Journal of Advances in Medical Education & Professionalism

Abstract Generation Z (Gen Z) or iGen describes individuals born between 1995 and 2012. They are the first generation raised entirely in the digital world. They have always had the technology, the Internet, and social media.

Abstract Introduction: This systematic review and meta-analysis investigated the impact of utilising peer-generated multiplechoice question (MCQ) banks on the summative performance of undergraduate students studying medicine and allied subjects. Answering and writing peer-made MCQ questions are hypothesised to enhance learning through achievement of the
domains of Bloom’s taxonomy and thus summative examination performance.
Methods: A random-effects meta-analysis of correlation coefficients was conducted on six studies (n = 1,571) published between 2011 and 2021, drawn from MEDLINE, Scopus, Web of Science, PubMed, CENTRAL, and ERIC. The studies included undergraduate medical students from four countries. The risk of bias was assessed using the ROBINS-I tool.
Results: A weak positive correlation was found between answering peer-made MCQs and summative performance (Spearman’s ρ = 0.22, 95% CI: 0.15 to 0.29, p < 0.0001), with a prediction interval of 0.00 to 0.42, indicating that in future studies, the effect of answering peer-made questions is likely beneficial or, at worst, neutral. A similar weak positive correlation was observed for writing peer-made MCQs (Spearman’s ρ = 0.21, 95% CI: 0.09 to 0.32, p < 0.0004), though the prediction interval (-0.27 to 0.61) cannot exclude negative correlation between writing questions and summative performance in future studies. The findings suggest that answering and creating peer-generated MCQs positively influence exam performance. The modest correlations likely
reflect confounding factors, such as prior academic performance and socio-economic background. This complicates isolating the impact of MCQ banks and may understate their true impact.
Conclusion: This study advocates for the integration of peergenerated MCQ banks into medical curricula, highlighting their potential as a cost-effective method to improve summative
performance. Future research should focus on large-scale observational studies to better quantify these effects as well as controlling for confounding factors. The study underscores the value of peer engagement in learning and the utility of peer-made MCQ banks as educational tools.

Abstract Introduction: Artificial intelligence (AI) has become integral to various fields, including medical education. This study explores AI applications in medical education through a review of relevant
studies.
Methods: Using the umbrella review method, this study synthesized findings from reviews conducted between 2018 and 2024. The PRISMA framework guided a comprehensive search of databases, including Science Direct, Springer, ERIC, PubMed, and Google Scholar. After quality assessment with the CASP framework, 77 systematic review articles were selected. Data analysis employed Elo and Kyngäs’s qualitative content analysis approach, supported by expert validation and researcher consensus.
Results: Six key themes of AI applications in medical education were identified: faculty, students, teaching and learning process, assessment, curriculum, and management/implementation.
Management and implementation had the highest representation (26.5%), followed by teaching and learning processes (25.9%). Examples of each theme were highlighted. China produced
the most articles, and three journals—International Journal of Educational Technology in Higher Education, Computers and Education: Artificial Intelligence, and Education and Information
Technologies—were the leading publication venues.
Conclusion: These six themes provide a roadmap for medical education policymakers to adapt to AI advancements. Emphasizing management and executive applications, the findings predict
significant changes in the future of medical education and practice. This framework can help medical universities align curricula and operations with the evolving landscape of AI in healthcare.

Abstract Introduction: Surgeons’ professionalism is vital for ensuring safe surgical care, particularly in Indonesia, where cultural and systemic factors present unique challenges to healthcare delivery.
Professionalism affects surgical outcomes, patient safety, and interprofessional collaboration directly. This study represents the first national-level exploration of surgical professionalism, involving culturally diverse participants from various regions. To explore how healthcare professionals and patients perceive surgeon professionalism in Indonesia, emphasizing cultural and systemic influences.
Methods: This qualitative study employed a phenomenological approach to capture the lived experiences and perspectives of informants regarding surgeons’ professionalism. This study was conducted at public, private, and military healthcare institutions in Indonesia, including type B, C,
and D hospitals, as well as specialty hospitals. A total of 27 participants, including surgeons, anesthesiologists, pediatricians, internists, operating room nurses, ward nurses, hospital management, and patient representatives, were recruited through snowball sampling to ensure
diverse perspectives. In-depth interviews were conducted to elicit the participants’ perceptions of surgeons’ professionalism in their healthcare context. Reflexivity and triangulation methods were applied to ensure validity and minimize bias. The study identified key themes and subthemes
of professionalism as perceived by participants, highlighting non-technical aspects of surgeon professionalism in Indonesia.
Results: Four non-technical themes of surgeon professionalism were identified: fulfilling roles and responsibilities, upholding integrity, having good communication skills, and engaging in multidisciplinary collaboration. These aspects were influenced by cultural values and systemic challenges, including disparities in healthcare resources.
Conclusions: Surgeons’ professionalism in Indonesia is shaped by cultural and structural factors distinct from global standards. The findings provide insights for culturally sensitive interventions that enhance professionalism and surgical care quality in Indonesia. Addressing these unique dynamics is essential for improving patient safety, healthcare outcomes, and professional relationships.

