The research team followed the PRISMA 2020 reporting guidelines, the international standard for conducting and reporting systematic reviews in health care. They searched four major electronic databases, PubMed, Scopus, the Cochrane Library, and ERIC, in December 2025, casting a wide net across the medical education literature. From an initial pool of 4,233 records, only twelve studies published between 2007 and 2022 ultimately met the strict inclusion criteria. To qualify, studies had to evaluate surgical training outcomes among ophthalmology residents, covering measures such as intraoperative or postoperative complications, surgical efficiency, case-volume and learning-curve effects, surgical success, trainee competency, or the impact of simulation-based training. Research on non-residency populations or on educational interventions unrelated to surgery was excluded.

That attrition rate, from more than four thousand records to just twelve included studies, tells its own story. Despite decades of concern about how surgeons learn their craft, the evidence base for one of medicine’s most technically demanding specialties remains remarkably thin and fragmented. The twelve studies that survived screening came from the United States, the United Kingdom, India, Australia, and sub-Saharan Africa, a geographic spread that the authors note is heavily skewed toward high-income countries. Because the included studies varied so widely in their populations, interventions, and outcome measures, the team chose a narrative synthesis rather than a meta-analysis, meaning they could map the direction and consistency of reported effects but not pool them into a single summary statistic.

One of the clearest signals to emerge concerns case volume. Across the reviewed literature, higher cumulative surgical volume was consistently associated with lower complication rates, reinforcing the long-standing intuition that practice makes safer surgeons. Yet the picture is not purely mechanical. The review found that case-specific risk factors, such as the complexity of an individual patient’s pathology, independently predicted complications even after accounting for trainee experience. In other words, a resident’s hundredth cataract operation on a routine patient may be safer than a supervised first operation on an eye with a traumatized cornea or a weak lens support. This finding carries practical weight: it suggests that training programs should think not only about how many operations a resident performs, but about which operations, matched to the resident’s current level of skill and the level of supervision available.

The review also confronted a question that every surgical patient implicitly asks: is it safe to let a trainee operate? The evidence indicates that surgery performed by residents is associated with higher short-term complication rates compared with surgery performed by experienced surgeons, a result that will surprise no one. More encouraging, however, is the finding that long-term outcomes were often comparable between trainee-performed and consultant-performed procedures. This distinction between immediate and delayed results matters enormously for how training programs and patients think about the learning process. It suggests that the short-term bump in complications associated with supervised trainee surgery may not translate into lasting harm, provided that cases are appropriately selected and supervised and that patients receive adequate follow-up to catch and manage early problems.

Perhaps the most consistent and practically important finding of the entire review involves simulation. Across four studies, including two randomized controlled trials, simulation-based and virtual-reality training was consistently associated with lower complication rates and higher competence scores among trainees. Randomized controlled trials sit at the top of the evidence hierarchy, so their presence in this small literature is notable, and the fact that both pointed in the same direction strengthens confidence in the conclusion. Virtual reality cataract surgery simulators, which allow residents to practice capsule tearing, phacoemulsification, and instrument handling on a computer-generated eye with real-time feedback on tremor and tissue damage, have become increasingly sophisticated over the past two decades. The review’s findings suggest that this technology is not merely a convenient substitute for the operating room but an active driver of safer surgical performance once residents reach real patients.

The authors assessed the methodological quality of the included studies using design-specific tools. Observational studies were appraised with the Joanna Briggs Institute critical appraisal checklists, randomized controlled trials with the Cochrane Risk of Bias 2 tool, and the single instrument validation study with the COSMIN Risk of Bias checklist. Two reviewers independently screened titles, abstracts, and full texts, with disagreements resolved by consensus. This multi-tool approach reflects the heterogeneity of the underlying literature, but it also exposed a deeper problem: most of the evidence rests on observational designs, which are vulnerable to confounding and selection bias. Programs that give residents more cases may also differ in countless other ways from programs that give fewer, making it difficult to isolate the true causal effect of volume alone.

If simulation emerged as the strongest positive finding, the assessment of competency emerged as the weakest link. The review found that validated competency assessment instruments remain strikingly limited, with only one study in the entire evidence base addressing instrument validity in depth. This is a critical gap for a specialty built on microsurgical precision. Without validated tools to measure surgical competence, program directors are left to judge readiness using subjective supervisor impressions, logged case counts, or ad hoc rating scales whose psychometric properties are largely unknown. The authors highlight cataract surgery, the most common operation most ophthalmology residents will perform and the procedure on which much of the global burden of avoidable blindness depends, as an area particularly in need of validated assessment instruments.

The geographic concentration of the evidence adds a further layer of concern. With studies drawn predominantly from the United States, the United Kingdom, India, Australia, and parts of sub-Saharan Africa, the review notes that the evidence base is concentrated in high-income settings, leaving vast regions of the world where cataract surgical backlogs are greatest essentially unstudied in the medical education literature. Training conditions, case mix, supervision ratios, and available technology differ enormously between a well-funded academic center in North America and a district hospital in a low-resource setting. Findings about learning curves and complication thresholds generated in one context may simply not transfer to another, which is why the authors call for more geographically diverse, prospective research.

The overall message of the review is one of cautious optimism paired with a demanding agenda. Simulation-based training and structured, experience-matched case selection are associated with improved surgical outcomes and surgical competence among ophthalmology residents, giving training programs concrete, evidence-supported levers to pull today. At the same time, the field needs prospective studies that follow residents over time, validated assessment tools that can objectively certify competence, and research that extends beyond wealthy countries to the settings where surgical training capacity is most constrained. As virtual reality simulators become cheaper and more widespread, and as regulators and patients increasingly demand objective proof of surgical readiness, the pressure to build a rigorous educational evidence base for eye surgery will only grow. This review provides both a map of what is known and a clear picture of how much work remains.

Subject of Research: Surgical training and competency assessment in ophthalmology residency programs

Article Title: Ophthalmology residency surgical training and competency assessment: a systematic review of medical education evidence

Article References: Krungkraipetch, L., Leelawongs, S., & Krungkraipetch, K. (2026). Ophthalmology residency surgical training and competency assessment: a systematic review of medical education evidence. BMC Medical Education. https://doi.org/10.1186/s12909-026-10546-7

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10546-7

Keywords: ophthalmology residency, surgical education, competency assessment, simulation training, virtual reality, cataract surgery, case volume, learning curve, systematic review, medical education, surgical complications, BMC Medical Education

Dental public health, known in Iran as Community Oral Health, is the branch of dentistry devoted to preventing oral disease and promoting oral health at the population level. Instead of filling a single cavity, the discipline integrates policy-making, epidemiologic assessment, and resource management to protect entire communities. That makes high-quality undergraduate education in the field essential: every dentist who graduates without a solid grounding in population-based prevention becomes another practitioner in a treatment-oriented system. Yet the evidence suggests Iranian graduates have been underprepared, with an outdated curriculum, inconsistent national implementation, and insufficient infrastructure and funding undermining the field for years.

To confront the problem head-on, Iranian dental educators organized three national symposia titled Evaluating the Educational Status of DPH in Iran, held between 2019 and 2023. The initiative came from the Secretariat of the Dental Education Council of the Ministry of Health and was organized by the Iranian Association of Community Oral Health, university DPH departments, the Research Center for Caries Prevention, and the Department of DPH at Tehran University of Medical Sciences. Each gathering brought together 40 to 50 participants, including DPH specialists, department heads, PhD students, and dental school representatives, all invited through official channels to ensure broad and representative involvement.

