Ethical Considerations and Fundamental Principles of Large Language Models in Medical Education: Viewpoint.

This viewpoint article first explores the ethical challenges associated with the future application of large language models (LLMs) in the context of medical education. These challenges include not only ethical concerns related to the development of LLMs, such as artificial intelligence (AI) hallucinations, information bias, privacy and data risks, and deficiencies in terms of transparency and interpretability but also issues concerning the application of LLMs, including deficiencies in emotional intelligence, educational inequities, problems with academic integrity, and questions of responsibility and copyright ownership. This paper then analyzes existing AI-related legal and ethical frameworks and highlights their limitations with regard to the application of LLMs in the context of medical education. To ensure that LLMs are integrated in a responsible and safe manner, the authors recommend the development of a unified ethical framework that is specifically tailored for LLMs in this field. This framework should be based on 8 fundamental principles: quality control and supervision mechanisms; privacy and data protection; transparency and interpretability; fairness and equal treatment; academic integrity and moral norms; accountability and traceability; protection and respect for intellectual property; and the promotion of educational research and innovation. The authors further discuss specific measures that can be taken to implement these principles, thereby laying a solid foundation for the development of a comprehensive and actionable ethical framework. Such a unified ethical framework based on these 8 fundamental principles can provide clear guidance and support for the application of LLMs in the context of medical education. This approach can help establish a balance between technological advancement and ethical safeguards, thereby ensuring that medical education can progress without compromising the principles of fairness, justice, or patient safety and establishing a more equitable, safer, and more efficient environment for medical education.

Use of the International IFOMPT Cervical Framework to inform clinical reasoning in postgraduate level physiotherapy students: a qualitative study using think aloud methodology.

BACKGROUND: Vascular pathologies of the head and neck are rare but can present as musculoskeletal problems. The International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) Cervical Framework (Framework) aims to assist evidence-based clinical reasoning for safe assessment and management of the cervical spine considering potential for vascular pathology. Clinical reasoning is critical to physiotherapy, and developing high-level clinical reasoning is a priority for postgraduate (post-licensure) educational programs. OBJECTIVE: To explore the influence of the Framework on clinical reasoning processes in postgraduate physiotherapy students. METHODS: Qualitative case study design using think aloud methodology and interpretive description, informed by COnsolidated criteria for REporting Qualitative research. Participants were postgraduate musculoskeletal physiotherapy students who learned about the Framework through standardized delivery. Two cervical spine cases explored clinical reasoning processes. Coding and analysis of transcripts were guided by Elstein's diagnostic reasoning components and the Postgraduate Musculoskeletal Physiotherapy Practice model. Data were analyzed using thematic analysis (inductive and deductive) for individuals and then across participants, enabling analysis of key steps in clinical reasoning processes and use of the Framework. Trustworthiness was enhanced with multiple strategies (e.g., second researcher challenged codes). RESULTS: For all participants (n = 8), the Framework supported clinical reasoning using primarily hypothetico-deductive processes. It informed vascular hypothesis generation in the patient history and testing the vascular hypothesis through patient history questions and selection of physical examination tests, to inform clarity and support for diagnosis and management. Most participant's clinical reasoning processes were characterized by high-level features (e.g., prioritization), however there was a continuum of proficiency. Clinical reasoning processes were informed by deep knowledge of the Framework integrated with a breadth of wider knowledge and supported by a range of personal characteristics (e.g., reflection). CONCLUSIONS: Findings support use of the Framework as an educational resource in postgraduate physiotherapy programs to inform clinical reasoning processes for safe and effective assessment and management of cervical spine presentations considering potential for vascular pathology. Individualized approaches may be required to support students, owing to a continuum of clinical reasoning proficiency. Future research is required to explore use of the Framework to inform clinical reasoning processes in learners at different levels.

Invisible borders in educational technology research? A comparative analysis.

