Global Medical Education Research Articles

Exploration of global community-based medical education curricula: a scoping review

Background: Community-Based Medical Education (CBME) offers learning and training for medical students in the community setting. This scoping review aimed to describe the characteristics of the CBME curriculum delivered to medical undergraduates globally and to summarize the reported outcomes and impacts. Material and methods: A scoping review was carried out to address the study objectives, using the five-step methodological framework of H. Arksey and L. O’Malley. Published articles on CBME were retrieved using a systematically prebuilt search strategy applying Boolean operators. These search parameters were: no time limit; articles published other than on the medical profession; review articles; and non-English language articles which were excluded. PRISMA-ScR checklist was followed for reporting. Results: Of the 36 articles selected for scoping review, 17 (47.2%) were published between 2010 and 2020; 13 (36.1%) were from the South-East Asian region; and 18 (50%) were descriptive. Cognitive component on health issues was commonly taught (55.6%), 44.4% had CBME in multiple semesters, taught by the Community Medicine faculty, and each had a family survey as a teaching method. Taught in a rural setting among 83.4% of studies, 27.8% had CBME exposure throughout the course, and 47.2% were posted at primary health care. The most common formative and summative assessments were reflections/feedback, and presentations (19.4% each). Conclusions: The components of CBME curricula vary widely across the globe, shaped by the specific contexts of the universities and countries in which they are implemented. Recognizing and understanding these diverse approaches is essential for designing CBME curricula that are holistic, context-specific, and effectively tailored to meet local needs.

Export of medical education in the world market of educational services

The article examines current trends and challenges related to the export of medical education in the global educational services market. The analysis of the data on the number of foreign students at medical universities leading exporting countries, including USA, UK, Australia, Canada, Germany, Russia and China. The factors influencing the choice of a country for study, such as the quality of educational programs, tuition fees, and the availability of visa and immigration procedures, are highlighted. Special attention is paid to the impact of the COVID-19 pandemic and the growth of online education on international student mobility and accreditation of medical programs. In conclusion, recommendations are proposed for exporting countries to strengthen their positions in the global medical education market.

The Evolution From Standardized to Virtual Patients in Medical Education.

Standardized patients (SPs) are widely used in medical education to teach clinical skills and provide assessments. SPs allow students to practice history taking, physical exams, and communication in controlled settings. However, SPs have limitations such as fatigue, performance variability, and the inability to simulate certain conditions, which virtual patients (VPs) can address. VPs can address these limitations and offer consistency, scalability, and adaptability. Although VPs are being implemented in research settings, they have the potential to be powerful medical education tools. Advancements in immersive technologies such as virtual reality, haptic feedback, and artificial intelligence (AI) will allow the creation of hyper-realistic, interactive training environments that mimic the complexity of real patient encounters. Medical students will be able to engage with VPs in fully immersive settings, complete with haptic feedback and AI-driven dialogue, allowing for more lifelike diagnostic and procedural experiences. The wider availability of such technologies through web services has implications for global medical education and assessment.

Exploring Intercultural Dynamics in Medical English Education in China: an In-depth Analysis and Strategic Enhancement

With the continuous development of modern society, information transmission has become more rapid and convenient, which has gradually increased the economic exchanges among various countries in the world, and has also led to more frequent communication among political, cultural, medical and other fields between different regions. At the same time, the mutual penetration and integration between foreign medical culture spread through English and domestic traditional medical concepts have also put forward new demands for the cultivation of high-quality talents in China's medical field. Researchers have explored the cross-cultural complexity of Medical English Teaching (MET) in Chinese higher education institutions and its impact on global medical communication. With the increasing internationalization of healthcare services, English, as the main language of medical communication, is gaining prominence in education. In this broader context. The status of English in global medical education and its teaching in non-native English-speaking environments are facing great challenges, especially in China's higher education settings. Based on an in-depth analysis of the literature and empirical research, this study reveals cross-cultural barriers to MET practice and adopts a mixed-methods research design that combines both quantitative and qualitative methods of data collection and analysis in order to comprehensively examine the current status of MET in China. Special attention was paid to teachers' intercultural competence development, teaching method innovation, and course content adaptation. Based on this, the researcher proposes targeted strategies aimed at improving intercultural competence in MET, including strengthening teacher training, improving curriculum design, and promoting the integration of intercultural communication skills. The findings of the study not only provide insights into existing MET practices, but also offer constructive suggestions for future educational strategies and research directions. Through this study, we expect to contribute a valuable reference and guidance to the field of medical English education in China and globally.

