Growing emphasis has been placed on the importance of local authorship in research from low and middle-income countries (LMICs). This study aimed to investigate local authorship of simulation-based education research conducted in LMICs through an in-depth authorship analysis of publications retrieved from a systematic review. After retrieving 27,738 records, 97 studies from 50 LMICs were included. The median number of authors was 8, ranging was from 2 to 18. Ninety-three studies (95%) included a local author, and local authors composed 145/291 (49%) of the total first, second, or final (FSF) authorship positions. Although there was a substantial increase in the number of published studies, there were no significant changes to the proportion of local FSF authors over time: 44% in 2002-2006; 63% in 2007-2011; 47% in 2012-2016; and 49% in 2017-2022 ( P = 0.45). The representation of local FSF authors is lower compared with other fields, though this may be reflective of including only studies that conducted high-level evaluation, or the fact that simulation is a relatively new field. Simulation researchers should actively support and include local authors to ensure programs are appropriate, contextualized and impactful, while making concerted efforts to develop local research capacity in LMICs.

In this commentary we make a call to action to rethink “technical” competence. This commentary was invited in response to an article published by Cloonan et al. (2025) who report on patterns of feedback for surgical residents using a binary classification of data classified as “technical” and “non-technical”. While we welcome detailed analysis of skills, we argue that these categorisations oversimplify surgical practice and do not reflect the complex sets of skills required for safe surgical practice.

Introduction Empathy is a complex, multi-dimensional process involving perception, cognition, motivation and regulation. Despite the recognition of the value of clinician empathy (Michalec & Hafferty, 2021), quantitative studies have shown that surgeons have lower empathy scores than other specialities (Hojat, 2018; Tariq et al., 2018; Walocha et al., 2013). While this has prompted educational interventions, little is known about the contextual factors shaping empathy in surgical practice. Existing research tends to focus on students or patient perceptions, overlooking the experience of surgeons themselves. This study explored how surgeons’ tasks and responsibilities influence their response to patient emotions, with the aim of creating a theory to explain this process. Methods This qualitative study explored how general surgeons in Australia experienced and enact empathy in clinical settings. Using semi-structured interviews and Constructivist Grounded Theory, we examined how surgeons understand their roles, manage emotional demands and respond to patient distress. Participants were currently practising Fellows of the Royal Australasian College of Surgeons. Results We found that surgeons conceptualise their work in five distinct phases: information delivery, decision-making, technical performance, consequence management and management of impact on self. Each phase demands different cognitive and emotional responses that influence how empathy is expressed. Surgeons described shifting mindsets across phases, with sometimes focussing more on emotional responses, and sometimes focusing more on logical and technical processes. Conclusion This study highlights the need to move beyond individualised models of empathy and consider how clinical context, task demands, and professional identity shape the ways that surgeons use empathy in clinical settings. It raises questions about how to interpret empathy scores in surgeons and challenges assumptions in empathy education.

Background: Factors that influence medical students’ decisions to pursue surgical careers include clinical exposure, role-modelling and perception of fit to a specialty. The Royal Australasian College of Surgeons has a commitment to improve diversity within surgery in Australia. Addressing barriers to pursuing a career in surgery may improve the diversity of the surgical workforce, to better represent and serve the community. This study, therefore, aimed to understand the factors that influenced Australian medical students to pursue or avoid a surgical career. Methods: An interpretivist approach guided methods used. Eight Australian medical students representing several different cultural backgrounds and stages of training participated in individual online interviews, which were analysed using reflexive thematic analysis. Results: Four themes were identified: navigating tensions between personal priorities and passion for a surgical career, the challenging pathway to becoming a surgeon, the experience of surgical culture and the emerging influence of social media. Conclusion: While this study found that medical students in Australia cited factors already known to influence decisions to pursue or avoid a career in surgery, new concepts were also reported. These included the challenging unaccredited registrar years, the shifting culture within surgery and the influence of social media on this generation of students. Some women and individuals from underrepresented populations still believed they needed to have a certain “personality” to become a surgeon.

