Journal of Advances in Medical Education & Professionalism

Abstract Introduction: The landscape of medical education has witnessed significant transformations over the past decades, particularly with the advent of active teaching methodologies. However, despite these advancements, the traditional theoretical assessment methods have remained largely unchanged. This lack of evolution in assessment systems poses a challenge as it is crucial for assessment methods to evolve in tandem with teaching approaches to ensure a comprehensive and effective learning process in medical education. This paper reviews the integration and effectiveness of open-book examinations (OBEs) in medical education, reflecting their growing significance.
Methods: An integrative review of the literature was conducted, drawing from a range of relevant publications over the last decade, sourced from databases such as PubMed, Web of Science, Scopus, and ERIC. The inclusion criteria focused on full-text articles in English, with search terms including “medicine,” “assessment,” “open book examination,” “open book exam,” and “open book assessment,” combined using Boolean operators. Thirteen publications were selected and critically appraised using The Critical Appraisal Skills Program checklist.
Results: The analysis identified three primary thematic categories: “Teaching Strategy for Pandemic and Challenging Conditions,” “Tool of Learning & Educational Impact”, and “Operational Challenges & Future Directions”. These themes were explored to understand the role and impact of open-book examinations in medical education.
Conclusion: The findings indicate that open-book examinations are a crucial component in the evolving landscape of medical education. While certain reservations remain, open-book
examinations have shown significant potential in fostering critical thinking, argumentation skills, and lifelong learning among medical students. They reflect the ongoing evolution of knowledge in the medical field and contribute to the development of professionals’ adept at navigating and applying complex information. Further research is recommended to solidify these findings and expand the understanding of open-book examinations in medical education.

Abstract Introduction: The irrational use of medicines remains prevalent globally despite education efforts, leading to decreased treatment quality and increased healthcare costs. With the rise of online
learning during the COVID-19 pandemic, virtual simulation offers a promising solution to enhance the teaching of rational medicine use among medical students. This study aimed to investigate medical students’ perspectives and needs regarding the implementation of virtual simulation in learning the rational use of medicines.
Methods: This study, conducted at Universitas Indonesia from August 2022 to September 2023, used a mixed-method approach to assess the needs for developing virtual simulation in education
of rational medicine use. A validated questionnaire with 14 closed ended and 14 open-ended questions was completed by 281 medical students. The quantitative data were analysed descriptively, using SPSS v16, while thematic analysis was applied to open-ended responses.
Results: Students perceived virtual simulations to be the most effective tool for distance learning and suggested features like case scenarios, realistic representation, a good user interface, and
user-friendly navigation. The majority preferred a 10–20-minute duration for virtual simulations. Additionally, 52.3% had no prior knowledge of the rational use of medicines, but acknowledged
its importance. Virtual simulations could be used to explain the concept, management, and implementation of the rational use of medicines.
Conclusion: Virtual simulation should be implemented in distance learning on rational medicine use to increase students’ motivation, understanding, retention, interactivity, and focus. The findings might be utilized by medical educators to tailor virtual simulation design to meet medical students’ needs and expectations.

Abstract Introduction: Medical schools face substantial challenges in objectively selecting the best applicants, and the admission process can impact medical students’ academic performance.
This study aimed to estimate the students’ academic success in the preclinical stage of undergraduate medical education using admission tests.
Methods: This cross-sectional study was conducted on 1,193 students’ records from the 2014 to 2019 cohorts. The students’ admission data comprised the cohort, sex, admission track,
psychological test, and academic tests. The academic success was based on the student’s end-year academic evaluation. Data were analyzed using contingency and Kendall’s tau b tests with IBM® SPSS® Statistics version 16.0 for Windows. 
Results: Most of the 1,193 preclinical medical students’ records included in the study were females (68.1%), from the regular admission track (78.5%), from the considered psychology test category (52.8%), and had an academic admission test of less than or equal to the median. (51.6%). Most students (89.7%) met all the academic requirements to pass the end-year evaluation. The bivariate analyses showed significant correlations between academic success and cohort (P<0.001), psychology test (P=0.005), and academic test (P<0.001). The analyses showed no significant
correlation between academic success and sex (P=0.324), and admission track (P=0.128).
Conclusions: This study indicated that cohort and psychology tests could estimate the student’s academic success at the preclinical stage of undergraduate medical education. The admission criteria related to the academic tests during the admission process should be re-evaluated, so that the academic tests could select the best students among the applicants.