Nutrition and Physical Activity Education in Medical School: A Narrative Review.

This review explores the diverse landscape of integrating nutrition and physical activity education into medical school curricula, focusing on the imperative role of physicians in promoting health through lifestyle changes. By examining global medical education structures, we uncovered disparities in nutrition and physical activity training, and highlighted the need for a shared framework to address international and regional challenges. Despite acknowledging the importance of both nutrition and physical activity, studies have consistently uncovered deficiencies in medical school curricula, especially in skills related to providing lifestyle advice and behavioral counseling. Survey studies among medical students have illuminated various perceptions and knowledge gaps, emphasizing the need for more comprehensive and mandatory nutrition and physical activity training. While acknowledging progress, challenges, such as time constraints, resource availability, and faculty expertise, persist. Integrating lifestyle education results in resistance, a demand for strategic communication, and faculty buy-ins. These findings underscore the importance of a holistic approach that balances theoretical knowledge, practical skills, and confidence that medical students need to promote effective nutrition and physical activity in healthcare.

Adopting a pedagogy of connection for medical education.

In this article, we propose developing a "pedagogy of connection" based on the history and evolution of medical education in Brazil. This pedagogy emerged from the intersection of the healthcare and higher educational systems, both dedicated to the principles of social justice and universal access, in response to the country's efforts to address the enduring impacts of slavery and social inequality. Following the "Sanitary Reformation" movement-a foundational moment for Brazil's healthcare and medical education systems-Brazil established the Unified Public Healthcare System (Sistema Único de Saúde - SUS). SUS is founded on principles of universality, integrality, equity, community participation, political and administrative decentralisation, hierarchisation and regionalisation. Aligned with these core principles and inspired by critical pedagogy, Brazilian medical education has evolved with a profound commitment to social justice, critical consciousness, professional presence and compassion. This evolution has given rise to a "pedagogy of connection," which imbues medical education with a sense of purpose and joy, preparing future medical professionals to address the challenges of our ever-evolving society and healthcare systems. The connections fostered by this pedagogy occur in complementary dimensions: (a) healthcare system and society, (b) community, (c) profession, (d) patients, and (e) ourselves. This innovative pedagogy enhances medical education discourse and practice by emphasising the development of a professional identity grounded in social justice and patient-centred care, which remain challenges for current medical education systems. As the global medical education community embraces decolonisation, this pedagogy offers a framework that can be adapted and enriched in various contexts worldwide, fostering opportunities for mutual learning from diverse educational systems in a dialogical and democratic manner.

Power and place: Uncovering the politics of global medical education.

Politics is characterised by power relations, and the deployment of power is inescapably political. In an increasingly globalised and interconnected modern world, politics is shaping the field of medical education more than ever before. Global frameworks that classify peoples and places are political tools that are fundamentally shaped by hegemonic knowledge systems. Despite this, they continue to form the basis for global thinking and practices, including in medical education. Political analysis can help to expose and challenge such thinking. To better understand impacts of globalisation in medical education, we explore the previously under-examined political dimensions that underpin it, focusing particularly on deconstructing power relations. We situate our analysis of global medical education in political terms, including through examination of ideology, economics, market and the enduring effects of colonialism. We interrogate the construct of the Global South (GS), considering the geopolitical and historical ideas that have enabled it to be widely propagated. We go on to examine the consequences of the GS construct in medical education and consider what this tells us about how power is enacted in the field. In analysing the politics of global medical education, we shed light on how power is exerted and draw attention to forces that permit and enable trends, policies and positions. Notwithstanding the emancipatory rhetoric that has been associated with the GS construct, we highlight its reductive potential and argue that it can lead to an oversimplification of power relations and vested interests. Given the growing recognition that educational approaches do not transfer well across countries and cultures, we encourage the medical education community to consider why ideas from more dominant countries continue to be imitated so routinely. In doing so, we urge them to use political lenses to recognise the influence of multiple complex and interconnected forces of global power that shape all aspects of medical education.

