Flexner's legacy and the future of medical education:Embracing challenge and opportunity

This editorial comments on the article by Alzerwi.We focus on the development course,present challenges,and future perspectives of medical education.Modern medical education is gradually undergoing significant and profound changes worldwide.The emergence of new ideas,methodologies,and techniques has created opportunities for medical education developments and brought new concerns and challenges,ultimately promoting virtuous progress in medical education reform.The sustainable development of medical education needs joint efforts and support from governments,medical colleges,hospitals,researchers,administrators,and educators.

Mindfulness training in medical education as a means to improve resilience,empathy,and mental health in the medical profession

The high rates of depression,burnout,and increased risk of suicide among medical students,residents,and physicians in comparison with other careers signal a mental health crisis within our profession.We contend that this crisis coupled with the inadequate acquisition of interpersonal skills during medical education results from the interaction between a challenging environment and the mental capital of individuals.Additionally,we posit that mindfulness-based practices are instrumental for the development of major components of mental capital,such as resilience,flexibility of mind,and learning skills,while also serving as a pathway to enhance empathy,compassion,self-awareness,conflict resolution,and relational abilities.Importantly,the evidence base supporting the effectiveness of mindfulness-based interventions has been increasing over the years,and a growing number of medical schools have already integrated mindfulness into their curricula.While we acknowledge that mindfulness is not a panacea for all educational and mental health problems in this field,we argue that there is currently an unprecedented opportunity to gather momentum,spread and study mindfulness-based programs in medical schools around the world as a way to address some longstanding shortcomings of the medical profession and the health and educational systems upon which it is rooted.

Virtual reality:The bridge between medical education and clinical practice

After perusing the paper by Kim et al,I discovered that this is an interesting manuscript and a successful study.Virtual reality(VR)is an emerging and promising technology employed in the domain of medical practice and medical education over the past decade.In the era of big data,VR is constantly progressing in the fields of medical education and clinical diagnosis and treatment.As a novel scientific and technological tool,VR not only overcomes multiple limitations of the traditional medical teaching mode but also reduces the reliance on personnel and equipment.VR can simulate the real clinical situation,stimulate the enthusiasm of young doctors and nurses for clinical study,and simultaneously safeguard and promote medical safety and doctor-patient harmony.Favorable outcomes have been attained in clinical teaching and diagnosis and treatment activities.While enhancing the training conditions of medical cosmetics and elevating the level of clinical practice and teaching,the risks resulting from improper clinical diagnosis and treatment have been circumvented.All of this is evident and comprehensible.

3D image system improves the learning curve and contributes to medical education of rhinoplasty

Background: Rhinoplasty is a complex surgical procedure that requires critical analysis and precise design before surgery, making it a challenging operation for both the surgical team and medical educators. This study aimed to evaluate the impact of 3D design involvement on learning curves and to establish a more effective method for rhinoplasty education.Methods: Surgeons who participated in an educational program were divided into two groups. The experimental group was involved in the 3D design before the operation, and the control group was asked to review the rhinoplasty atlas. A self-assessment questionnaire was used to evaluate the learning curve of the eight rhinoplasty procedures for each surgeon, and the overall satisfaction rate data were also collected.Results: The self-assessment scores in both groups showed an increasing trend from the first to the eighth operation. The mean scores of the experimental group were significantly higher than those of the control group at the fifth operation(P=0.01). The satisfaction rate of the experimental group(91.7%) was higher than that of the control group(54.5%).Conclusion: The 3D imaging system can improve the learning curve and satisfaction rate of rhinoplasty education,proving that it is an easy and effective tool for medical education.