The first symposium, held in person at Tehran University of Medical Sciences in April 2019, used a structured, participatory consultation and consensus-building process. After an opening presentation on the role of DPH departments in dental education, participants worked through multiple rounds of facilitated group discussions, with ideas recorded in real time on shared whiteboards and in facilitator notes. The organizing team consolidated the input by grouping similar contributions and removing duplicates, then refined the results through further brainstorming until consensus emerged. That process distilled the challenges into five domains: infrastructure, budget and service delivery; workforce development and management; curriculum design; community-centric research; and community engagement and outreach. Participants then formed domain-specific working groups whose proposed solutions were presented in plenary sessions, refined through collective feedback, and finalized the following day.

The second symposium, held virtually in October 2020, and the third, held in person in July 2023, revisited those findings and prioritized three domains for reform based on perceived impact, feasibility, and alignment with national needs: infrastructure strengthening, workforce development, and community engagement. The 2023 meeting also featured a training workshop for DPH educators, and participant databases and virtual groups were created afterward to sustain dialogue and resource sharing between events. The multi-year, iterative design gave the process a durability that one-off conferences rarely achieve, allowing recommendations to be tested and sharpened across changing circumstances, including the disruptions of a global pandemic.

On infrastructure, the symposia identified concrete and surprisingly practical gaps. DPH programs struggle with scarce fluoride varnish supplies, transportation difficulties reaching community course sites, and low patient referrals to dental schools, alongside province-specific problems such as oral cancer in Sistan and Baluchestan and molar-incisor hypomineralization in Ardabil. The proposed fixes include memorandums of understanding between the Ministry of Health and dental school departments to secure resources, referral pathways from schools to DPH departments with lower tariffs, insurance contracts, and patient databases maintained by DPH PhD students. To match local needs, the participants recommended agreements between DPH departments and provincial health deputies, tailored initiatives such as oral cancer screening in the hardest-hit provinces, and the introduction of Family Dentistry to give students genuine community-based experience.

The workforce picture is equally stark. Iran has too few DPH departments nationwide, low appeal of the specialty among dental students, a shortage of experts below the national goal of one DPH PhD student per school or province by 2025, underuse of PhD students in teaching, and limited cross-specialty collaboration. The solutions draw on a hub model in which ten regional lead universities share faculty and resources with nearby schools, short competency-building courses for other specialties, dual degrees with pediatrics, periodontics, and restorative dentistry, funded PhD places for top students, and expanded career paths through oral health committees and Ministry of Health service contracts. Senior PhD students past their comprehensive examinations would serve as teaching assistants, multiplying scarce faculty capacity.

Curriculum reform rounds out the agenda. Participants called for integrating the oral health needs of patients with special health care needs into DPH and other specialties’ curricula, inviting such patients directly into dental schools, and establishing dedicated committees and fellowships. Teaching improvements include nationwide educator-training workshops, three to four standardized course models to address limited hours and transportation, and practical checklists for hands-on courses. Assessment would shift toward higher-level exam questions aligned with course objectives, with part of the final grade devoted to practical application, and evaluation would rely on systematic stakeholder feedback through dialogue, surveys, and specialized forms. The establishment of the Iranian DPH board in 2022 provides an institutional anchor for these changes, while research reforms would tie postgraduate thesis topics to Ministry of Health needs assessments and translate findings into policy briefs.

What makes the Iranian experience resonate far beyond its borders is how closely its challenges mirror global patterns. In Egypt, limited postgraduate training has left DPH teaching largely to pediatric dentistry faculty, and community-based training is used by only about a quarter of schools. Across Europe, only about two-thirds of dental schools have dedicated DPH departments, and outreach accounts for a mere 11 percent of teaching, often cited as good practice rather than routine. Colombia and Kenya have no dedicated DPH track, Brazil offers only three programs, and India’s community outreach remains insufficiently structured. Iran’s difficulties, in other words, are not an outlier but a symptom of how prevention is undervalued in dental systems worldwide, where clinical and specialty-based dentistry traditionally outranks public health in prestige and resources.

The commentary is candid about its limitations. The insights emerged from discussions among academic and institutional stakeholders rather than empirical measurement, participation was invitation-based and may have introduced selection bias, and the influence of senior participants on group consensus cannot be excluded. The findings are also shaped by Iran’s specific educational and policy context. Still, the multi-year process and participation from across the country lend the recommendations breadth and credibility. Progress, the authors suggest, can be tracked through tangible indicators: the number of newly established DPH departments, competency-based DPH modules, and expanded community-based training opportunities, with periodic stakeholder reviews to monitor reform. If those measures take hold, Iran could offer a replicable blueprint for any country wrestling with the same quiet crisis in dental public health education, and its dentists could finally be equipped to treat the causes of oral disease, not just the symptoms.

Subject of Research: Reform of undergraduate dental public health education in Iran based on national consensus symposia

Article Title: Strengthening undergraduate dental public health education in Iran: insights from national symposia

Article References: Varmazyari, S., Eshrati, M., Hessari, H., & Khami, M. R. (2026). Strengthening undergraduate dental public health education in Iran: insights from national symposia. BMC Medical Education, 26(1), Article 1570. https://doi.org/10.1186/s12909-026-10474-6

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10474-6

Keywords: dental public health, dental education, Iran, oral health, curriculum reform, workforce development, community engagement, health policy, medical education, consensus-building, prevention, BMC Medical Education

The logic behind the intervention rests on a well-established body of organizational psychology. Empowering leadership refers to a set of behaviors through which leaders share power, highlight the significance of subordinates’ work, involve them in decision-making, express confidence in their abilities, and remove obstacles that block autonomous performance. In aged care settings, where frontline nursing staff often work under emotional strain, low pay, and heavy workloads, the way charge nurses and unit leaders behave can determine whether employees stay or leave. The researchers anchored their program in the theory of leader empowerment behavior, a framework that specifies the psychological and behavioral mechanisms by which leaders transfer responsibility and build capability in their teams. Rather than treating leadership as an abstract trait, the theory frames it as a set of learnable practices, which makes it an ideal target for structured educational intervention.

What distinguishes this study from conventional leadership workshops is the flipped-learning design. In a traditional classroom model, learners first hear a lecture and then practice skills afterward, often without guidance. Flipped learning reverses that sequence: participants study theoretical content independently before sessions, typically through reading materials, videos, or other self-paced resources, and then use valuable face-to-face time for application, discussion, role-play, and feedback. For busy nurse leaders in residential facilities, who can rarely be released from the floor for extended lectures, this architecture promises efficiency and relevance. The 24-hour program distributed across 12 weeks allowed participants to digest core concepts on their own time and then arrive at sessions ready to rehearse the difficult, concrete behaviors of empowerment, such as delegating meaningful tasks, coaching rather than directing, and structuring work so that staff members exercise genuine discretion.

The study was conducted between August 2018 and May 2019 in six non-profit residential aged care facilities in Taiwan. Because leadership training delivered to individuals within the same workplace inevitably spills over to colleagues, the researchers used a cluster design, assigning entire facilities rather than individual leaders to the intervention or control condition. Two facilities, with a total of ten nurse leaders, received the flipped-learning program, while four facilities, with eleven nurse leaders, served as a booklet-only control group. The cluster quasi-experimental structure acknowledges a practical reality: in workplace-based research, true randomization is often impossible, and the unit of intervention must match the unit of social interaction. The leader-level outcome, measured with the Leader Empowerment Behavior Scale before and after the program, was analyzed at the facility level, the level at which the intervention was actually assigned.

The results show a clear divergence between the two arms of the study. In the two intervention facilities, leader empowering behavior scores rose by 37.2 and 39.6 points respectively. In all four control facilities, by contrast, scores declined, with drops ranging from 8.5 to 13.0 points. An exploratory three-level linear mixed model, reported as a sensitivity analysis, produced a consistent estimate of the intervention effect at 48.13 points. The authors are careful about statistical inference: with only six facilities, the study cannot and does not claim statistical significance. That caution is scientifically appropriate, because cluster designs with so few clusters have limited power and wide uncertainty. What the study delivers instead is preliminary descriptive information, the essential first step in the pilot-to-trial pipeline that guides the development of complex interventions in health services research.