Empathy in undergraduate medical students: a multi-center cross-sectional study in China

BackgroundFostering empathy has been continuously emphasized in the global medical education. Empathy is crucial to enhance patient-physician relationships, and is associated with medical students’ academic and clinical performance. However, empathy level of medical students in China and related influencing factors are not clear.MethodsThis was a cross-sectional study among medical students in 11 universities. We used the Jefferson Scale of Empathy Student-version of Chinese version to measure empathy level of medical students. Factors associated with empathy were identified by the univariate and multivariate logistic regression analyses. Based on the variables identified above, the nomogram was established to predict high empathy probability of medical students. Receiver operating characteristic curve, calibration plot and decision curve analysis were used to evaluate the discrimination, calibration and educational utility of the model.ResultsWe received 10,901 samples, but a total of 10,576 samples could be used for further analysis (effective response rate of 97.02%). The mean empathy score of undergraduate medical students was 67.38 (standard deviation = 9.39). Six variables including gender, university category, only child or not, self-perception doctor-patient relationship in hospitals, interest of medicine, Kolb learning style showed statistical significance with empathy of medical students (P < 0.05). Then, the nomogram was established based on six variables. The validation suggested the nomogram model was well calibrated and had good utility in education, as well as area under the curve of model prediction was 0.65.ConclusionsWe identify factors influencing empathy of undergraduate medical students. Moreover, increasing manifest and hidden curriculums on cultivating empathy of medical students may be needed among medical universities or schools in China.

The impact of core curriculum revisions on Japanese medical schools: Navigating curriculum evolution

Purpose This study examines the impact of the 2010 and 2016 Model Core Curriculum (MCC) revisions on medical education across all 82 medical schools in Japan. Methods A cross-sectional survey was conducted in 2021, focusing on the response to the MCC revisions, curriculum changes, and factors influencing these changes. The survey included questions on approaches to implementing the MCC revisions, timing of curriculum updates, factors triggering these revisions, changes in student performance and career paths, and the introduction of new subjects. Results The response rate was 100%. Most universities rapidly implemented changes following the 2016 MCC revision, demonstrating agility in adapting to national standards. Key factors influencing curriculum revisions included external evaluations and the MCC revisions themselves. Despite no significant changes in student performance or career paths from faculties’ perspective, an increase in scholarly activities was noted. The introduction of new subjects post-2016 reflects a shift toward holistic perspectives such as behavioral science, general medicine/community medicine, and professionalism. Conclusions The findings highlight a commitment to maintaining educational quality in Japanese medical education. The responsiveness to MCC revisions suggests a growing interest in medical education among faculties and an alignment with global medical education trends to meet evolving healthcare needs.

Evolving landscapes in global medical education: navigating challenges and embracing innovation

Evolving landscapes in global medical education: navigating challenges and embracing innovation

Comparing Medical Training Costs Internationally: A Systematic Review.