Getting physical with medical education:Exercise based virtual anatomy review classes for medical students

The benefits of regular physical activity are well known.Yet,few studies have examined the effectiveness of integrating physical activity(PA)into curricula within a post-secondary setting.To investigate the incorporation of PA into medical curriculum,we developed a series of optional exercise-based review sessions designed to reinforce musculoskeletal(MSK)anatomy course material.These synchronous sessions were co-taught by a group fitness instructor and an anatomy instructor.The fitness instructor would lead students through both strength and yoga style exercises,while the anatomy instructor asked questions about relevant anatomical structures related to course material previously covered.After the sessions,participants were asked to evaluate the classes on their self-reported exam preparedness in improving MSK anatomy knowledge,PA levels,and mental wellbeing.Thirty participants completed surveys;a majority agreed that the classes increased understanding of MSK concepts(90.0%)and activity levels(97.7%).Many(70.0%)felt that the classes helped reduce stress.The majority of respondents(90.0%)agreed that the classes contributed to increased feelings of social connectedness.Overall,medical students saw benefit in PA based interventions to supplement MSK course concepts.Along with increasing activity levels and promoting health behaviours,integrating PA into medical curriculum may improve comprehension of learning material,alleviate stress and foster social connectivity among medical students.

Analysis of the Necessity and Modalities of Imparting Death Education to Medical Students Undergoing Training in Oncology Departments

Patients with advanced-stage tumors may experience various psychological problems that can have a significant impact on the effectiveness of cancer treatment and the quality of their survival.Therefore,it is crucial for oncologists to prioritize addressing the psychological issues that patients encounter throughout the diagnosis and treatment process.As future frontline healthcare professionals,oncology medical students should receive education on end-of-life care early on in their training.This will enable them to develop a profound appreciation for the value of life,deliver improved medical services,and contribute to the humanization of medicine.Furthermore,they will be able to provide terminal patients and their families with effective professional guidance,assisting patients in finding peaceful endings with minimal pain and helping families come to terms with the inevitable realities they face.Moreover,this education can effectively enhance their sense of responsibility toward life and cultivate a positive and optimistic attitude toward their own lives.

Current Situation and Improvement Strategies of Teaching Engagement by Teachers in Higher Medical Colleges Under the Background of“New Medical Education”

The“New Medical Education”is a new requirement for the development of medical education in the new era.As a key and core element of the construction of the“New Medical Education,”the engagement in teaching work of university teachers is a key issue that determines the level of teaching development of university teachers and affects the quality of talent cultivation in universities.Using the literature review method,this study analyzed 39 relevant literatures retrieved from China National Knowledge Infrastructure(CNKI)from 1997 to 2023.The concept,connotation,current situation,influencing factors,and improvement strategies of teaching engagement by university teachers were reviewed and summarized.The results showed that the issue of teaching engagement by university teachers has not received high attention in the field of higher education,especially in higher medical education,which has not yet been reported.Although the overall number of literature is not large,some of the conclusions have important implications for the next research on the influencing factors and mechanisms of double-qualified teacher engagement in higher medical colleges.

Analysis of Professional Quality Cultivation Strategies for Infant and Child Care Service Talents from the Perspective of Collaboration of Medical Care,Parenting,and Education,and Integration of Industry and Education

The collaboration of medical care,parenting,and education aims to integrate nursing,midwifery,infant and child care services,and management with speech and hearing rehabilitation technology,among other elements related to the infant care industry chain.This integration targets pediatrics talent training in nine infant care positions,including nursing,infant health care and management,and child rehabilitation,to ensure that the capabilities and quality of professional talents can meet the health care needs of infants and young children.This article briefly explains the background of the“collaboration of medical care,parenting,and education,and integration of industry and education.”It analyzes the necessity of cultivating infant and child care service talents based on the perspective of“collaboration of medical care,parenting,and education,and integration of industry and education.”Based on this perspective,we conducted an in-depth study of the cultivation of professional qualities of infant and child care service talents.

Building towards Expertise in CME （Continuous Medical Education）： Suggestions for a New Paradigm

To build towards expertise, one has to accept to modify his way of practicing, including： （1） a need to reflect on and about the action; （2） a continuous concern about our competence to practice; （3） tireless effort to combine metacognition and mental practice in a trans-disciplinary approach; （4） adding research with neuroscience, understanding neuroplasticity, modulation and artificial intelligence. Usual practice actually does not include a continuous concern for CME （continued medical education） and is intermittent at best. This new paradigm constitutes the basis of our approach. Expertise starting in 2015 is described as an asymptotic curve unable to be obtained with usual practice and intermittent education. We suggest a new way of conceiving CME combining practice, reflection on action and in-situ simulation laboratory near work. We are describing TEE （technology-enhanced education） coupled with certain neuro-enhancers to achieve a break in the asymptotic curve of expertise. This is in reality a new conception of CME in medicine.