Alongside the primary outcome, the researchers collected three ancillary facility-reported contextual indicators that speak directly to the operational anxieties of aged care administrators: nursing staff retention, staff turnover, and resident hospitalization transfer rates. In the two intervention facilities, mean staff retention rose from 83.0 percent to 85.0 percent, while turnover fell from 13.9 percent to 11.5 percent. The four control facilities moved in the opposite direction, with retention falling from 61.0 percent to 58.8 percent and turnover climbing from 26.2 percent to 28.8 percent. Resident hospitalization transfer rates were 8.0 percent and 7.9 percent in the intervention facilities at the two time points, compared with 4.2 percent at both time points in the control facilities. The authors emphasize that these indicators are descriptive only and cannot be definitively attributed to the intervention, a caveat that reflects the small sample, the absence of randomization, and the many confounding forces that shape staffing and clinical transfer patterns in long-term care.

Even with those caveats, the contrast between the arms is hard to dismiss. Aged care facilities worldwide face a staffing crisis, and turnover rates above 25 percent, as observed in the control facilities, impose heavy costs in recruitment, training, continuity of care, and resident wellbeing. Leadership behavior is one of the few modifiable factors in that equation. If a relatively low-cost, 24-hour educational program can shift how nurse leaders behave toward their staff, and if those shifts ripple outward into retention and turnover, the implications for workforce policy in long-term care could be considerable. The flipped-learning format adds a further layer of practicality, since it minimizes time away from clinical duties and could be scaled through digital pre-session materials without requiring every facility to employ specialist leadership trainers.

The study also contributes methodologically. By analyzing leader-level outcomes at the facility level and reporting a three-level linear mixed model, the researchers modeled the nested structure of the data, in which leaders are nested within facilities and measurements are nested within leaders. This kind of multilevel thinking is often neglected in workplace education research, where individual-level analyses can inflate apparent effects by ignoring shared workplace influences. The retrospective registration of the trial on ClinicalTrials.gov, under identifier NCT07774767, and the explicit framing of the work as exploratory reflect a growing emphasis on transparency in pilot studies, which are frequently misused as underpowered hypothesis tests rather than as tools for estimating feasibility, recruitment, and effect-size parameters for future definitive trials.

For the research team, the next step is clear: the observed facility-level pattern warrants evaluation in a prospectively randomized cluster trial with enough facilities to support formal statistical inference. Such a trial would need to address the limitations inherent in the pilot, including the quasi-experimental allocation, the small number of clusters, and the reliance on self-reported leadership behavior, which could be vulnerable to social desirability bias in participants who know they received an active program. Objective or subordinate-rated measures of empowering leadership, longer follow-up, and a broader range of facilities would strengthen the evidence base. The study was supported by grants from Taiwan’s Ministry of Science and Technology, and the funding sources played no role in the design, analysis, or publication decisions.

What makes this pilot study resonate beyond its modest size is the convergence of two urgent problems: the crisis of workforce retention in aged care and the persistent challenge of translating leadership theory into changed behavior on the ward. Flipped learning, born in classrooms and universities, here meets the theory of leader empowerment behavior in one of healthcare’s most demanding environments. The numbers, 37.2 and 39.6 points of improvement against declines of up to 13 points in controls, are preliminary but internally consistent, and the ancillary staffing trends point in a direction that aged care administrators will watch closely. Whether the effect survives the scrutiny of a properly powered randomized trial remains to be seen, but the study demonstrates that empowering leadership can be taught, that aged care nurse leaders can learn it in a format compatible with their workloads, and that the payoff may extend from the leaders themselves to the staff they supervise and, ultimately, to the residents in their care.

Subject of Research: Flipped-learning leadership education for nurse leaders in residential aged care facilities

Article Title: Flipped learning for leader empowering leadership among nurse leaders in residential aged care facilities: a pilot cluster quasi-experimental study

Article References: Flipped learning for leader empowering leadership among nurse leaders in residential aged care facilities: a pilot cluster quasi-experimental study. (n.d.). https://doi.org/10.1186/s12909-026-10511-4

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10511-4

Keywords: flipped learning, empowering leadership, nurse leaders, aged care, nursing homes, leadership training, nursing education, staff turnover, cluster quasi-experimental study, Taiwan, BMC Medical Education, workforce retention

Fiber post-core restoration is a particularly instructive test case for educational technology. The procedure is not a single maneuver but a chain of interlocking decisions and actions: the clinician must assess whether the remaining tooth structure can support a post, select the appropriate post system, determine the correct length and diameter of the post space, handle the root canal environment without compromising the seal, and then build and shape the core so that the eventual crown has a sound foundation. Each of these steps depends on case-specific judgment, which means a student who has memorized the sequence can still fail if they cannot reason through an individual patient’s presentation. Traditional preclinical teaching, which relies heavily on bench-top simulation and limited instructor contact time, struggles to give every student enough supervised practice in both dimensions at once.

The platform described in the study was designed as a closed-loop system rather than a simple skill trainer. According to the authors, most existing virtual simulation systems in dental education function primarily as procedural rehearsal tools, allowing students to practice hand movements and instrument sequences on a simulator without any structured support for the decision-making that surrounds those actions. The new platform integrates three components intended to address that deficiency. The first is a dynamic AI virtual patient consultation, in which students interact with a simulated patient whose presentation drives the diagnostic and treatment-planning phase of the exercise. The second is a domain-specific procedural question-and-answer assistant that provides targeted guidance during the operative phase, effectively standing in for the one-on-one instruction that is scarce in crowded preclinical courses. The third is a standardized, rubric-based medical record evaluation workflow, which requires students to document their clinical decisions and then assesses that documentation against explicit criteria.

The study enrolled two independent cohorts of fourth-year dental students, thirty-eight in 2024 and forty-two in 2025, in a pre-post design. Before training, students completed a clinical case analysis assessment intended to measure clinical reasoning. After the full training cycle, they repeated the case analysis assessment and also completed a simulator operation assessment measuring procedural performance at course completion. The researchers then compared pre- and post-training scores within each cohort and examined the relationships between reasoning scores, procedural scores, and the change in reasoning performance over the course.

The headline quantitative result was a statistically significant improvement in clinical case analysis scores in both cohorts. In the 2024 group, median scores rose from 69 before training to 81.5 afterward; in the 2025 group, the median climbed from 71 to 83. Both increases were highly significant, with p values below 0.001. On its face, that pattern suggests that students emerged from the AI-supported curriculum substantially better at working through the diagnostic and planning decisions that precede a fiber post-core restoration. The consistency of the improvement across two separate years of students adds a degree of reassurance that the observation was not a one-off artifact of a single unusual cohort.

Yet the authors are notably careful about how far that conclusion can be pushed, and their caution is a useful lesson in reading educational research. The study found a strong negative correlation between pre-training scores and score gains: students who started low improved the most, with a correlation coefficient of -0.879 in 2024 and -0.789 in 2025. The researchers point out that this pattern should be interpreted with caution because it may reflect statistical artifacts rather than genuine educational effects. Regression to the mean, the tendency of extreme baseline values to move toward the average on retesting, naturally produces the largest apparent gains among the weakest performers. Ceiling effects compress the possible improvement for high scorers. And there is a mathematical coupling problem inherent in correlating a baseline score with a change score that is computed from that same baseline. In other words, the striking correlation says less about the platform than about the arithmetic of pre-post designs.

A second set of correlations was more straightforwardly encouraging. Post-training clinical reasoning scores and post-training procedural operation scores were strongly and positively associated in both cohorts: r = 0.927 in 2024, r = 0.722 in 2025, and r = 0.840 across the combined sample, all statistically significant. This suggests that, at the end of the course, students who reasoned well through clinical cases also tended to perform well on the simulator. The authors frame this as a positive association between decision-making and procedural performance rather than proof of causation, but the alignment matters for curriculum design. It indicates that the platform’s dual emphasis on reasoning and technique did not leave the two strands of competence developing independently; students strong in one tended to be strong in the other.