Abstract Introduction: The clinical learning environment (CLE) is an important element of competency-based postgraduate medical education (CBME). Trainee perceptions of their CLE serve as a quality indicator of the teaching and learning taking place at the workplace. This study aimed to investigate the trainees’ perceptions regarding their CLE and identify strengths and
weaknesses to support CBME.
Methods: A universal sampling was employed for this crosssectional survey. The electronic version of the Postgraduate Hospital Educational Environment Measure (PHEEM) inventory was sent via email to all the trainees who were enrolled in all 35 residency programs at our university and consented to participate in the study.
Results: A total of 347 (69.4%) residents responded; of them, 65.7% were females. The overall mean score was 107 (66.8%), suggesting a generally favorable opinion of the workplace, with room for improvement. Mean scores for the subscales of Autonomy, Teaching, and Social Support were 33.42±7.24 (more positive), 42±8.9 (moving in the right direction), and 27.9±6.2 (more pros than cons), respectively. There was no difference in the CLE perceptions based on gender. Overall and subscale scores differed significantly across residency programs, with the highest in Radiology (122.3±13.5) and the lowest in Surgical disciplines (95.47±19.0); and year of residency, with the highest in the first year (111.3±17.8) and the lowest in the final year (81.5±34.3).
Conclusion: Evaluating the EE offers valuable insights into enhancing training quality by identifying both strengths and weaknesses, and prioritizing areas in any planned enhancements. The EE for the postgraduate training appears to be prepared for implementing CBME, with certain areas warranting improvement.

Abstract Introduction: Teaching hospitals integrate healthcare, education, and research but face challenges in assessing residents as learners and healthcare providers. Conventional supervisor-led assessments may not fully capture real-world competencies, necessitating multi-source evaluation. This study examines stakeholder perspectives on resident performance assessment and key evaluation criteria.
Methods: This study employed a qualitative content analysis and inductive approach to examine stakeholder perspectives on residents’ performance. Data were collected through focus group
discussions with purposively sampled clinical educators, allied health practitioners, and senior residents. Transcribed discussions were analysed using inductive thematic analysis in MAXQDA,
following a reflexive six-phase approach. Researchers developed codes, organised them into potential themes, and refined them into a coherent narrative addressing the research questions.
Results: Five themes emerged: Clinical Competency, Learning-Teaching and Mentorship, Professionalism and Ethics, Communication and Teamwork, and Managerial and Administrative Roles. Clinical educators prioritized Learning-Teaching and Mentorship alongside Professionalism, while allied health professionals emphasized Communication and Teamwork, and Managerial and Administrative duties. Residents primarily focused on Learning-Teaching and Mentorship. Subthemes emphasised varied across participant groups.
Conclusion: Teaching hospital stakeholders assess residents differently. Addressing hierarchical barriers, enhancing communication, and fostering professionalism are essential for comprehensive, context-sensitive, and effective resident training and performance assessment.

Abstract Introduction: The concept of Entrustable Professional Activities (EPAs) is central to competency-based medical education, which enables the assessment and guidance of learners in clinical settings. While EPAs have been widely adopted in various medical specialties, their application in hematopathology training remains underexplored. This study aimed to develop and validate
a set of Entrustable Professional Activities (EPAs) tailored for hematology training in pathology residency programs.
Methods: This cross-sectional Delphi study was conducted in 2023 at Aga Khan University Hospital, Pakistan, to seek consensus for EPAs. Sixteen essential EPAs for hematology postgraduate education were identified through literature review and faculty expertise, aligning with core ACGME competencies. Teaching/learning and assessment strategies were detailed for each EPA. The modified Delphi method, involving two iterative rounds, was employed to achieve expert consensus. The panel comprised 22 experts, 16 of whom participated from various institutions.
Results: In the first Delphi round, 14 out of 16 EPAs reached the desired consensus of more than 80%, along with certain teaching/assessment strategies. The second round aimed to finalize
consensus on the remaining items. Two EPAs related to Platelet Function Disorders and Von Willebrand Disease failed to reach the predefined consensus criteria. Lectures as a teaching strategy and certain assessment strategies also lacked consensus. The study concluded with the acceptance and finalization of 14 EPAs and their associated teaching and assessment strategies.
Conclusions: The study identified essential EPAs, competencies, and effective teaching and assessment strategies. This collaborative effort advances hematology medical education and guides curriculum development, preparing competent hematologists for the unique context of the Pakistani and related healthcare systems.