Abstract Introduction: Patient safety is the most important priority in the healthcare system. Medical universities always attempt to find innovative and more effective educational methods to improve
the students’ abilities for clinical decision-making and quality and safe care. Thus, this study was designed to evaluate the effect of scenario-based learning on the knowledge, attitude, and
perception of nursing students about patient safety.
Methods: This quasi-experimental study was conducted between September 2023 and January 2024. The study sample comprised 78 nursing and midwifery students from the fourth and fifth semesters of their bachelor’s degrees, each of whom was systematically reviewed. The participants were allocated to the intervention (n=43) and control groups (n=35) randomly, using simple randomization. The educational content was presented via scenario-based learning for participants in the intervention group, while it was presented through lecture and discussion in the control group. The questionnaire was standardized and structured, and its validity and reliability were assessed. Data gathering was performed one month after the intervention using a knowledge, attitude, and practice questionnaire. Data were analyzed in SPSS software version 16 using descriptive statistical methods and inferential tests, including the chi-square test, independent T-test, paired T-test, and ANCOVA.
Results: The study findings indicated that there were no significant differences in attitude (P=0.152) and perception (P=0.264) scores between the intervention and control groups before the intervention. However, after the intervention, a significant difference was observed (P<0.001). [Knowledge 14.97±3.70 vs. 19.37±3.31), attitude (31.74±5.38 vs. 34.62±9.59), perception
(35.60±7.51 vs.38.95±8.21)].
Conclusion: Scenario-based learning can be a more effective way to teach nursing and midwifery students about patient safety. Thus, researchers recommend that this educational method should be used by nursing and midwifery instructors to improve the students’ ability to provide safer care for patients.

Abstract Introduction: Lack of clinical competence can endanger the patient’s safety and reduce the quality of providing health care services. The aim of this study was to examine the impact of formative Objective Structured Clinical Examinations (OSCEs) with immediate verbal and visual feedback on the clinical competence of fourth-year nurse anesthesia students.
Methods: This was a single blind quasi-experimental study with a pre-test/post-test design in compliance with the CONSORT (Consolidated Standards of Reporting Trials) statement. Fortyeight
students were allocated to intervention (n=24) and control (n=24) groups. During the academic semester, the students of the intervention group attended 3 sessions of formative OSCE (5 stations) with immediate verbal and visual feedback. In the control group, however, the students received in-person feedback according to curricular routine. The data collection tool included
two sections. The first section included a questionnaire to collect demographic information such as age, sex, grade point average and marital status. In the second section, clinical competence
of students was measured by Common Clinical Assessment Tool (CCAT). The collected data were analyzed by Analysis of Covariance, paired T-test, Chi-square, and Fischer’s exact test in
SPSS, version 16.
Results: Comparing post-test scores by ANCOVA showed a significant difference between groups (P=0.001) because there was a significant positive change in the overall clinical competence
score in the intervention group after receiving formative OSCE.
Conclusion: This study showed that regular implementation of formative OSCEs in nurse anesthesia education fosters learning and has a positive effect on improving students’ educational
behaviors and helps them learn more efficiently. However, it is recommended to conduct more studies with a larger number of participants to confirm this conclusion.

Abstract Introduction: This study investigated Iranian, English as a foreign language (EFL) teachers’ attitudes toward reflective teaching compared with their classroom assessment preferences and up-take of strategy based instruction. It compared their views in the two key higher education provider contexts of the university and institute.
Methods: In this cross-sectional correlational study, a total of 90 teachers, half drawn from each university in a major city in Iran, were selected using controlled quota sampling. Data were collected through a four-part survey. Besides gathering demographic data (Part A), the survey drew upon three established instruments that used a Likert Scale format. Part B comprised the Teacher Reflectivity questionnaire, and Part C focused on the Classroom Assessment Preferences Survey Questionnaire for Language Teachers. Also, part D administered the Teachers’ Beliefs Inventory for Strategy Instruction. The reliability of this and the CAPSQ-LT was confirmed by the researchers using Cronbach’s alpha at 0.842 and 0.951, respectively. A total of 90 questionnaires were distributed, with 72 fully completed (80%) and returned. the Statistical Package for Social Sciences (SPSS) was employed to analyze the data, using the independent sample t-test and ANOVA. Also, Pearson productmoment correlations were used to measure the association between the variables. A p-value less than 0.05 was considered as significant.
Results: As shown in Table 2, a statistically significant and positive correlation was found between the teachers’ reflective teaching scores and classroom assessment preference scores (r=0.473, P=0.001). This correlation was moderately high and positive, thus supporting that higher teacher reflective practices reflect a broader application of classroom assessment. The Table also shows that there was no significant correlation between the teachers’ attitudes toward reflective teaching and their uptake of strategy-based instruction (r=0.094; P=0.434). Similarly, there was no statistically significant correlation between the teachers’ attitudes toward classroom assessment preferences and their beliefs about strategy-based instruction (r=0.038, P=0.752). As shown, no statistically significant difference was observed between the teachers’ attitudes toward reflective
teaching and their uptake of strategy-based instruction (P<0.05).
Conclusion: This study draws attention to the need for teachers in EFL contexts, such as this, to have access to professional development opportunities that deeply engage and guide them to be reflective practitioners who can make the connections between assessment techniques, strategy-based instruction, and students’ improved language learning outcomes.

Abstract Artificial Intelligence (AI) has rapidly transformed various sectors, including medical education, with the introduction of advanced tools that can enhance learning and teaching methods. These AI-powered systems, ranging from language models to intelligent tutoring systems, offer innovative ways to support and augment human capabilities.

Abstract Considering the increasing usage of Artificial Intelligence (AI) and Machine Learning (ML) in various specializations of medicine, it seems necessary to instruct our medical students on how to utilize them. This paper provides a view on incorporating ML educational content into the medical curriculum.