The subjective side of the evaluation was similarly positive. Students completed a study-specific questionnaire covering learning interest and satisfaction, self-perceived outcomes, career expectations, and acceptance of AI in their training. The questionnaire’s face and content validity were assessed through internal review by the three study authors who developed it, an important caveat the authors themselves flag, since this constitutes an internal-team assessment rather than independent external expert validation. Internal-consistency reliability was assessed for the multi-item dimensions. Across the two cohorts, students reported high course satisfaction with a mean rating of 4.26 on a five-point scale. Their endorsement of AI’s utility was even stronger, at a mean of 4.29, with the platform’s perceived ability to compensate for limited one-on-one teacher guidance standing out as a particular strength. Career expectations were the highest-rated construct of all, at a mean of 4.34, suggesting that students saw the training as relevant to their professional futures rather than as an academic exercise.

Those perception findings speak to a real structural problem in dental education. Preclinical courses typically pair large student cohorts with a limited number of instructors, which means each student receives only fragments of individualized feedback during hands-on sessions. An AI assistant that is available at every step of a simulated procedure, answering procedural questions on demand, effectively scales the guidance that a single instructor can provide. The students’ strong ratings of that function suggest they experienced the technology as filling a genuine gap rather than as a gimmick. At the same time, satisfaction surveys measure how students feel about a course, not whether the course made them better clinicians, and the authors are explicit that the questionnaire was built for this specific investigation rather than validated externally.

Indeed, the most distinctive feature of the paper may be the discipline of its own conclusions. Because the study used an uncontrolled pre-post design, with no comparison group receiving conventional instruction, and because procedural performance was assessed only after training with no pre-training baseline, the authors state that the findings should be interpreted as preliminary implementation-related observations rather than evidence of the platform’s effectiveness, educational equity, or improvement in procedural skills. That framing is refreshingly honest in a field where educational technology is often promoted with far stronger claims than the data can bear. What the study does establish is that the platform can be implemented across successive cohorts, that clinical reasoning scores rose after the curriculum, that reasoning and procedural performance moved together, and that students embraced the experience. The work was supported by a virtual simulation teaching reform project at Nankai University, and the authors declare no competing interests. Whether the closed-loop approach, with its virtual patient consultations, procedural AI assistant, and rubric-based record evaluation, ultimately outperforms traditional preclinical teaching will require the controlled comparative trials that this implementation study deliberately stops short of claiming. For now, it offers a detailed and cautiously reported blueprint for how AI might be woven into the earliest stages of surgical training without overstating what the evidence shows.

Subject of Research: AI-enhanced virtual simulation for preclinical dental education in fiber post-core restoration

Article Title: A closed-loop AI virtual simulation platform for preclinical fiber post-core restoration: two-year prospective evaluation of learning outcomes and student perceptions

Article References: Li, Y., Chen, C., & Liao, X. (2026). A closed-loop AI virtual simulation platform for preclinical fiber post-core restoration: two-year prospective evaluation of learning outcomes and student perceptions. BMC Medical Education. https://doi.org/10.1186/s12909-026-10510-5

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10510-5

Keywords: artificial intelligence, virtual simulation, dental education, prosthodontics, fiber post-core restoration, clinical reasoning, preclinical training, medical education, student perceptions, BMC Medical Education, Nankai University, competency-based education

The examination emerged from a growing body of educational theory that distinguishes between assessment of learning, which measures what a candidate knows at a fixed moment, and assessment for learning, which uses evaluation itself as a developmental tool. Traditional single-point practical examinations, the authors argue, capture performance under artificial conditions but say little about whether a trainee can function independently in a real workplace over time. The EFPE inverts this logic. Rather than compressing assessment into one event, it spreads it across an extended period, embedding practical tasks within the trainee’s own institution and tying them directly to the needs of that institution. The result is an examination that doubles as a period of supervised, authentic professional work.

To understand how this model performs in practice, the research team conducted a reflective qualitative study spanning multiple medical schools. They gathered data from three distinct samples: a convenience sample of postgraduate students, and purposive convenience samples of faculty members and medical school stakeholders. Each group was interviewed using semi-structured interviews, a method that combines a consistent core of questions with the flexibility to probe unexpected themes as they arise. All interviews were audio recorded, transcribed verbatim, and subjected to thematic analysis, the standard qualitative technique of coding transcripts and iteratively grouping codes into themes and subthemes that capture the shared structure of participants’ experiences.

The thematic analysis surfaced three dominant themes across the three samples. The first concerned the format of the EFPE and how it differs from conventional examinations. The second addressed the examination’s impact on learners and institutions. The third mapped the challenges and areas for improvement that participants encountered. This structure allowed the researchers to compare perspectives across students, faculty, and stakeholders, revealing where the three groups converged and where their priorities diverged. Such triangulation is a key strength of qualitative designs that draw on multiple stakeholder samples, because it reduces the risk that findings reflect only one vantage point within a complex educational system.

On the question of format, participants consistently highlighted the alignment between EFPE tasks and institutional needs. In the EFPE model, the practical work a trainee undertakes is not an abstract exercise but a functional contribution to the hospital or school hosting them. This grounding in real institutional priorities is what the authors describe as the examination’s experiential character: learning by doing, with assessment woven into the doing. Participants also emphasized the positive role of feedback and mentorship, which in the EFPE framework are not afterthoughts but structural components. Continuous guidance during the assessment period means that errors become teaching moments rather than terminal failures, a stark contrast to the one-shot examination in which a single mistake can define the outcome.

The impact theme was the most emphatic. Participants reported that the EFPE led to significant skill development and confidence building among postgraduate students. This finding aligns with a well-established principle in medical education: competence in knowledge, skills, and attitudes develops through repeated, supported practice in authentic settings, not through isolated test events. Because the EFPE is process-focused, it rewards the trajectory of improvement rather than a single terminal performance. Students in the study were described as highly valuing this practical, structured approach, which they experienced as more meaningful and more transferable to their daily clinical responsibilities than traditional practical testing.

The study’s honesty about limitations is notable. Participants identified real costs to the model. Stress and workload emerged as significant concerns, since an extended examination necessarily demands sustained effort over weeks or months rather than a concentrated burst of preparation. Resource demands were another pressure point: longitudinal, mentorship-rich assessment requires faculty time, institutional infrastructure, and coordination that conventional examinations do not. Participants also flagged problems with topic selection and clarity, suggesting that in some cases the tasks chosen for the extended examination were not optimally defined or communicated. These findings matter because they temper enthusiasm with realism; an assessment innovation that ignores its own operational burden is unlikely to spread beyond enthusiastic early adopters.

From these challenges, the participants generated concrete recommendations. They suggested extending the duration of the EFPE, on the logic that a longer runway would distribute workload more evenly and allow deeper engagement with each task. They called for involving students in topic selection, which would increase the relevance of assessed work and give trainees a stake in shaping their own evaluation. They urged that continuous feedback and mentorship be maintained as non-negotiable features rather than optional extras. Finally, they stressed that tasks must remain relevant and sustainable, balancing educational value against the practical capacity of institutions to support them. Together, these suggestions sketch a roadmap for refining the model without abandoning its core principles.

The broader significance of the study lies in its contribution to the debate over longitudinal assessment in medical training. Assessment scholars have long argued that competence is too complex and too context-dependent to be validly measured at a single point in time, and programs worldwide have experimented with workplace-based assessment, portfolios, and longitudinal integrated clerkships. The EFPE adds a postgraduate-specific model to this landscape, one that explicitly fuses assessment with institutional service. By anchoring the examination in the host institution’s real needs, it addresses a persistent weakness of simulated assessments: the gap between what candidates do in an examination hall and what they must do on the ward. The study’s multi-school design suggests the model is not an idiosyncratic local experiment but a transferable framework, though the qualitative methodology means it captures perceptions of value rather than objective outcome measures such as subsequent clinical performance.