Acquiring a thorough understanding of the expenses linked to the education of health sciences students is crucial for effective university planning, budgeting, and overall preparedness. This systematic review aimed to identify and compare the per capita costs associated with educating medical and other health science students internationally-particularly emphasizing the context of Iran. A systematic review was conducted in 2023 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search covered the period from January 1, 2000, to November 11, 2022, using MeSH and EMTREE terms. Databases such as PubMed, Scopus, Web of Science, Embase, and Iranian databases were searched. Manual searches were performed using Google and Google Scholar. The study retrieved 1336 publications from bibliometric databases and, following thorough screening, included 8 relevant articles from 5 countries (Australia, Iran, United States, Thailand, and Vietnam). An additional 17 relevant articles from Iranian databases were also included. Based on USD purchasing power parity (PPP) 2019, the results show that the mean per capita cost of training a medical student for 1 academic year in Iran is $61,493.86 (range, $28,102-$133,603; standard deviation, $35,476.03). In comparison, the cost of training a medical student for 1 year is $263,305 in the United States and $44,674 in Australia. In Thailand and Vietnam, a 6-year medical program costs is $284,058 and $69,323, respectively. Moreover, according to most studies, training students in other health sciences in Iran for 1 academic year generally costs ˂$20,000 (PPP 2019). The study reveals that the costs associated with medical student education in Iran exceed that of most countries, second only to the United States. These findings highlight the importance of such data in improving the efficiency, sustainability, and informed resource allocation of global medical education programs for future planning and budgeting.

Global Medical Education: The Bharat vision

Global Medical Education: The Bharat vision

Preclinical medical student satisfaction of Team-based learning in Chiang Mai University

Introduction: Global medical and healthcare education systems are increasingly adopting team-based learning (TBL). TBL is an interactive teaching programme for improving the performance, clinical knowledge, and communication skills of students. The aim of this study is to report the learning experience and satisfaction of participants with the TBL programme in the preclinical years of the Faculty of Medicine, Chiang Mai University. Methods: Following the implementation of TBL in the academic year 2022, we asked 387 preclinical medical students, consisting of 222 Year 2 and 165 Year 3 medical students who attended the TBL class to voluntarily complete a self-assessment survey. Results: Overall, 95.35% of the students were satisfied with the structure of the TBL course and agreed to attend the next TBL class. The overall satisfaction score was also high (4.44 ± 0.627). In addition, the students strongly agreed that the TBL programme improved their communication skills (4.50 ± 0.796), learning improvement (4.41 ± 0.781), and enthusiasm for learning (4.46 ± 0.795). Conclusion: The survey findings indicated that students valued TBL-based learning since it enabled them to collaborate and embrace learning while perhaps enhancing their study abilities. However, since this is a pilot study, further investigations are warranted. Keywords: Team-based learning, Small group interaction, Medical education, Implementation

Ethical Considerations of Climate Justice and International Air Travel in Short-Term Electives in Global Health.

In July 2022, the American Society of Tropical Medicine and Hygiene Green Task Force advocated to acknowledge the health impacts of climate change, particularly on those in low- and middle-income countries, and called on global health organizations to act. Simultaneously, academic medical centers are resuming Short-Term Electives in Global Health (STEGH) as travel restrictions imposed during the COVID-19 pandemic ease in most countries. International flights by trainees from academic medical centers in high-income countries (HIC) on these electives encapsulate the climate injustice of who generates carbon emissions and who bears the impacts of climate change. Using "decolonization" and "decarbonization" as guiding principles, we suggest several strategies that global medical education programs in HIC could implement. First, restructure rotations to halt STEGH with minimal benefit to host institutions, optimize trainee activities while abroad, and lengthen rotation duration. Second, programs can calculate the carbon impact of their STEGH and implement concrete measures to cut emissions. Finally, we urge academic medical centers to promote climate-resilient healthcare infrastructure in host countries and advocate for climate solutions on the global stage.