Educational research is reflective of the nature and structure of national and regional education systems and their historical evolution. Educational technology research, as an area within educational research, reflects this case particularly prominently. Although individual countries and regions have varying research traditions, the publication of research in English as the scientific lingua franca can lead to missing nuances in terminology, which is often not reflected upon. Despite this, the exploration of research from different countries can still uncover diverse topical clusters. This study aims to identify the research topics in educational technology research in three countries (Germany, Spain and the United Kingdom), each with their own research traditions, through the terms used. To this end, a bibliometric analysis of 3034 article abstracts and keywords from 29 English-language Web of Science journals in the field of education and educational research was conducted, with a focus on educational technology. In addition, the quantitative findings are comparatively analysed by considering the corresponding cultural clusters. Main findings include diverse research foci in the three countries, also showing that distinct research traditions are still present, despite using English as lingua franca. Therefore, research articles written in English by non-English authors often do not reflect the same meanings in each country, despite using the same words. The conclusions reflect upon the need to establish ways of understanding the traditions behind those research articles and build collaborative systems to illustrate nuances in this research.

An impact of content delivery, equity, support and self-efficacy on student's learning during the COVID-19.

Due to the outbreak of Covid-19, the colleges and universities across the world have shifted to online classes in place of face-to-face classes. In the wake of this outbreak, the present study focuses on analyzing the impact of sudden shift to online classes, on the undergraduate and postgraduate student's overall learning. The PLS-SEM results concluded that the content delivery has been the most significant construct to impact both self-efficacy and overall learning. The self-efficacy partially mediates the support and equity relationship with the overall learning. The student with greater self-efficacy will have better overall learning from this e-synchronous teaching methodology. However, content delivery has a stronger role in impacting the overall learning even if there is absence of self-efficacy, thus concluding no mediation.

Exploring how national educational organizations can promote educational research amongst members: a survey-based study.

BACKGROUND: Engagement of academic faculty in research remains low. While barriers to research have been explored, there are no data on how national organizations can help overcome these barriers. Our study explored faculty satisfaction and motivational drivers for engagement with research opportunities offered by the Council on Medical Student Education in Pediatrics (COMSEP), an organization of pediatric medical educators, and characterize strategies perceived by faculty to promote the use of these opportunities. METHODS: In 2021, 5 survey questions were administered to faculty members of COMSEP to explore satisfaction with COMSEP's research offerings, the perceived value of educational research, and the facilitators, barriers and potential opportunities for COMSEP to promote research. Clark's Commitment and Necessary Effort model on motivation served as the theoretical framework for our study, which explores motivation, self-efficacy and contextual factors influencing an individual's pursuit of goals. Chi-square analysis and Wilcoxon Signed Ranks Test were used to compare categorical and scaled variables among groups who did and did not avail of COMSEP's research offerings. RESULTS: 90 (25%) of 360 recipients responded. 61% expressed satisfaction with COMSEP's research offerings. 68% indicated research was an expectation of their academic appointment, that education was their primary research focus (74%) and that they did not have other research opportunities that met their needs (58%). Of respondents, 75.7% of females had submitted a proposal compared to 60% of non-responders who were females. The comparison by gender was not statistically significant. Exploration by academic rank revealed that 35% of instructor/assistant professors had submitted a proposal compared to 65% of associate professors/professors (p =.05). Barriers leading to non-submission to any of the offerings included having too much other work, lack of enjoyment in writing and inability to find mentors. Respondents endorsed the importance of several strategies to promote engagement in research-skill building opportunities, personalized consultations and increased funding. CONCLUSIONS: Faculty educators value the importance of educational research and recognize that research opportunities offered by COMSEP address an unmet need, but express ambivalence in the enjoyment of writing (reflecting their mood), and endorse structural barriers, that are amenable to change, affecting their personal agency.

Academics' Experiences in Veterinary Educational Research: Results of an International Survey.