What emerges from the research is a portrait of assessment reform that is both ambitious and self-aware. The EFPE, as evaluated by Talaat, Wasfy, and Abouzeid, is highly valued for its practical, structured, and process-focused approach, and it demonstrably builds skill and confidence in the postgraduate students who experience it. At the same time, the study does not pretend the model is cost-free. Stress, workload, resources, and clarity of task design remain open problems, and the participants’ own proposals for longer durations, shared topic selection, and sustained mentorship indicate that the examination is still evolving. For medical educators watching the global shift from assessment of learning toward assessment for learning, the study offers a detailed case study of what that shift looks like when it is implemented across real institutions with real constraints, and a reminder that the future of medical examination may look less like a single afternoon in an examination hall and more like the practice of medicine itself.

Subject of Research: Longitudinal practical assessment in postgraduate medical education

Article Title: The extended functional practical examination (EFPE): an innovative model for advancing assessment for learning in postgraduate medical education

Article References: Talaat, W., Wasfy, N. F., & Abouzeid, E. (2026). The extended functional practical examination (EFPE): an innovative model for advancing assessment for learning in postgraduate medical education. BMC Medical Education. https://doi.org/10.1186/s12909-026-10345-0

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10345-0

Keywords: medical education, postgraduate assessment, extended functional practical examination, longitudinal assessment, experiential learning, assessment for learning, thematic analysis, feedback and mentorship, clinical competence, Suez Canal University, BMC Medical Education, extended

The research team, led by Muna Alshammari and Bader Alwadaany of the College of Nursing at the Public Authority for Applied Education and Training, together with colleagues from Kuwait’s Ministry of Health and international collaborators, surveyed graduates across six general hospitals in Kuwait. Using purposive non-probability sampling, the team collected 357 participant records. After applying listwise deletion across the prespecified demographic variables, programme characteristics, and the full set of 25 five-point Likert-scale items, 310 complete cases remained for analysis. The statistical work was carried out in Python, a choice that reflects the growing role of open-source data science tools in health services research, and included descriptive statistics, 95 percent confidence intervals, reliability analysis, group comparisons, and multiple linear regression with heteroscedasticity-consistent standard errors.

The headline finding is broadly encouraging for Kuwait’s health authorities. Among the 310 complete cases, 230 participants, or 74.2 percent, reported completing a nine-month version of the rotation programme, making that duration the dominant model in the sample. The overall perception score averaged 3.81 on the five-point scale, with a standard deviation of 0.69 and a 95 percent confidence interval running from 3.73 to 3.88. The internal consistency of the survey instrument was exceptionally high, with a Cronbach’s alpha of 0.952, indicating that the 25 items held together as a coherent measure of programme perception. Scores of that reliability are uncommon in survey research and lend weight to the descriptive findings, even though the study design cannot establish causality.

Beneath the overall average, the domain-level results tell a more nuanced story. Knowledge and skills emerged as the strongest dimension of the programme, scoring 4.13 with a standard deviation of 0.73. Graduates clearly felt that the rotation gave them concrete clinical competencies and practical know-how that their academic preparation alone could not deliver. At the opposite end of the spectrum, the evaluation process received the lowest domain score of 3.34 with a standard deviation of 0.82, and that figure was calculated after reverse-scoring an item asking whether programme forms needed updating. In other words, the paperwork and feedback mechanisms of the programme were perceived as its weakest link, a pattern that echoes international literature on transition-to-practice schemes, where administrative evaluation often lags behind clinical content.

Two global questions sharpened this picture further. In the complete sample for the global items, which comprised 302 respondents, 279 graduates, or 92.4 percent, considered the programme useful, an overwhelming endorsement of its core purpose. Yet 245 of the same respondents, or 81.1 percent, stated that the programme required development. The combination is striking: nearly every graduate found value in the rotation, while more than four in five saw clear room for improvement. This is not a programme facing rejection but one facing expectations. New nurses in Kuwait appear to want the rotation to succeed and are simultaneously candid about where it falls short, particularly in the areas of supervision, feedback, and structured assessment.

The regression analysis added an unexpected twist. In the adjusted model covering all 310 participants, employment setting was the only characteristic independently associated with perception scores. Graduates who had moved into primary health care employment rated the programme significantly higher than those working in hospitals, with a regression coefficient of 0.56, a 95 percent confidence interval of 0.24 to 0.87, and a p-value of 0.001. None of the other included participant or programme characteristics showed an independent association with perception scores. The authors are careful to note that this is an observational, self-reported dataset, so the association between primary care employment and more favourable perceptions does not demonstrate that the rotation caused those attitudes, nor does it explain the mechanism behind them.

Why might primary care graduates view the same rotation more positively? The study does not answer that question directly, but several plausible interpretations deserve attention. Primary health care in Kuwait involves a different pace, patient mix, and degree of professional autonomy compared with acute hospital wards. Graduates who transitioned into primary care may have found that the broad, multi-department exposure of the rotation mapped more naturally onto the generalist demands of community practice, whereas hospital-based graduates may have measured the programme against the specialized, high-acuity expectations of ward work. Alternatively, differences in workplace culture, supervision density, or post-rotation support between the two settings could shape how graduates retrospectively judge their training. Disentangling these possibilities would require longitudinal and qualitative designs that the current study, by design, cannot provide.

The authors are explicit about the limits of their evidence. These are self-reported perceptions, not objective measures of clinical competence, patient outcomes, or retention. A favourable perception score does not establish that the programme objectively improves practice, and the cross-sectional design captures a single moment in time rather than change over the course of the transition. The use of purposive non-probability sampling also means the 310 complete cases cannot be assumed to represent all Kuwaiti nursing graduates, and the exclusion of 47 records through listwise deletion raises the possibility that incomplete respondents differed systematically from those with complete data. These caveats do not undermine the study’s value; they simply define what kind of claim the data can support.

Even so, the practical implications are concrete. The study recommends structured mentorship, trained preceptors, standardized competencies, regular feedback, and longitudinal objective evaluation as the priorities for reform. Each recommendation maps onto a specific weakness identified in the data. Trained preceptors and structured mentorship address the supervision gap that likely underlies the low evaluation-process score. Standardized competencies would give graduates and supervisors a shared yardstick for progress across departments. Regular feedback and longitudinal evaluation would replace the static, form-heavy assessment that graduates flagged as outdated with a dynamic system capable of tracking development over the full nine months and beyond. For a programme that already enjoys 92 percent perceived usefulness, these are refinements rather than rebuilds.

The broader significance of the study lies in its setting. Kuwait, like many countries in the region, faces persistent pressure to retain and develop its nursing workforce, and the transition from student to practitioner is a known point of attrition worldwide. By producing locally grounded, methodologically transparent evidence about how graduates experience the Ministry of Health rotation programme, the research team has given policymakers a baseline against which future reforms can be measured. The study received no external funding, was approved by the Ministry of Health Ethical Review Committee under approval number 2022/1942, and was conducted in accordance with the Declaration of Helsinki, with informed consent and anonymized data handling. Published open access, it invites replication and extension, ideally with longitudinal follow-up and objective outcome measures. For now, the message from Kuwait’s newest nurses is clear: the rotation works, and with sharper supervision and modernized evaluation, it could work considerably better.