Global “systemness” in medical education: A rationale and framework to assess performance

Healthcare is global. The challenges of the “triple aim” – achieving high-quality healthcare, maximal value, and an excellent patient experience and outcomes – are universal. Medical education is similarly global with worldwide efforts towards competency-based reform, the adoption and adaptation of accreditation standards, and the expansion of international collaborations between healthcare organizations (HCOs). The focus of many of these efforts centers around recognizing education as a talent pipeline to serve local and global healthcare needs. Accordingly, many U.S.-based academic medical centres are pursuing an increasingly global footprint by developing international partnerships between HCOs. The educational leadership at the Cleveland Clinic (an HCO that has ventured internationally in Canada, the United Kingdom, and the United Arab Emirates) has adopted a “systemness” approach to medical education collaboratives. Systemness describes the ability of academic health systems to leverage existing structures, expertise, and other resources to address broadly shared educational needs across geographies, disseminate best practices, and ultimately improve the care that is delivered. The rationale for systemness, a concept derived from the healthcare administration and business world, affords the opportunity to achieve educational outcomes through synergy that exceeds the capability of any single component of a system. In this perspective, we posit a “systemness” taxonomy to be used to assess the performance and success of international collaborations in medical education and provide examples of its application to existing international partnerships in medical education. This framework is grounded in developmental assessment approaches, akin to those used in assessing learner performance, and defines levels of educational collaboration proficiencies, ultimately towards the alignment of these efforts with the health needs of the communities they serve. As global medical education collaboratives advance, ongoing assessment of existing partnerships and further research will be needed to define competencies and integrative activities that define high-performing medical education partnerships.

When educators are locked down: transitioning an international faculty development program from in-person to online during the COVID-19 pandemic in China.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic forced international faculty development programs in medical education to forgo in-person activities and transition to online learning. We sought to examine changes in international medical educators' evaluations of our faculty development program as it transitioned due to the pandemic. Methods: We compared survey responses from participants in our International Medical Educators Program between 2019 (in-person) and 2020 (online). The 43-item survey addressed aspects such as program evaluation and self-assessment of curriculum development and teaching skills. We analyzed data using t-tests to compare means and chi-square test for categorical variables, and performed thematic analysis of open-ended responses. Results: We found that trainees in both cohorts rated the program highly with regard to overall program quality and self-assessed learning outcomes, but the 2019 group reported stronger relationships with peers and instructors. Some scores for self-assessed outcomes were lower for the 2020 class, but no statistically significant differences were found in pre- and post- training scores between the two cohorts. Four themes emerged from the feedback: positive program utility, IMEP as an example of good curriculum design, timing issues, and online learning environment challenges. Conclusions: Despite pandemic challenges, the transition to online faculty development was favorably evaluated, with high confidence in the applicability of learned skills. Future efforts should focus on fostering community and optimizing interaction times to enhance learning experiences. The study contributes insights for global medical education communities in pandemic circumstances.

Medicial Education Strategy In The Era of Digitalization and Disruption

Background: This article aims to (1) examine the current condition of education in the digitalization and disruption era and (2) examine medical education strategies in the digitalization and disruption era. Writing scientific papers is based on library research, whose object of study uses library data in the form of books as a data source.Content: Based on the literature review, it was found that: (1) global medical education currently uses the SPICES strategy (student-centered learning, problem-based, integrated, community-based, elective, and systematic), accompanied by nine educational trends; (2) SPICES is a medical education strategy that will produce graduate profiles that refer to World Health Organization (WHO) and World Organization of Family Doctor (WONCA) conference agreements. A doctor must have six-star doctor characteristics, namely: care provider, decision makers, communicators, community leaders, managers as well as creators and innovators; (2) the minimum standard of competence for doctors in Indonesia, constitute of seven areas of graduate competency namely; has noble professionalism, is always aware and develops himself, can communicate effectively, is reliable in managing information, always has a scientific basis in medical science, has clinical skills and can manage health problems well.Conclusion: A special strategy for medical education is required in the era of digitalization and disruption by applying a lifelong education approach. Indonesian medical education uses the SPICES strategy to create six-star doctors and master the seven defined competency areas.

Global Medical Education and Its Value to Radiology

Global Medical Education and Its Value to Radiology

Competency-Based Time-Variable Anesthesiology Residency Training: Identification of Problems and Solutions.