Simulation-enhanced interprofessional education (Sim-IPE) has been successfully used in various health professions and shown to improve communication and teamwork. Surgery, where preventable serious adverse outcomes are often attributed to issues with communication and teamwork, represents a compelling context for Sim-IPE. However, implementing Sim-IPE in surgery requires investment in faculty development, equipment and facilities while incurring the cost of reduced staff availability and theatre productivity during simulation activity. We conducted a scoping review to characterise how Sim-IPE in surgery is practised and researched. This scoping review followed the methodological framework described by Arksey and O’Malley. Reporting followed the PRISMA-ScR checklist. Electronic databases (Medline, EMBASE, Web of Science, PsycINFO and ERIC) were searched for records pertaining to Sim-IPE in surgery published after 1st January 2000 and in English. The final analysis included 81 articles. Simulation scenarios showed a rich variety of combinations of professions, disciplines, training levels and settings. While most scenarios used manikins (N = 54, 75

Background Examining how Australian medical students form career intentions is essential to supporting quality surgical healthcare provision and outcomes in Australia. Creating a diverse workforce through empowering under-represented groups, such as female surgeons, is therefore a critical consideration in workforce planning. This qualitative study investigates factors that shape students' views of surgical careers in Australia.Methods A total of 12 final-year medical students (11 cisgendered female, 1 cisgendered male) joined focus groups exploring factors influencing surgical career intention. Data were transcribed and analysed using reflexive thematic analysis.Results A total of 4 themes and 10 subthemes were identified as contributing to students' perceptions: inclusion before surgery; varying learning opportunities; the pathway to surgery is challenging; and the decision to pursue a surgical career is readily influenced by outsiders.Conclusion Multiple factors influence students' perceptions of a surgical career. As respondents were predominantly cisgender female, the results are particularly relevant in efforts to support cis female surgeons. A broader framework that encompasses surgeon-trainee interactions, the broader hospital team and the wider community may enable future actions to support workforce diversity.

Introduction Working with simulated participants (SPs) offers many benefits in healthcare providers’ simulation-based education. Although many SP programmes compensate SPs for their involvement, there are reports of volunteer simulated participant (VSP) programmes, where SPs contribute their time without financial compensation. Considerable variation exists in how their work is defined, documented and supported. Research is needed to clarify current practices and inform the development of future standards and frameworks for engaging with VSPs. This article describes the protocol for a scoping review addressing this gap. Research question This scoping review asks: what is known about VSPs in healthcare providers’ education? Methods This scoping review protocol follows Arksey and O’Malley’s framework as progressed by Levac et al. and guided by the Joanna Briggs Institute guidelines will be followed, including engaging knowledge users in a ‘co-creation through consultation’ process. Anticipated findings and implications Findings will map current VSP practices, identify challenges and benefits and generate evidence-informed recommendations to guide the development of standards and frameworks for engaging with VSPs.

Background:The collection of clinical audit data are important for audit, research and other quality improvement processes. Low- and middle-income countries (LMICs) face a range of challenges to effective data collection and use. In this study, we explored factors affecting the collection of clinical data at a tertiary centre in Papua New Guinea. Methods:This qualitative study was based on semi-structured individual interviews with healthcare workers at a tertiary hospital in Papua New Guinea. Questions focused on participants' experiences and perspectives regarding the collection of clinical data. We transcribed the interviews and analysed them using reflexive thematic analysis. We collected demographics using a short survey. Reporting of the research was guided by COREQ. Results:We conducted 20 interviews with predominantly nursing staff (n/N = 15/20; 75%). Of the participants, 16/20 (80%) had previously collected data for an audit or research project. Five themes and eight subthemes were conceptualised. Themes related to organisational culture, staff workload, data documentation practices, research infrastructure and study procedures. Although participants were motivated to complete data collection, they faced significant challenges that hindered their ability to do so. While staff often had to choose between collecting data and providing patient care, data collection initiatives could also improve patient care by improving communication between healthcare workers. Conclusions:In this study, we revealed numerous factors which affect the success of clinical data collection for audit and research purposes. These factors may be considered in the design of future initiatives. This has significant implications given the public health importance of strengthening data collection in Papua New Guinea, the Pacific Islands and LMICs in other regions.

The identification and remediation of underperformance are essential responsibilities of postgraduate medical training programs. Despite calls for a programmatic approach, remediation practices remain inconsistent, with many institutions lacking formal policies. The aim of this study was to identify the core components for developing remediation frameworks for postgraduate trainees. A narrative review format was chosen. Eligible papers for inclusion included studies, opinion pieces, systematic reviews, and meta-analyses. Fifty-four papers were included for analysis. We identified seventeen components which were organized into three overarching phases: (1) assess and support, (2) plan and implement, and (3) evaluate and follow-up. ‘Assess and support’ components included: ensure an accurate diagnosis; give feedback; ensure the trainee’s perspective is heard; address external stressors and system causes; provide emotional support; address attitudes and motivation of the trainee; and destigmatize remediation. ‘Plan and implement’ components included: involve remediation and educational experts; create individualized remediation plans; document plans clearly; and teach goal setting and self-regulation. ‘Evaluate and follow-up’ components included: monitor progress and reassess; feed forward carefully; separate those conducting from those judging remediation; ensure transparent policies and due process; and develop compassionate exit pathways. Guiding principles such as transparency, fairness, and alignment with educational theory often supported these components. This narrative review has identified the components to be considered when developing remediation frameworks in postgraduate medical education. Understanding core components and their connections helps design literature-informed frameworks that can be tailored to local contexts, optimizing remediation outcomes in postgraduate training programs.