Subject of Research: Nursing graduates' perceptions of the Kuwait Ministry of Health postgraduate rotation programme

Article Title: College of nursing graduates’ perceptions of Kuwait ministry of health rotation programme: a cross-sectional study

Article References: College of nursing graduates’ perceptions of Kuwait ministry of health rotation programme: a cross-sectional study. (n.d.). https://doi.org/10.1186/s12909-026-10443-z

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10443-z

Keywords: nursing education, new graduate nurses, transition to practice, rotation programme, clinical supervision, mentorship, preceptors, Kuwait, cross-sectional study, programme evaluation, primary health care, BMC Medical Education

SGM youth, a term encompassing young people who identify as lesbian, gay, bisexual, transgender, queer, or otherwise outside cisgender heterosexual norms, experience markedly elevated rates of depression, anxiety, and suicidality compared with their peers. Researchers attribute these disparities less to identity itself than to minority stress: stigma, rejection, and discrimination accumulate and wear down mental health. Access to affirming healthcare, in which providers understand and validate minority identities rather than pathologize them, is one of the strongest protective factors available. Yet many young people report that the clinicians they encounter lack the vocabulary, the conceptual grounding, and the practical skills to deliver such care, even when those clinicians sincerely intend to help.

The Israeli research team set out to map precisely where that translation from intention to action breaks down. Rather than treating attitudes, beliefs, knowledge, and behaviors as separate variables in a conventional regression, the investigators used network analysis, a statistical framework borrowed in part from psychology and complexity science. In a network model, each measured construct is represented as a node, and the statistical associations between nodes are drawn as edges, producing a map of how the components of a professional’s orientation toward SGM youth reinforce or fail to reinforce one another. The approach allows researchers to identify which nodes occupy bridging positions, meaning they connect otherwise weakly linked parts of the system and can therefore act as levers for change.

The study recruited 318 Israeli healthcare professionals drawn from medical, mental health, and allied health disciplines. The sample was almost evenly divided between those who had received training specific to SGM populations, 48.7 percent, and those who had not, 51.3 percent, allowing a direct comparison of the two networks. Most participants identified as women, 74.5 percent, followed by men at 19.2 percent, nonbinary or genderqueer individuals at 3.5 percent, and other identities at 2.8 percent. Each participant completed validated measures covering four domains: attitudes toward SGM youth, affirmative practice beliefs, SGM-specific knowledge, and affirmative practice behaviors, the concrete actions clinicians take to make their practice welcoming and competent for minority youth.

The first finding was straightforward and encouraging. Professionals who had received SGM-specific training reported significantly more positive attitudes toward SGM youth, greater SGM-specific knowledge, stronger affirmative practice beliefs, and more frequent affirmative practice behaviors than their untrained colleagues. Training, in other words, was associated with improvement across the entire profile of professional orientation, not merely with an accumulation of facts. This pattern is consistent with the idea that structured education does more than transmit information; it also normalizes engagement with minority health topics and builds confidence to act on one’s values.

The network results, however, revealed a more subtle and arguably more important story. In the network estimated for trained professionals, knowledge, and specifically clinical and conceptual knowledge about SGM populations, occupied a prominent bridging position between attitudes and beliefs on one side and affirmative practice behaviors on the other. In plain terms, for clinicians who had been trained, knowing things was the connective tissue that turned positive feelings and supportive convictions into actual practice. Attitudes alone, however warm, did not flow directly into behavior; they traveled through knowledge. This makes mechanistic sense. A physician may wholeheartedly support transgender youth yet hesitate in the examination room when unsure about terminology, developmental considerations, or evidence-based protocols. Knowledge dissolves that hesitation and gives goodwill a concrete channel.

The network for untrained professionals looked structurally different, and the difference is diagnostic. Among clinicians who had never received SGM-specific training, knowledge was comparatively disconnected from affirmative practice behavior. Instead, affirmative practice beliefs carried greater bridge connectivity, serving as the main pathway linking attitudes to action. The authors interpret this as a system running on conviction without competence. Untrained professionals may believe firmly in affirming care, and those beliefs may nudge them toward supportive behaviors, but without a substrate of clinical and conceptual knowledge, the pathway from belief to skilled practice remains thin. Goodwill can carry a clinician only so far when the clinical questions, the correct language, and the relevant evidence base are unfamiliar.

Why does this structural distinction matter so much? Because it identifies a target for intervention. If knowledge sits at the bridge between intention and action in trained professionals, then knowledge is the node most worth strengthening. The authors argue that SGM-specific knowledge represents a potentially important target for professional training and for future longitudinal and experimental evaluation. Longitudinal studies could track whether increases in knowledge precede and predict increases in affirmative behavior over time, while experimental designs could test whether targeted knowledge interventions, such as case-based modules on SGM health, produce measurable shifts in clinical practice. The cross-sectional design of the present study cannot establish causality, and the authors are careful on this point, but the network architecture provides a principled hypothesis about where causal leverage likely lies.

The policy implications follow directly. The authors conclude that, considered alongside prior evidence, their results support investing in structured, evidence-based SGM training within professional education, accreditation standards, and continuing education. This is a notable reframing of the usual diversity-training debate. Much criticism of such programs targets interventions that raise awareness without building skill. The present findings suggest the criticism is partly warranted but points in the wrong direction as a reason to abandon training. The problem is not that training adds knowledge; it is that knowledge without integration into clinical routines is insufficient, and conversely, that attitudes without knowledge are inert. Structured curricula that pair conceptual grounding, such as minority stress theory and SGM developmental contexts, with clinical application, such as affirming intake practices and competent communication, are precisely the kind that build the bridge the network analysis identified.

For SGM youth, the stakes of this line of research are concrete. Every gap between a clinician’s good intentions and their actual practice is a moment in which a vulnerable young person may feel unseen, misgendered, or subtly judged, and may disengage from care altogether. The Haifa team’s work offers a technically grounded map of where that gap lives and how it might be closed. The message to medical schools, licensing bodies, and continuing education providers is unusually clear: empathy is the starting point, but knowledge is the bridge, and bridges are things we can deliberately build. The study was funded by the Israel National Institute for Health Policy Research and approved by the University of Haifa ethics committee, and it appears in an open-access journal, making the full network models available to educators and policymakers worldwide who are weighing how best to prepare the next generation of clinicians to serve minority youth.

Subject of Research: How SGM-specific knowledge links healthcare professionals' attitudes and beliefs to affirming clinical practice for sexual and gender minority youth

Article Title: A network analysis of healthcare professionals’ attitudes, affirming beliefs, and behaviors toward SGM youth: professional knowledge as a bridge

Article References: Berkowitz, R., Gewirtz-Meydan, A., & Maoz, S. (2026). A network analysis of healthcare professionals’ attitudes, affirming beliefs, and behaviors toward SGM youth: professional knowledge as a bridge. BMC Medical Education. https://doi.org/10.1186/s12909-026-10492-4

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10492-4

Keywords: network analysis, SGM youth, healthcare professionals, affirmative practice, medical education, SGM training, professional knowledge, health disparities, minority stress, cross-sectional survey, clinical behavior, BMC Medical Education

The study, conducted across 13 clerkship blocks, took advantage of the natural sequencing of a curriculum rather than random assignment. Seven blocks received the game-based learning activity during the first or second week of the rotation, forming what the researchers called the game-based group, while six blocks followed conventional teaching until after the week-four post-test and only then received the game, serving as a delayed-exposure comparison group. All students sat the same pre-test and post-test, allowing the team to compare adjusted post-test scores between the two schedules using a linear mixed-effects model that accounted for pre-test performance and for clustering within clerkship blocks.

The results were striking. The adjusted mean post-test score was 3.671 in the game-based group against 2.635 in the conventional teaching group, an adjusted difference of 1.036 points with a 95 percent confidence interval running from 0.560 to 1.513 and a p-value below 0.001. In practical terms, students who encountered the game early in their clerkship retained substantially more child development knowledge at the end of the rotation than peers who had not yet played it. The authors are careful, however, to note the limits of this design: differences in assessment timing and the intervening clerkship exposure mean the advantage cannot be attributed to game-based learning alone.