Abstract Introduction: Cognitive error styles refer to faulty patterns of thinking that can negatively influence individuals’ decision-making and behavior. Among midwifery students, identifying and understanding these errors is particularly important, as their decisions directly impact maternal and neonatal outcomes. Thus, the present study aimed to explain the cognitive error styles of midwifery students in clinical decision-making.
Methods: This qualitative study was carried out using a directed qualitative content analysis approach. Initially, empirical literature and studies from databases such as ERIC, PubMed, Web of Science, ScienceDirect, and Scopus were reviewed to identify relevant components of cognitive error styles among midwifery students. Next, unstructured and semi-structured interviews were conducted with 12 midwifery students (bachelor’s and master’s levels) enrolled at Shahrekord University of Medical Sciences, Iran, from August 2023 to May 2024.
Results: Among 32 main categories extracted from the literature review, 11 functional components of cognitive error styles were confirmed by the midwifery students, including emotional reasoning, procrastination, lack of confidence, anchoring , recency bias, catastrophizing, stereotyping, negative filtering, labeling, fortune telling, and all-or-nothing thinking.
Conclusions: Given the significant impact of cognitive error styles on clinical decision-making by midwives and midwifery students, it is essential to identify the causes of medical errors associated with these cognitive biases to minimize mistakes and their related financial consequences. A deeper understanding of these errors can ameliorate the education and clinical performance of midwifery students, ultimately enhancing healthcare delivery.

Abstract Introduction: The importance of retaining content in the longterm memory of medical students is well-documented. Given the narrative structure of medical disciplines, digital storytelling is an effective educational tool. This study investigates the effect of digital storytelling on the learning and satisfaction of nursing and midwifery students.
Methods: This quasi-experimental study included 20 thirdsemester midwifery students (intervention group, digital storytelling) and 50 first-semester nursing students (control group, traditional lectures), all enrolled in an undergraduate psychology course. Both groups participated in five initial lecturebased sessions. Thereafter, the intervention group received six weekly digital storytelling sessions, each featuring a 3–8 minute narrative followed by instructor-led discussions, while the control group continued with standard lectures and question–and–answer sessions. Learning outcomes were measured using pre- and posttests, and student satisfaction was assessed using a validated questionnaire. Statistical analyses were performed, adjusting for
baseline scores and demographic confounders.
Results: The digital storytelling group showed significantly higher post-test scores in learning outcomes (75.21±17.75 vs. 54.97±23.40, p=0.001) and satisfaction (38.15±6.45 vs. 31.22±4.59, p=0.0003) compared to the traditional lecture group. The potential effect of baseline values, as well as non-homogeneous demographic variables across groups, was removed using non-parametric ANCOVA. The result confirmed that gender had no confounding effects on either learning outcomes or satisfaction. Additionally, the differences between the two groups in terms of learning and satisfaction remained significant (p<0.001).
Conclusion: Digital storytelling offers a meaningful and learnercentered approach that extends beyond content delivery. By fostering active engagement and deeper cognitive involvement,
it transforms traditional instruction into a more personalized and reflective learning experience. This approach is recommended in healthcare education to improve instructional effectiveness and
student satisfaction.

Abstract As an ideology for managing healthcare relying on internal professional oversight, medical professionalism entrusts the responsibility of regulation to the members of the profession themselves. This allows them to demonstrate to the public that the necessary measures are in place to ensure the competency of individuals practicing medicine and to oversee their performance according to professional standards. This commentary explores how medical councils maintain professionalism through selfregulation and their critical role in sustaining public trust.
The medical council plays five key roles in fulfilling its selfregulatory function: A. Setting medical education standards and accrediting medical schools, B. Granting licenses to practice medicine, C. Establishing continuous education standards to maintain professional competency, D. Defining professional performance regulations, and E. Handling disciplinary matters related to professional conduct.
The strengths and weaknesses of their execution in our country’s medical council will be analyzed by introducing and providing examples of successful implementations of each of these roles in various countries. Finally, three solutions are recommended to maintain public trust and enhance these functions through conflict-of-interest management: separating the professional advocacy section from the self-regulation section, including non-medical professionals in the Medical Council and its various commissions, and ensuring transparency in policies, member information, and disciplinary rulings.