INTRODUCTION:Remediation is a critical component of surgical training, designed to support trainees who are not progressing as expected and to ensure they reach the standards required. Despite its importance, remediation practices remain poorly understood. A clearer understanding of current remediation practices is essential if training bodies are to better support trainees, protect patient safety, and strengthen the integrity of training programs. The aim of this study was to examine the current remediation policies affecting surgical trainees in Australia and Aotearoa New Zealand (ANZ). METHODS:We undertook a systematic approach for document analysis in health policy research of publicly available documents from the regulators and accrediting professional bodies relating to underperformance and remediation within the Surgical Education and Training (SET) program in ANZ. RESULTS:In total, 47 documents were reviewed in relation to the management of underperformance and remediation within surgical training. Four themes were identified: when policy shapes remediation; similarity of remediation processes; inconsistent terminology and focus on due process. CONCLUSION:This study examined the current remediation policy affecting surgical trainees in ANZ, which is shaped from standards and regulations set by multiple organizations. Although this creates similar regulatory processes across training programs, it results in a strong focus on due process rather than the educational aspects of remediation. Inconsistent terminology around assessment and remediation further impedes effective comparison and data collection. Addressing these concerns will allow opportunities for improving future remediation processes.

Simulation in healthcare has evolved from a focus on individual skills training to a broader set of applications spanning education and cultural and systems-level change. Yet conceptual clarity remains lacking, particularly in how Simulation-Based Education (SBE) and Transformative Simulation (TfS) relate, given that they stem from different philosophical orientations and theories. This essay proposes a conceptual bridge between these two purposes of simulation, grounded in the meta-theory of transformative pedagogy. While SBE draws on diverse theories and concepts to support learning, TfS emphasizes collaboration, systems thinking and user engagement to drive collective understanding, insight and change. We use a metaphor of a bridge to illustrate the passage for a bi-directional model showing how SBE can lead to transformation and how TfS insights can be educationally embedded. This offers a cohesive structure positioning simulation as a tool for individual, interprofessional and cultural and systems-level development and reform.

Growing emphasis has been placed on the importance of local authorship in research from low and middle-income countries (LMICs). This study aimed to investigate local authorship of simulation-based education research conducted in LMICs through an in-depth authorship analysis of publications retrieved from a systematic review. After retrieving 27,738 records, 97 studies from 50 LMICs were included. The median number of authors was 8, ranging was from 2 to 18. Ninety-three studies (95%) included a local author, and local authors composed 145/291 (49%) of the total first, second, or final (FSF) authorship positions. Although there was a substantial increase in the number of published studies, there were no significant changes to the proportion of local FSF authors over time: 44% in 2002-2006; 63% in 2007-2011; 47% in 2012-2016; and 49% in 2017-2022 (P = 0.45). The representation of local FSF authors is lower compared with other fields, though this may be reflective of including only studies that conducted high-level evaluation, or the fact that simulation is a relatively new field. Simulation researchers should actively support and include local authors to ensure programs are appropriate, contextualized and impactful, while making concerted efforts to develop local research capacity in LMICs.

Excellence in educational practice is recognised by the ASPIRE Award program at AMEE. The focus of this paper draws on exemplars from the ASPIRE-to-Excellence Award for Simulation to illustrate how excellence is built in simulation programs. Our focus is on institutional programs that support entry-level and practising clinicians in developing and maintaining clinical knowledge and skills, thereby impacting patient safety and quality of care. We briefly outline the history of the award and then describe the elements and criteria for the award. We position the award alongside the many standards of practice, professional guidelines, quality frameworks, accreditation and certification documents available to the healthcare simulation community. Selected sub-criteria are illustrated making explicit what excellence looks like. We then shift focus to characterise panellists' credentials and share their reflections on the process of reviewing applications, followed by reflections from awardees on the benefits of the award and their experience of preparing the application. We draw on all these reflections to offer tips for preparing an application. Institutional program review in comparison to established international standards for excellence can facilitate improvements to simulation programs, even if it does not progress to a formal submission or award.