Potential and limitations of ChatGPT and generative artificial intelligence in medical safety education

The primary objectives of medical safety education are to provide the public with essential knowledge about medications and to foster a scientific approach to drug usage.The era of using artificial intelligence to revolutionize medical safety education has already dawned,and ChatGPT and other generative artificial intelligence models have immense potential in this domain.Notably,they offer a wealth of knowledge,anonymity,continuous availability,and personalized services.However,the practical implementation of generative artificial intelligence models such as ChatGPT in medical safety education still faces several challenges,including concerns about the accuracy of information,legal responsibilities,and ethical obligations.Moving forward,it is crucial to intelligently upgrade ChatGPT by leveraging the strengths of existing medical practices.This task involves further integrating the model with real-life scenarios and proactively addressing ethical and security issues with the ultimate goal of providing the public with comprehensive,convenient,efficient,and personalized medical services.

Flexner has fallen:Transitions in medical education system across time,a gradual return to pre-Flexnerian state(de-Flexnerization)

The modern medical education system has gradually evolved starting from 1910 incorporating the suggestions by Abraham Flexner,his public disclosure of the poor conditions at many medical schools provided a means to galvanize all the constituencies needed for reform to occur.He could say what other reformers could not,due to their links to the medical education community.But now we are again going back to a pre-Flexnerian state due to multiple reasons such as gradually diminishing importance of basic science subjects for the students,the decline in the number and quality of investigator initiated research among clinical researchers,lesser emphasis to bedside training by means of detailed clinical examination and making appropriate observation of signs to reach to a diagnosis rather than over reliance on the laboratory tests and radiological modalities for the diagnosis,poor exposure to basic clinical skills starting from college throughout residency and the trend of disrespect and absenteeism from both theoretical and clinical/practical classes.The attitude of students is just to complete their required attendance so that they are not barred from appearing in examinations.This de-Flexnerization trend and regression to pre-Flexnerian era standards,ideologies,structures,processes,and attitudes,are bound to beget pre-Flexnerian outcomes,for you get what you designed for.

Path Breakthrough of Medical Humanities Education From the Perspective of“All-Staff,Whole-Process,and All-Round Education”

Medical education is an important cornerstone for the development of healthcare,and medical humanities education,as an integral part of medical education,plays an irreplaceable role in cultivating people’s health guardians with high medical ethics.We adopted the method of stratified random sampling to select 309 students and 107 faculty members from three independent medical colleges in Sichuan province as the research subjects and distributed questionnaire surveys investigating in three dimensions:overall cognition of medical humanities,evaluation of medical humanistic qualities,and the current situation of medical humanities education,supplemented by an in-depth literature review and interviews with subject matter experts.We found that“tech-centrism”still has a great influence,the self-evaluation of medical students’humanistic quality is generally not high,the educational concept of“emphasizing professional skills over morality”of faculty and staff is still quite prevalent,and there is still the“last mile”phenomenon in medical humanities education.In order to promote the integrated development of“new medicine”and“new liberal arts”and break the barriers of“tech-centrism”and“instrumental rationality,”it is necessary to change the educational concept and strengthen the education of all employees,break through the bottleneck of internships and strengthen the whole process of education,integrate educational resources and strengthen all-round education,improve the incentive mechanisms,strengthen the assessment methods,and provide Chinese wisdom and Chinese solutions for the development of medical humanities education.