Research conducted by the veterinary education community is critical to continual improvement of educational outcomes. Additionally, research productivity is one metric in promotion and tenure decisions. We sought to identify challenges encountered or anticipated when undertaking or planning veterinary educational research (VER), to learn how these challenges might be overcome, and to synthesize tips for success from those who have performed VER. A branching survey was developed and deployed along the authors' worldwide veterinary education contacts in a cascading manner. The survey collected quantitative and qualitative information from participants who had performed VER and those who planned to perform VER in the future. The 258 participants represented 41 countries. Of the participants, 204 had performed VER (79%) and 54 planned to in the future (21%). The median time spent teaching was 14 years, and median time performing VER was 5 years. The most commonly reported challenges in performing VER were lack of funding, lack of time, and difficulties encountered when undertaking a study, including data collection, analysis, and publishing. When asked about overcoming the challenges, a major theme emerged around people, who provided expertise and mentoring. The most commonly reported tip for success was collaboration; 73% of experienced researchers reported people as most helpful upon beginning VER. Collaborators provided diverse help with ideas, study design, statistics, and other aspects. These results suggest that institutions can offer support to academics in the form of small grants, protected research time, writing workshops, and mentorship to assist with the production of meaningful VER.

Approach to cardiology residents clinical aptitude evaluation. Multicenter design.

INTRODUCTION: To the best of our knowledge, the research herein presented is the first multicenter study in Mexico to analyze the development of clinical aptitude in medical units that train cardiologists. OBJECTIVE: To determine the degree of development of clinical aptitude in cardiology residents at three High Specialty Medical Units. METHODS: Multicenter, cross-sectional design. All students of the 2019-2020 academic year were included in the study. An instrument was constructed that evaluated clinical aptitude based on eight indicators and 170 items; conceptual/content validity and reliability were assessed by five cardiologists with teaching and educational research experience. RESULTS: By indicator and year of residence, significant statistical differences were observed in the CMN20Nov academic site. At HCSXXI and INCICh, statistically significant differences were observed in one of eight indicators. Differences between R1 residents (n = 41) of all three academic sites were estimated by indicator, with statistical significance being recorded in three of eight indicators. Between R2 (n = 35) and between R3 residents (n = 43), the result was similar. CONCLUSIONS: The degree of clinical aptitude development can be considered intermediate in all three academic sites, probably because the instrument explored problematized clinical situations that required for the residents to critically reflect on their clinical experience.

INTRODUCCIÓN: Hasta donde se tiene conocimiento, la investigación que se presenta constituye el primer trabajo multicéntrico en México que estudia el desarrollo de la aptitud clínica en unidades formadoras de cardiólogos. OBJETIVO: Determinar el grado de desarrollo de la aptitud clínica en residentes de cardiología en tres unidades médicas de alta especialidad. MÉTODOS: Diseño transversal multicéntrico. Se analizaron todos los estudiantes del ciclo académico 2019-2020. Se construyó un instrumento que evaluó la aptitud clínica a partir de ocho indicadores y 170 ítems; la validez conceptual/de contenido y la confiabilidad fueron valoradas por cinco cardiólogos con experiencia docente y en investigación educativa. RESULTADOS: Por indicador y año de residencia se observaron diferencias estadísticas significativas en la sede CMN20Nov; en HCSXXI e INCICh se observaron diferencias estadísticamente significativas en uno de ocho indicadores. Se estimaron diferencias entre residentes R1 (n = 41) de las tres sedes por indicador, con significación estadística en tres de ocho indicadores. El resultado fue semejante al comparar R2 (n = 35) y R3 (n = 43). CONCLUSIONES: El grado de desarrollo de la aptitud clínica se puede considerar medio en las tres sedes académicas, probablemente debido a que el instrumento exploró situaciones clínicas problematizadas que exigieron del residente la reflexión crítica de su experiencia clínica.

The road taken - changing one's professional focus at a large research university.