Global medical education is gradually moving toward more comprehensive implementations of a competency-based education (CBE) model. Elimination of standard time-based training and adoption of time-variable training (competency-based time-variable training [CB-TVT]) is one of the final stages of implementation of CBE. While CB-TVT has been implemented in some programs outside the United States, residency programs in the United States are still exploring this approach to training. The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) are encouraging member boards and residency review committees to consider innovative ways programs could implement CB-TVT. The goals of this study were to (1) identify potential problems with the implementation of CB-TVT in anesthesiology residency training, (2) rank the importance of the problems and the perceived difficulty of solving them, and (3) develop proposed solutions to the identified problems. Study participants were recruited from key stakeholder groups in anesthesiology education, including current or former program directors, department chairs, residents, fellows, American Board of Anesthesiology (ABA) board members, ACGME residency review committee members or ACGME leaders, designated institutional officials, residency program coordinators, clinical operations directors, and leaders of large anesthesiology community practice groups. This study was conducted in 2 phases. In phase 1, survey questionnaires were iteratively distributed to participants to identify problems with the implementation of CB-TVT. Participants were also asked to rank the perceived importance and difficulty of each problem and to identify relevant stakeholder groups that would be responsible for solving each problem. In phase 2, surveys focused on identifying potential solutions for problems identified in phase 1. A total of 36 stakeholders identified 39 potential problems, grouped into 7 major categories, with the implementation of CB-TVT in anesthesiology residency training. Of the 39 problems, 19 (48.7%) were marked as important or very important on a 5-point scale and 12 of 19 (63.2%) of the important problems were marked as difficult or very difficult to solve on a 5-point scale. Stakeholders proposed 165 total solutions to the identified problems. CB-TVT is a promising educational model for anesthesiology residency, which potentially results in learner flexibility, individualization of curricula, and utilization of competencies to determine learner advancement. Because of the potential problems with the implementation of CB-TVT, it is important for future pilot implementations of CB-TVT to document realized problems, efficacy of solutions, and effects on educational outcomes to justify the burden of implementing CB-TVT.

Taiwan’s Experience in Promoting Competency-Based Medical Education and Establishing Entrustable Professional Activities for Radiographers

&lt;p&gt;勝任能力導向醫學教育(Competency-Based Medical Education, CBME)是近年來國際醫學教育趨勢，而可信賴專業活動(Entrustable Professional Activities, EPAs)是將CBME精神具體實行的方法之一。中華民國醫事放射師公會全國聯合會為落實醫事放射職類以勝任能力為導向的訓練，提供教師與時俱進的師資培育活動，遂擬定「醫事放射職類CBME訓練計畫三部曲」，透過三階段的方式推廣並落實能力導向醫學教育：「醫事放射學員的能力進展架構」-臺灣醫事放射職類可信賴專業活動的建置、「為勝任能力量身打造的教學與學習經驗」-CBME師資培訓推廣、「計畫性、系統性的評估設計與能力進展的行程」-醫事放射職類CBME訓練計畫全國執行。本會期望輔導各級教學醫院全面推廣台灣醫事放射職類CBME訓練與落實EPAs職場直接觀察教學，並建置執業模式下的能力進展架構與系統化評估，確保醫事放射師專業能力發展和教育品質提升。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Competency-based medical education (CBME) has become a trend in global medical education. Entrustable professional activities (EPAs) are one of the means to implement CBME. To provide up-to-date teacher training for implementing radiographers&amp;rsquo; CBME, the Taiwan Association of Medical Radiation Technologists has organized a Three-Stage Radiographer CBME program. The three stages are as follows: (1) Competency development: establishing EPAs for radiographers. (2) Competency-oriented teaching and learning experience: promoting CBME teacher training. (3) Planned and systematic competency development and assessment: promoting and implementing the CBME teacher training program nationwide. Through the promotion of CBME, teaching based on direct EPA observations, as well as the establishment of a competency development framework and a systematic assessment model for in-service radiographers, the Association expects to improve the competency development of and education quality for radiographers in Taiwan.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;