Learning by Living: Empathy Learned through an Extended Medical Education Immersion Project

Introduction: Medical student training and experiences in nursing homes are often viewed as negative;however, long-term care services represent a growing aspect of our medical system that receives little attention in medical education. The University of New England College of Osteopathic Medicine Learning by Living Nursing Home Immersion Project accelerates students learning about older adult care and the importance of empathy. Methods: Learning by Living applies qualitative ethnographic/autobiographic research methods to answer the question: “What is it like for me to live the life of an older adult nursing home resident?” Two first year medical students (female, 25 y/o & male, 27 y/o) were “admitted” into two different nursing homes for 11 days each. The students were wheelchair reliant from their assigned diagnoses of dominant-side paralysis secondary to stroke and aspiration pneumonia;requiring standard procedures of care experienced by older adults residents with similar conditions. Data were collected in the form of journal notes for pre-fieldwork, fieldwork, and post-fieldwork and included subjective and objective reporting of observations, experiences, and resident encounters. Analyses included journal review and thematic categorization and coding through content analysis. Results: Four themes of significance intersected for the two medical students: 1) control;2) quality of life;3) communication;and 4) isolation. Being immersed in nursing home life provided the students with firsthand experiences of loss and challenges faced by nursing home residents. This aided students’ learning about empathy and communication as key components of providing health care. Conclusion: This experience imparted knowledge to the medical students’ about aging, dignity, and the importance of making meaningful connections in order to thrive. These insights provided a gateway to establish a model of patient-centered care that is comprehensive and empathic for the older adult population.

Chinese medical service and medical education in urgent need of reform in the context of public welfare-based medical reform

After six years＇medical reform,about 7.8 billion person-times of medical service has been achieved by2014,and the number of persons covered by basic medical insurance for urban employees,basic medical insurance for urban residents,and new rural cooperative medical insurance exceeded 1.3 billion,of which the coverage ratio reached as high as over 95%,establishing the largest basic medical security network in the world.

From nuclear submarines to graduate medical education: applying David Marquet's intent-based leadership model

L.David Marquet,a decorated Navy Captain,transformed an under performing submarine crew by empowering his subordinates to be leaders and reach their full potential.He called this intent-based leadership(IBL).What would happen if Marquet’s model were implemented in Graduate Medical Education(GME)?In this letter to the editor,we summarize the potential of the IBL model in graduate medical education as opposed to the traditional leaderfollower method.IBL harnesses human productivity toward the shared goals of GME,which are patient care and trainee learning.This shift in mindset could lead both teachers and trainees to focus more on the real reason that we undertake GME and change behaviors for the better.We suggest that IBL can and should be adopted in GME and propose that both patients and providers will benefit from this action.

Continuing professional development:progress beyond continuing medical education

Continuing medical education(CME)is rapidly evolving into competency-based continuing professional development(CPD)and this is driving change in self-directed CPD programs undertaken by individual practitioners as well as CPD programs or frameworks offered by CPD educators.This progression is being led by many factors including the rapid change in medical knowledge and medical practitioners along with changes in patients and society,healthcare systems,regulators and the political environment.We describe our experiences primarily concerning low-resource environments,in creating the International Council of Ophthalmology(ICO)Guide to Effective CPD/CME and in developing a CPD program for the Cambodian Ophthalmological Society(COS)twinned with the Royal Australian and New Zealand College of Ophthalmologists(RANZCO).At the conclusion of the project,47(100%)Cambodian practicing ophthalmologists were registered in the CPD program and 21(45%)were actively participating in the online COS-CPD program recording.We discuss challenges in CPD,propose solutions to overcome them and recommend developing research in CPD as needed to effectively enhance educational activities with impact in public health.

Continuous ambulatory peritoneal dialysis telemonitoring and education:A scoping review

The risk of peritonitis complications in continuous ambulatory peritoneal dialysis(CAPD)can be prevented or reduced by providing proper education and continuous monitoring.Telemedicine and telemonitoring are methods that enable remote monitoring and patient care.This study aimed to determine the success and factors affecting telemonitoring in CAPD patient care.This study is a scoping review(ScR)using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR method.Article searches were carried out on ProQuest,PubMed,and ScienceDirect with a time range of 2018-2023.Data extraction was performed regarding knowledge level,quality of life,clinical outcomes(peritonitis),and risk of hospitalization.Of the 12 articles and studies included,6 articles were related to the effect of telemonitoring on CAPD patient outcomes,and 6 articles were associated with the effect of education on CAPD patient outcomes.Education provided to patients can improve patient understanding of therapeutic modalities for renal disorders,reduce the potential for peritonitis and dialysis complications,and improve the quality of life of patients with CAPD.CAPD patients who received telemonitoring had a better quality of life,good clinical outcomes,and a lower risk of hospitalization than those who did not receive telemonitoring and had fewer health-care visits.In summary,the implementation of telemonitoring and education in chronic kidney disease patients with CAPD modality therapy has been proven effective in improving quality of life and reducing dialysis-related risks.