Starting in 2024 to date, eight publications in the special series Building Excellence into Medical and Health Professional Education Programs in Medical Teacher have highlighted elements that define and evidence excellence across the domains of curriculum development, assessment, student engagement, faculty development, simulation, innovation, social accountability, and international collaboration. This commentary concludes the series by identifying critical cross-cutting features of the published articles, positioning excellence as an institutional ethos grounded in alignment of mission, cultures, and practices. Specifically, excellence is developmental, context responsive, and demonstrated through implementation, outcomes, and sustained impact. The AMEE ASPIRE-to-Excellence framework provides a constructive, globally informed roadmap for continuous quality improvement, supporting institutions in advancing equitable, socially responsive, and future ready education to meet evolving professional and societal needs.

BACKGROUND:The 2025 University of Melbourne Department of Surgery Research Showcase, held on 18 November 2025, brought together surgeons, researchers, educators, and trainees from across seven clinical precincts to examine emerging directions in surgical education research. The event aimed to facilitate knowledge exchange, interdisciplinary collaboration, and critical reflection on evolving training paradigms. METHODS:The Showcase was delivered in a hybrid format, combining in-person and virtual participation to maximize accessibility and engagement. The program comprised keynote presentations and precinct-led talks, alongside thematic discussions addressing contemporary issues in surgical education. Contributions were drawn from multiple disciplines, including engineering, data science, ophthalmology, oncology, and general surgery. RESULTS:Presentations highlighted innovations in simulation-based learning, robotic and technology-enhanced training, Artificial Intelligence-enabled assessment, large-scale online education, and real-time intraoperative performance monitoring. Additional themes included curriculum reform, competency-based assessment, trainee underperformance, gender equity in surgical training, and the transition from trainee to consultant. The Showcase demonstrated the increasing prominence of educational scholarship within surgical disciplines and illustrated how multidisciplinary approaches can strengthen training frameworks and support workforce sustainability. CONCLUSION:The Research Showcase provides a model for fostering regional academic communities in surgery through accessible, collaborative platforms. Its findings offer valuable insights for educators, academic surgeons, and policymakers addressing current challenges in surgical training. The reflections arising from the event contribute to the broader discourse in surgical education research and have important implications for the design of future curricula, assessment strategies, and professional development pathways.

Purpose:Renewal of surgical curricula is critical in maintaining relevance to contemporary healthcare needs. A curriculum document usually describes its purpose, intended outcomes, content, methods, and assessment and evaluation processes. The document may also consider cultural, professional, political, and social contexts. While there are published curriculum development approaches, guidance on renewal processes is limited. This scoping review aims to synthesise literature on surgical curriculum renewal, to understand the key elements of this process, and identify areas for improvement. Methods:A scoping review was conducted by the core author team, with co-creation involving a Knowledge User Group (KUG). Seven databases were searched for sources published since 2003. Sources relating to curriculum renewal were included, and data were extracted via iterative and consultative processes involving both core authors and the KUG. Themes were identified via qualitative content analysis and thematic mapping of reported features. Results:Eighteen sources were included from an originally identified 2359 articles. Six models of curriculum development were characterised, yet no curriculum renewal model was delineated. Terminology was inconsistent. Primary participants (trainees and trainers) tended to be consulted but not included in curriculum renewal teams. Factors including participant engagement, educational support, and financial resources were identified as enablers in particular environments, and considered as barriers in other contexts. Drivers for renewal included changes in surgical education and training; in surgical practice; and, participant concerns. Discussion:Addressing identified barriers can transform them into catalysts for change. Greater standardisation of terminology in surgical curriculum renewal is needed. The field would benefit from purpose-built frameworks, educational scholarship, co-design, and the implementation of strategies to ensure barriers to renewal become enablers of the surgical curriculum renewal process.

Emotions are key factors in surgical disease and treatment, both in the surgeon and in the patient. Despite the recognition of the value of clinician empathy (Michalec and Hafferty, Soc Theory Health STH 20: 1–19, 2021), quantitative studies have shown that surgeons have lower empathy scores than other specialities (Walocha, et al., Folia Med Cracov 53:35–42, 2013, Hojat, Med Educ 52:456–7, 2018, Tariq, et al., J Coll Physicians Surg–Pak JCPSP 58:310–3, 2018). The reason for this is unclear, and little is known about how surgeons manage emotions in clinical settings. This study explored the role of empathy in surgical treatment and how surgeons respond to patient emotions, with the aim of creating a theory to explain this clinical process. We used an exploratory qualitative study in the Constructivist Grounded Theory tradition, utilising online individual semi-structured interviews with fourteen general surgeons. Surgeons described multiple discrete approaches to patients’ emotions. Participants were conscious of modulating their emotional response to patients depending on need, and systemic factors like urgency and setting. General approaches to patient emotions included emotion-facing and emotion-avoidant strategies. While the approach used was often tailored to the situation, surgeons usually had a preferred style. The degree of emotional engagement was particularly influenced by time available, and urgency. Participants described some techniques to influence the degree of emotional involvement, primarily by altering consultation times. The management of emotions by surgeons is nuanced and affected by contextual factors. Management is not entirely automatic or subconscious, but opportunities can be created or limited by the surgeon as required to facilitate effective treatment. The results offer a new perspective on surgeon empathy in the context of the limited existing literature.