The scientific endeavor has many facets, extending well beyond the experimental research bench. However, in most fields, especially in the biomedical sciences, the traditional career pathway for scientists is first joining and later leading an experimental research laboratory or program. As a result, scientific education is often focused on training new bench researchers. My own journey from a traditional bench scientist to that of an educator and educational researcher will be discussed in the context of a large research university environment. Being a scientist with an educational focus at such an institution poses significant challenges, but also opens new opportunities. In my opinion, these two professional pathways are not exclusive or alternative choices, but rather are complementary, both representing important and essential elements of scientific progress.

A 45-year Retrospective Content Analysis of JVME Articles.

To study changes in Journal of Veterinary Medical Education (JVME) content, this article presents the results of an analysis of a purposeful sample (n = 537) and demographic analysis of all 1,072 articles published from 2005 to 2019. The findings were compared to a prior analysis of articles from 1974 to 2004. Article length increased, as did the number of authors and institutions per article. Female first author numbers grew at a greater rate than the proportion of female faculty at AAVMC-accredited colleges. Close to 85% of articles were by authors in the US, UK, Canada and Australia, while 40 other countries contributed the remainder. The primary topics of papers published from 2005 to 2019 were student affairs (17.3%), professional skills (15.1%), courses and curricula (12.7%), specialty/disciplinary training (12.5%), and technology/information resources (11.5%). The prevalence of articles with an identified research methodology grew from 14.2% in 1974-2004, to 55.9% (n = 300) in 2005-2019. Among research articles, 54.7% reported an intervention and 70.3% included a comparison. Random assignment to experimental or control conditions occurred in 32 articles (15.2%). Qualitative inquiry expanded, with 16.3% of research articles using this methodology alone. The most cited article was a review paper discussing the human-animal bond. Descriptions of courses and curricula constituted the majority of articles over the journal's lifespan, while no pattern was discerned between major reports in veterinary education and subsequent publications on that topic. Over the last 45 years, JVME has transitioned from a newsletter to a scholarly publication, with ongoing evolution.

Are we there yet? Research with and for teachers and children and the possibilities of schooling in a complex world.

Shifting the relationship between schooling, social justice and equity, and the present and future experiences of children, young people, and their families and communities, has been a focus of educational research, and indeed policy and practice, for many decades. In this paper, I discuss education and its preparedness to work towards social justice, by drawing on examples across a number of studies. While I consider the possibilities for teachers and young people and children in schools today and present several counter narratives to those in popular circulation, I also detail initiatives that I engaged in with members during the time I was President of AARE. The point is to highlight social justice issues in education in Australia and highlight some ways forward.

Digital competence of higher education professor according to DigCompEdu. Statistical research methods with ANOVA between fields of knowledge in different age ranges.

The tasks of the university educators must be linked to the digital demands posed by the more sophisticated professions of the twenty-first century. Faced with this panorama, the objective of this study is to examine and compare the degree of digital competence of Higher Education educators from different fields of knowledge and different age ranges according to the DigCompEdu framework. A non-probabilistic ex post facto sampling was utilized with 2180 university professors from Andalusia (Spain). The main results of the study provide evidence of an intermediate level of digital competence, for men and women. More specifically, the male professors in Architecture and Judicial & Social Sciences, younger and older than 40, possessed a higher level, as compared to the other fields. For the female professors, the highest level was found once again in Judicial and Social Sciences, in this case for both age ranges, without a clear trend found for the rest of the fields. For each dimension of the DigCompEdu instrument, the level of competence follows the same trend with respect to the overall level. More research is recommended to validate these preliminary results, as well as the development of training lines of action that are specific and adapted to each field of knowledge.

[Medical training in palliative care at the Hannover Medical School: development of the interdisciplinary and cross-sectoral education in the cross-sectional subject Q13 (WEISE-Q13)]. / Ärztliche Ausbildung im Fach Palliativmedizin an der Medizinischen Hochschule Hannover ­ Weiterentwicklung der interdisziplinären und sektorenübergreifenden Lehre im Querschnittsbereich Q13 (WEISE-Q13).

