montréal. The principles behind LbC are presented, as well as the steps required to create a LbC activity, and the possible applications in oral pathology training. Student feedback is also presented. Results In a LbC activity, the student is presented a variety of clinical scenarios requiring them to interpret incoming information and make decisions. It focusses on the many micro-decisions that a clinician makes throughout a clinical exam in order to provide a diagnosis or institute treatment. After answering a question, the student receives immediate feedback from a panel of chosen experts, allowing the student to assess if there is concordance. Through online applications and educational plaforms, LbC is now accessible to dental educators. Conclusions LbC is a simple, low-cost and efficient way to help students reinforce their clinical reasoning skills and auto-evaluate their understanding by comparing their reasoning to that of experts located worldwide. It can also provide valuable assessment of what students think and how they reason. In addition to clinical reasoning, it can be used to teach and assess professionalism. Its online applicability provides new teaching opportunities in undergraduate, graduate and continued dental education, especially in the new context provided by the COVID-19 pandemic.

The simultaneous integration of knowledge acquisition and development of clinical reasoning in preclinical medical education remains a challenge. To help address this challenge, the authors developed and implemented the Student-Generated Reasoning Tool (SGRT)-a tool asking students to propose and justify pathophysiological hypotheses, generate findings, and critically appraise information.In 2019, students in a first-year preclinical course (n = 171; SGRT group) were assigned to one of 20 teams. Students used the SGRT individually, then in teams, and faculty provided feedback. The control group (n = 168) consisted of students from 2018 who did not use SGRT. Outcomes included academic performance, effectiveness of collaborative environments using the SGRT, and student feedback.Students were five times more likely to get questions correct if they were in the SGRT group versus control group. Accuracy of pathophysiological hypotheses was significantly lower for individuals than teams. Qualitative analysis indicated students benefited from generating their own data, justifying their reasoning, and working individually as well as in teams.This study introduces the SGRT as a potentially engaging, case-based, and collaborative learning method that may help preclinical medical students become aware of their knowledge gaps and integrate their knowledge in basic and clinical sciences in the context of clinical reasoning.

Contexte et problématique : Les évaluations et les formations par concordance sont deux modalités éducatives qui reposent sur un cadre conceptuel commun illustré par la façon de poser les questions qui est commune à l’une et l’autre. Exégèse : Cette tribune plaide pour dire qu’il s’agit d’un couple dont les deux composantes sont optimisées si elles sont utilisées l’une et l’autre et qu’il est illogique de mettre en place le volet évaluation sans faire percevoir aux étudiants préalablement l’utilité du volet formation pour les faire progresser dans leur raisonnement. Enfin, la place que tient l’incertitude en matière de formation et évaluation par concordance est analysée.