The quality of palliative and end-of-life care (EOLC) in residential aged care (RACFs) is variable, and often suboptimal. The aim of IMPART is to improve palliative care in RACFs. IMPART provides online training and telehealth palliative-geriatric support to aged care staff and family physicians/general practitioners (GPs) to enable timely EOLC discussions, clinical support, and improve documentation of care preferences. This may lead to preference-based care, reduction of unplanned hospitalization, and improved quality of life and EOLC. This protocol describes a study to evaluate the effectiveness, cost, and implementation process of the IMPART intervention. This study is a pragmatic, stepped-wedge, cluster randomized controlled trial across 10 RACFs to evaluate the IMPART intervention. Clusters are randomly assigned to intervention or control groups. The IMPART intervention group 1) receives timely end-of-life support from specialist In-Reach teams using telehealth; 2) engages RACF staff and GPs in a Planning Ahead Team to reflect on current practices and co-design an Action Plan to improve EOLC planning and processes; 3) receives an online interactive, needs-based EOLC education program for staff and GPs working in RACFs. The control groups receive the IMPART intervention in subsequent waves. The primary outcome measure is reduction of unplanned hospital admissions and avoidable hospital transfers for residents at end-of-life when appropriate care in their RACF is possible and consistent with residents’ wishes. Secondary outcomes include reduction of emergency department presentations and length of stay of unplanned hospital admissions, and improvement in residents’ quality of life, comfort, satisfaction, and quality of EOLC. RACFs are high-mortality settings, yet the quality of palliative and EOLC varies across facilities. There is an urgent need for timely and integrated high-quality palliative care delivered in this context. Implementing IMPART, as a novel telehealth intervention, aims to address this need. This large multisite trial will provide robust evidence about the impact of the intervention (efficacy, cost-effectiveness, and process evaluation), to inform future roll-out and scale-up into the residential aged care sector. anzctr.org.au; ACTRN12622000760774. Prospectively registered on 27/05/2022.

INTRODUCTION:Upon graduation, newly qualified doctors are expected to manage complex and unwell patients, and adapt their prior learning to navigate an often-nuanced healthcare workplace environment. Surgical rotations can bring a unique set of learning curves and challenges to this already demanding transitional period. The aim of this study was to identify the training needs of medical students and early-career doctors in surgical skills, incorporating viewpoints from all stakeholder groups to provide a holistic insight into the provision of surgical education currently, and how it can be optimized to improve work preparedness. METHODS:Final-year medical students, interns and clinical educators from five clinical schools affiliated with the University of Melbourne were recruited for semi-structured interviews. Following transcription, multi-phased thematic analysis was performed to identify key themes. RESULTS:Thirty-seven participants were interviewed (18 students, 8 interns and 11 clinical educators). Outside of commonly utilized procedural skills, different emphases were placed on non-technical skills by students and interns, compared to clinical educators. Increased hands-on learning and structured teaching were thought to be key to increasing confidence and work preparedness. CONCLUSION:This qualitative study interviewed key stakeholders to identify important skills in order to help newly qualified interns to thrive in a surgical rotation. These skills in particular included more supervised hands-on practical teaching. Future studies involving graduates from other medical schools may provide a better understanding of surgical education in the wider Australian context.

Healthcare simulation educators, occupying unique and shifting roles between clinician, educator, and facilitator, often experience the impostor phenomenon (IP), a pervasive sense of self-doubt, despite objective evidence of competence. Approximately one in every two simulation educators reports feelings of impostorism, highlighting the prevalence of this phenomenon in their field. This inner struggle impacts their ability to fully inhabit their professional identity, compounding the challenges of career progression and well-being. While IP has been documented across many professional settings, little is known about how simulation educators experience and navigate IP throughout their careers. This study sought to illuminate how these educators live through and navigate IP and how such experiences can inform strategies for faculty development, resilience, and empowerment.