BACKGROUND: The implementation of the cross-sectional subject of palliative care (Q13) at medical faculties in Germany is heterogeneous. In faculties without a chair for palliative medicine, other solutions are needed. OBJECTIVES: This study describes the development and implementation process of the new educational concept in Q13 at the Hannover Medical School and its evaluation by medical students and lecturers. MATERIALS AND METHODS: The new educational concept was developed in 2017/18 following the six-step approach of curriculum development by Kern, and was implemented and tested in the academic year 2018/19. Evaluation was assessed in two steps, both in qualitative and quantitative terms (mixed methods): an anonymous written evaluation by students with the option of free text answers and feedback discussions with lecturers. RESULTS: Students and lecturers welcomed the new educational concept in equal measures. Students thought that education in Q13 stimulates reflection on the individual attitude towards the issues of death and dying and prepares them for encounters with terminally ill and dying people. The case-based learning units in particular led to a consolidation of theoretical knowledge (i.e. pain management) with adequate patient orientation. Teachers positively highlighted the organization and the educational material. Content structuring was considered to be particularly helpful. CONCLUSIONS: With the new teaching concept, medical students feel well prepared for the treatment of terminally ill and dying patients. The combination of different learning formats with an interdisciplinary and cross-sectoral focus promotes education with a practical orientation.

Enhancing older adult access to lifelong learning institutes through technology-based instruction: A brief report.

The number of lifelong learning institutes serving older adults in the U.S. has increased in the last few decades. To date, these institutes have functioned primarily in traditional, in-person classroom, and seminar formats; however, technology-enhanced methods may help provide greater access to high-quality lifelong learning experiences. This research note reports the results of a cross-institutional survey of Osher Lifelong Learning Network participants. The survey participants' high levels of computer utilization and experience with modern distance education capabilities opens the possibility that Technology-Based Instruction (TBI) can augment or supplement in-person lifelong learning experiences. Specifically, TBI may be effective in expanding access for older adults who have mobility or other health limitations, as well as those who live far from the location of any such program. Example approaches are suggested for developing blended, hybrid in-person, and online lifelong learning environments, which may offer enriching intellectual engagement and meaningful socialization.

El gringuito, Mr. Kate: transnational ethnographic fieldwork as a gender-nonconforming queer.

Using ethnographic data from a study in Honduras, this article looks at how my research was shaped by shifting perspectives on my gender, especially from the perspectives of the participants within the unique context, Gender identity was not always a personal conception, as is common in contemporary U.S. queer culture; instead, gender was co-constructed and dependent on the language used (Spanish or English), whether I had my children with me in the field, and visible access to material resources (a motorcycle, for example). This article is significant to the fields of qualitative and educational research methods, queer and gender studies, and transnational feminism.

Heteronormative gatekeeping when enacting queer research in elementary schools: an autoethnographic perspective.

Using authoethnography, the authors analyze how queerphobia and cis/heterosexism shape their research process regarding (LGBTQ)-inclusive empirical work in elementary school spaces. With examples from their own experiences, they show how queerphobic gatekeeping affects site access, negotiations required during data collection, and dissemination of the results to others. The authors argue that, taken together, these forces complicate - if not outright prevent - empirical, school-based research with young children, thereby artificially constraining the knowledge base of the field related to LGBTQ-inclusive education. They offer these analyses as affirmations to those facing similar challenges and as education to those in positions of power to change perceptions of, support of, and responses to queer, school-based educational research.

The Benefits of Required Forensic Clinical Experiences in Residency.

OBJECTIVE: The growth of forensic psychiatry has spurred efforts to improve forensic psychiatry training in general psychiatry residency. The Accreditation Council for Graduate Medical Education requires that residencies provide an experience that "exposes" residents to forensic issues, but leaves the specifics to individual programs. However, there is growing need for psychiatrists to understand the unique circumstances of individuals with mental illness involved in the criminal justice system. METHODS: The authors developed a new mandatory forensic rotation for general psychiatry residents and conducted a pilot study to assess its impact on residents' interest and comfort working with criminal justice-involved patients, interest in forensic fellowship, and knowledge of available resources for consultation and supervision. RESULTS: Rotation completion was associated with a significantly increased interest in working with forensic populations and pursuing forensic fellowship, but no changes in residents' level of comfort or knowledge of supervisory and consultative resources. CONCLUSIONS: This study adds to the growing body of literature describing the benefits of expanding forensic education for residents.