What makes the study unusual is its second layer of analysis. Rather than treating the educational game as a single undifferentiated intervention, the researchers asked students to appraise ten distinct game elements individually and measured their flow states using the Flow State Questionnaire. Flow, a concept from positive psychology, describes the absorbing state in which challenge and skill are balanced, attention narrows, and time seems to dissolve. Educational theorists have long proposed that flow is a key mechanism through which games promote learning, making it a natural target for empirical scrutiny.

Students rated all ten game elements highly, indicating that the game was well received across the board. When the researchers examined how these appraisals related to flow, patterns emerged quickly. Nine appraisal-flow associations met the false discovery rate criterion set by Benjamini-Hochberg procedures: six involving enjoyment, two involving sense of control, and one involving engagement. In other words, the students who found particular game elements enjoyable, controllable, or engaging were also the ones most likely to report deep immersion during play. The experiential side of the game clearly worked as intended.

The cognitive side told a different story. Among models linking game-element appraisals to adjusted post-test performance, only one association reached statistical significance, and it ran in an unexpected direction. Teamwork appraisal showed an inverse marginal association with test performance, with a coefficient of -0.811, a 95 percent confidence interval from -1.283 to -0.339, and an FDR-adjusted q value of 0.0113. Students who rated the teamwork element more highly tended, if anything, to score slightly lower on the knowledge test. None of the Flow State Questionnaire subscales was significantly associated with post-test performance at all.

These findings lead the authors to a provocative hypothesis: experiential and cognitive outcomes of game-based learning may involve partly distinct processes. A game can succeed brilliantly at generating enjoyment, engagement, and flow while having little detectable relationship to how much factual knowledge students retain. This does not mean the flow experience is worthless in medical education, but it does challenge the common assumption that immersion is the engine of learning in game-based settings. The authors emphasize that this hypothesis requires prospective testing before firm conclusions can be drawn.

The course itself focused on child development, a core competency in pediatric training that includes developmental screening concepts such as those embodied in the Denver Developmental Screening Test. The content aligned with standards from the Council on Medical Student Education in Pediatrics, and the game was designed to let students apply developmental principles in a low-stakes, interactive format. The study protocol was approved by the Institutional Review Board of MacKay Memorial Hospital, with a waiver of written informed consent covering educational records generated between January 2024 and December 2025.

For medical educators, the study carries a double message. On one hand, it adds to the evidence that well-designed games can improve knowledge outcomes in demanding professional curricula, with an effect size that translated into a full point of adjusted difference on the post-test. On the other hand, it warns against evaluating games solely through the lens of learner experience. High ratings of enjoyment and strong reports of flow do not guarantee cognitive gains, and educators who want games to teach as well as entertain may need to design and assess the two dimensions separately.

The research team, drawn from MacKay Memorial Hospital, MacKay Children’s Hospital, and National Taiwan University College of Medicine, suggests that future work should prospectively test whether separating experiential from cognitive design goals improves both. As game-based learning spreads through medical schools worldwide, studies like this one provide a template for moving beyond the blunt question of whether games work toward the sharper question of which components of a game do the teaching, and which simply make the teaching enjoyable.

Subject of Research: Game-based learning and flow experience in medical education for child development

Article Title: Game element appraisals and learning outcomes in a game-based child development course for medical students

Article References: Ten, C.-W., Ko, M. H.-J., Peng, C.-C., Chiu, Y.-L., & Chen, H.-L. (2026). Game element appraisals and learning outcomes in a game-based child development course for medical students. BMC Medical Education. https://doi.org/10.1186/s12909-026-10461-x

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10461-x

Keywords: game-based learning, medical education, child development, flow state, pediatrics clerkship, board game, flow state questionnaire, medical students, BMC Medical Education, learning outcomes, false discovery rate, curriculum design

The study, led by Demet Koç and Duygu Demirbaş Keskin of the Department of Medical Education at Acıbadem Mehmet Ali Aydınlar University, together with colleagues Melike Şahiner and Levent Altıntaş, set out to map, for the first time at national scale, how Turkish medical schools are confronting the climate-health nexus. The research team distributed an online questionnaire to academic leaders responsible for undergraduate medical education across Türkiye, probing the depth of curricular integration, the perceived effectiveness of existing teaching, faculty preparedness, available educational resources, institutional strategies, and the barriers standing in the way of reform. Fifty-three faculties responded, corresponding to a response rate of 58.9 percent—an unusually broad snapshot of a national medical education system.

The headline numbers are sobering. Just 26 percent of responding faculties reported fully including climate change content in their teaching. Another 32 percent indicated only partial integration, while 42 percent reported no inclusion whatsoever. In other words, in more than four out of ten of Türkiye’s medical faculties, the health consequences of a warming planet—heat-related illness, the spread of vector-borne diseases, respiratory impacts of air pollution, water scarcity, and climate-driven displacement—simply do not appear in the training of future physicians. Where climate content does exist, it is typically embedded within pre-existing mandatory courses rather than delivered through dedicated modules, and it tends to focus on basic concepts and general health impacts rather than applied clinical skills.

The gaps run deeper than mere presence or absence of content. The survey revealed that sophisticated and increasingly essential topics are being left out almost entirely. Climate literacy—the ability to critically interpret climate science and communicate it to patients and communities—was rarely addressed. The mental health dimensions of climate change, including eco-anxiety, trauma following extreme weather events, and the psychological toll of environmental degradation, were similarly neglected. Perhaps most strikingly, climate communication—teaching future doctors how to talk with patients and policymakers about climate-related health risks—was infrequently covered, even though physicians consistently rank among the most trusted voices in public discourse.

Faculty preparedness emerged as a critical weak point. Only 5.7 percent of respondents had received any training on how to teach climate-health content. This means that even in faculties where climate change has formally entered the curriculum, the educators delivering it are, in most cases, self-taught. Medical education researchers have long recognized that curriculum reform without parallel faculty development tends to produce shallow, inconsistent teaching, and the Turkish data conform precisely to that pattern. Without structured training programs, conference workshops, or institutional incentives to build climate-health teaching capacity, early adoption risks being symbolic rather than substantive.

Institutional support was similarly thin. Few faculties reported having dedicated structures—such as curriculum committees tasked with planetary health, designated coordinators, or formal policies—that could drive sustained integration. Student-led initiatives, which have proven to be powerful engines of curriculum change in other countries and in international assessment frameworks such as the Planetary Health Report Card, were likewise rare in Türkiye. The absence of these structural scaffolds suggests that even motivated individual faculty members face an uphill battle: without administrative backing, protected time, and dedicated resources, isolated efforts rarely translate into durable curricular reform.

Perhaps the most telling finding concerns perception. When asked to evaluate the effectiveness of the climate education currently offered at their institutions, 48.4 percent of respondents rated it as ineffective. Yet this pessimism coexists with a striking consensus on the importance of the topic: over 80 percent of respondents rated climate change education as important for medical students, and 83 percent supported the development of a national guidance tool to help faculties integrate climate-health content in a standardized way. That gap—between widespread recognition of importance and pervasive dissatisfaction with delivery—captures the central dilemma of climate education in medical training today. Awareness is not the problem. Structure, resources, and coordination are.

The barriers identified by respondents reflect challenges familiar to curriculum reformers worldwide. Overcrowded curricula leave little room for new content in programs already packed with biomedical science, clinical rotations, and licensing requirements. The absence of national learning objectives or standardized guidance means each faculty must invent its own approach, producing fragmentation and duplication of effort. Limited teaching materials in the local language, scarce expertise, and low institutional prioritization compound the problem. The authors of the study conclude that climate change education in Türkiye’s undergraduate medical programs remains fragmented, underdeveloped, and inconsistently implemented, and that structural and pedagogical barriers are actively hindering progress despite growing awareness.