IoTFLiP： IoT-based flipped learning platform for medical education

Case-Based Learning （CBL） has become an effective pedagogy for student-centered learning in medical education, which is founded on persistent patient cases. Flippped learning and Internet of Things （IoTs） concepts have gained significant attention in recent years. Using these concepts in conjunction with CBL can improve learning ability by providing real evolutionary medical eases. It also enables students to build confidence in their decision making, and efficiently enhances teamwork in the learning environment. We propose an IoT-based Flip Learning Platform, called IoTFLiP, where an IoT infrastrneture is exploited to support flipped case-based learning in a cloud environment with state of the art security and privacy measures for personalized medical data. It also provides support for application delivery in private, public, and hybrid approaches. The proposed platform is an extension of our Interactive Case-Based Flipped Learning Tool （ICBFLT）, which has been developed based on current CBL practices. ICBFLT formulates summaries of CBL cases through synergy between students＇ and medical expert knowledge. The low cost and reduced size of sensor device, support of IoTs, and recent flipped learning advancements can enhance medical students＇ academic and practical experiences. In order to demonstrate a working scenario for the proposed IoTFLiP platform, real-time data from IoTs gadgets is collected to generate a real-world case for a medical student using ICBFLT.

A Culturally-Sensitive Model for CME Distance Learning Demonstratesa Way Forward： Kenya＇s Experience with ACME-IT （Advancing Continuing Medical Education Through Information Technology）

A distance learning Continuing Medical Education （CME） project based on live interactive presentations and a group participatory model demonstrated that important strides can be made in the quality of CME available to health care professionals in African rural settings. Implementers choose a communication model consistent with the fundamental orality of Kenyan and other sub-Saharan African countries. The project involved four hospitals and one training institution in rural Kenya. The testing of learners and focus group discussions with learners, facilitators and presenters indicated that the project＇s methodologies, that strove to be culturally and work place friendly, contributed to gains in knowledge, competencies including case management, the continuity of patient care, team work, staff morale and other issues of expressed importance to the hospital healthcare work force and hospital administrators. The learning system, known as Advancing Continuing Medical Education through Information Technology （ACME-IT）, was implemented by the Kenyan Ministry of Medical Services, EC Associates and the US-funded Aphia2 Western initiative implemented by PATH. The findings of this pilot suggests that the ACME-IT methodology that set up learning centers at the participating institutions is a promising viable alternative to the traditional and relatively expensive workshop training that characterizes much of CME in lower and middle income countries.

Current State of Affairs with Regard to Continuing Medical Education for Technicians in Radiology in Francophone West Africa

Background: This study aimed to determine the level of continuing medical education (CME) of medical imaging technicians in French-speaking West Africa. Materials and methods: This opinion survey was administered to radiology technicians in French-speaking West Africa from 1st June to 31st October 2020, i.e. over a period of 5 months concerning their level of CME and their need for CME. Results: Out of 100 technicians, 69% were men. The mean age was 40 years, with extremes ranging from age 23 to age 57. The majority of technicians (64%) worked in the public sector and 78% had work experience of less than 11 years. Most technicians were holders of a Bachelor’s degree (73%). The types of CMEs they knew were congresses, seminars, and modular training in 46% of the cases. The most available CMEs were seminars (63%). All technicians agreed on the need for CME and 96% said it had an impact on the delivery of radiology services. Technicians who had received CME at least once represented 61%. For 90% of technicians, the specific CME sought was management in radiology (33.33%) and radiation protection (25.81%). Conclusion: The need for CME is increasingly indisputable to radiology technicians in French-speaking West Africa;however, it remains a luxury for them, due to its scarcity and its high cost.