Development and Implementation of a School-Wide Institute for Excellence in Education to Enable Educational Scholarship by Medical School Faculty.

PROBLEM: Educational scholarship is an important component for faculty at Academic Medical Centers, especially those with single-track promotion systems. Yet, faculty may lack the skills and mentorship needed to successfully complete projects. In addition, many educators feel undervalued. INTERVENTION: To reinvigorate our school's educational mission, the Institute for Excellence in Education (IEE) was created. Here we focus on one of the IEE's strategic goals, that of inspiring and supporting educational research, scholarship, and innovation. CONTEXT: Using the 6-step curriculum development process as a framework, we describe the development and outcomes of IEE programs aimed at enabling educational scholarship at the Johns Hopkins University School of Medicine. OUTCOME: Four significant programs that focused on educational scholarship were developed and implemented: (a) an annual conference, (b) a Faculty Education Scholars' Program, (c) "Shark Tank" small-grant program, and (d) Residency Redesign Challenge grants. A diverse group of primarily junior faculty engaged in these programs with strong mentorship, successfully completing and disseminating projects. Faculty members have been able to clarify their personal goals and develop a greater sense of self-efficacy for their desired paths in teaching and educational research. LESSONS LEARNED: Faculty require programs and resources for educational scholarship and career development, focused on skills building in methodology, assessment, and statistical analysis. Mentoring and the time to work on projects are critical. Key to the IEE's success in maintaining and building programs has been ongoing needs assessment of faculty and learners and a strong partnership with our school's fund-raising staff. The IEE will next try to expand opportunities by adding additional mentoring capacity and further devilment of our small-grants programs.

Robust (and Ethical) Educational Research Designs.

Educational research can be quite confusing to individuals without formal training in educational research methods. Many educators trained in "high-consensus" fields such as the health and medical sciences often expect to utilize the same esteemed experimental and quasi-experimental designs in their educational research efforts, but are surprised to learn that this is often impossible for ethical reasons. This article presents five robust research designs that generally are compatible with education studies, and discusses how each design may be used in a variety of educational research scenarios.

Interdisciplinary approach to education: preparing general dentists to manage dental trauma.

The traditional dental curriculum presents limited opportunities for students to evaluate and treat patients with acute dental trauma. In an effort to increase student experiences, faculty at a dental school initiated and taught an interdisciplinary trauma course from 2014 to 2016. This course was elective, offered in the final year of dental school, and combined student-led and faculty-led case-based discussions of management of traumatic dental injuries with hospital trauma call shadowing. Modifications of the course were made based on student feedback. Preliminary data from student surveys showed a favorable opinion of the course. Attendees were exposed to a higher number of acute traumatic injuries and they expressed greater confidence in their diagnosis and management abilities than their peers.

Assessing student characteristics in palliative care education research: a literature review.

BACKGROUND: Assessing characteristics in educational research is important to describe a student sample. However, consistency in measuring student characteristics is lacking, particularly in palliative and end-of-life (PEOL) care education research. METHODS: A literature review was conducted to determine the primary characteristics to assess in PEOL education research, the corresponding level of measurement and associated statistical analyses to perform with the data. RESULTS: Key characteristics to measure include: age, previous PEOL healthcare experience, previous personal experience with death/loss, previous PEOL education, program of enrolment and religion. Gender, ethnicity/race and living situation/place of residence were not supported as key characteristics to assess. Best methods by which to measure characteristics remain unclear and the utilisation of characteristics in research is inconsistent. CONCLUSION: Identified characteristics should be measured in PEOL education research at the highest level of measurement. The influence of characteristics on outcomes should be considered in association with research questions.