Why does this matter beyond Türkiye? The World Health Organization has described climate change as the single biggest health threat facing humanity, and the Intergovernmental Panel on Climate Change has documented escalating impacts on food and water security, infectious disease patterns, and extreme heat mortality. Health systems themselves are both vulnerable to these impacts and significant contributors to greenhouse gas emissions, placing physicians at the center of both adaptation and mitigation. International bodies, including the Association for Medical Education in Europe, have urged medical schools to embed planetary health across the training pipeline. A physician who cannot recognize heat stroke in a changing climate, counsel patients during air quality emergencies, or anticipate shifting disease vectors is, by any modern standard, incompletely trained. The Turkish findings therefore serve as a warning for many countries where climate-health education has been championed in declarations and position papers but has yet to reach the lecture hall.

The study’s authors point toward a clear path forward. A coordinated national strategy—anchored by the guidance tool that 83 percent of surveyed educators support—could establish minimum competencies in climate and health, provide ready-made curricular materials, and give faculties a shared framework for implementation. Parallel faculty development initiatives would address the training deficit revealed by the 5.7 percent figure, while institutional investment in dedicated structures and student engagement could sustain momentum over time. The researchers emphasize that undergraduate medical education plays a foundational role in shaping future physicians, and that integrating climate-health content has become an urgent priority. If the medical profession is expected not only to understand the health effects of climate change but also to lead mitigation, adaptation, and advocacy efforts, that preparation must begin in medical school. Türkiye’s national survey has measured the distance between aspiration and reality—and, in doing so, has handed educators, policymakers, and professional bodies a detailed map of exactly what must change.

Subject of Research: Climate change education in undergraduate medical curricula in Türkiye

Article Title: Climate change education in undergraduate medical faculties in Türkiye: a national descriptive cross-sectional study

Article References: Koç, D., Keskin, D. D., Şahiner, M., & Altıntaş, L. (2026). Climate change education in undergraduate medical faculties in Türkiye: a national descriptive cross-sectional study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10395-4

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10395-4

Keywords: climate change, medical education, Türkiye, undergraduate curriculum, planetary health, curriculum integration, faculty preparedness, cross-sectional study, BMC Medical Education, health impacts, faculty development, national survey

Researchers led by Yu Zhang and Wei Cui of the Fourth Military Medical University in Xi’an, working with colleagues at Xi’an Medical University, distributed a cross-sectional questionnaire to all 109 public institutions approved by China’s Ministry of Education to offer undergraduate dentistry programs between 2021 and 2023. The questionnaire was adapted from validated frameworks used in the United Kingdom, reviewed by five subject-matter experts and pilot-tested before deployment. Forty-nine institutions returned valid responses, a participation rate of 45 percent, but the sample carried considerable weight: it included all 28 institutions holding an official discipline ranking of C-minus or above in the most recent national evaluation, and it spanned all seven major geographic regions of China.

The structural findings show a remarkable degree of consensus on how the subject is delivered. Nearly all responding institutions, 47 of 49 or 95.92 percent, teach dentoalveolar surgery not as a standalone course but embedded within a broader oral and maxillofacial surgery curriculum. Three-quarters of schools, 75.51 percent, schedule the material in the fourth academic year, positioning it after students have completed foundational biomedical coursework and general dental training but before graduation and clinical licensure.

Beneath that structural agreement, however, lies substantial variability in time commitment. For both theoretical and practical instruction, the most commonly reported duration was 10 to 20 hours, yet the actual range was dramatic: theory teaching ranged from as little as 4 hours to as many as 36 hours, while practical teaching spanned from 4 hours to more than 36 hours. That means a student at one Chinese dental school might receive nine times the hands-on surgical instruction of a peer at another institution, a disparity with potential implications for entry-level competence in procedures that carry real risks of nerve injury, fracture and infection.

The content itself follows an internationally recognizable core. Institutions consistently reported covering tooth extraction, local anesthesia, the extraction of impacted mandibular third molars, and the management of post-extraction healing and complications. These are the bread-and-butter procedures of general dental practice, and their prominence reflects the reality that most graduates will perform them daily rather than pursue surgical specialization.

Where the survey offers its most actionable insights is in the details of practical training pathways. Thirty institutions, 61.22 percent, described a progressive training sequence that moves students from instrument familiarization, through phantom-head simulation on artificial jaw models, to supervised peer-to-peer practice of local anesthesia injections. This staged approach mirrors competency-based models advocated in dental education literature, allowing students to build psychomotor skills incrementally before touching a patient. Yet simulation for more complex procedures lagged considerably: only 53.06 percent of schools provided simulation training for the surgical removal of impacted mandibular third molars, 42.86 percent for root or fractured-root removal, and just 36.73 percent for the extraction of other impacted teeth. These are precisely the procedures where inexperienced operators face the steepest learning curves and the highest complication rates.

Digital teaching tools present a similar picture of uneven adoption. Videos were nearly universal, used by 95.92 percent of institutions, and animations were employed by 79.59 percent, reflecting how inexpensive and easily deployed these passive formats have become. Interactive virtual programs, by contrast, were reported by only 24.49 percent of schools. The distinction matters educationally: passive media support observation and conceptual understanding, while interactive simulation platforms provide deliberate practice with feedback, the mechanism most strongly associated with skill acquisition in the surgical education literature.

Pedagogical innovation shows a clear hierarchy as well. Problem-based learning was the most widely adopted active-learning method, reported by 71.43 percent of institutions, followed by case-based learning at 42.86 percent and flipped-classroom teaching at 34.69 percent. These approaches ask students to reason through clinical scenarios before or instead of receiving didactic lectures, and their growing footprint suggests Chinese dental educators are engaging with international trends in health-professions education, even if penetration remains incomplete.

Assessment practices reveal perhaps the most significant gap between theory and practice in Chinese dentoalveolar surgery education. Summative theoretical examinations were nearly universal at 95.92 percent, confirming that knowledge acquisition is rigorously tested. But practical skills assessment was implemented at only 59.18 percent of institutions, and phantom-head assessment, in which students demonstrate operative technique on simulation models, at just 48.98 percent. In other words, at roughly half of Chinese dental schools, a student could complete the surgical component of their degree without ever being formally examined on their ability to perform the procedures they studied.

The authors conclude that undergraduate dentoalveolar surgery education in China has an established framework centered on tooth extraction and local anesthesia, with broad use of practical and digital teaching methods, but that marked variation persists in teaching hours, complex-procedure simulation, interactive digital tools and practical assessment. They suggest that future curriculum development may consider competency-guided learning objectives, strengthened simulation and case-based training, and more comprehensive assessment strategies, while cautioning that the educational effectiveness of such reforms requires empirical evaluation. For a country graduating thousands of dentists annually into a health system where tooth extraction remains one of the most commonly performed surgical procedures, the findings offer a data-driven baseline for national conversations about standardization, and a reminder that what happens in the simulation laboratory may matter as much as what happens in the lecture hall.

Subject of Research: Curriculum structure, simulation training and assessment in undergraduate dentoalveolar surgery education across Chinese dental schools

Article Title: Dentoalveolar surgery education in Chinese undergraduate dental schools: a national survey of curriculum structure, simulation training and assessment

Article References: Zhang, Y., Cui, W., Hu, K., Mo, J., He, F., Wang, Y., Wang, J., Zhang, W., Zhang, Z., Wang, Y., & Xue, Y. (2026). Dentoalveolar surgery education in Chinese undergraduate dental schools: a national survey of curriculum structure, simulation training and assessment. BMC Medical Education. https://doi.org/10.1186/s12909-026-10374-9

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10374-9

Keywords: dentoalveolar surgery, dental education, undergraduate curriculum, simulation training, tooth extraction, local anesthesia, China, BMC Medical Education, problem-based learning, phantom head, assessment, oral and maxillofacial surgery