The researchers followed PRISMA guidelines and searched MEDLINE, Scopus, ERIC and ProQuest Central through October 2024. From 1,866 references identified, they included 43 peer-reviewed original studies evaluating Visual Thinking Strategies as learning activities with medical learners and reporting qualitative or quantitative outcomes. The population spanned premedical students, medical students, residents, fellows, faculty and interprofessional learners. Studies limited to non-medical health professions or lacking evaluation were excluded. The reviewers extracted study characteristics, participant demographics, intervention design, outcomes and methodological rigor, while quantitative studies were assessed with the Medical Education Research Study Quality Instrument, or MERSQI.

Medical students were the largest learner group, appearing in 33% of the included studies, followed by residents at 28% and interprofessional students at 19%. Most studies were published between 2020 and 2024, accounting for 60% of the total, and 74% were conducted in the United States. The evidence base was dominated by single-institution, non-controlled interventional studies. MERSQI scores ranged from 7 to 15, which the review described as indicating moderate methodological quality. This combination of results supports interest in the approach while limiting confidence in broad conclusions about its effectiveness across medical-education settings.

Outcomes were primarily assessed at Kirkpatrick Level 1 in 47% of studies and Level 2 in 51%, with one study reaching Level 3. Quantitative research most frequently used Budner’s Tolerance of Ambiguity Scale and the Communication Skills and Attitudes Scale, together with other validated tools, while qualitative studies analyzed reflective narratives. Reported outcomes included enhanced observation, communication, empathy, tolerance of ambiguity and diagnostic reasoning. The review did not establish sustained effects on clinical practice or patient outcomes, because the prevailing study designs and limited higher-level assessment could not answer those questions. The authors therefore call for multi-site, longitudinal and higher-rigor research to determine whether the educational benefits persist and extend to clinical practice.

Subject of Research: Systematic review of Visual Thinking Strategies across medical education

Article Title: A systematic review of visual thinking strategies in medical education

Article References: Robertson, M. L., Kelly-Hedrick, M., Ike, J. D., Cohn, J., White, J., Moniz, T., Chisolm, M. S., & Walsh, A. L. (2026). A systematic review of visual thinking strategies in medical education. BMC Medical Education. https://doi.org/10.1186/s12909-026-10175-0

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10175-0

Keywords: medical education, visual thinking strategies, arts-based learning, medical students, clinical reasoning, communication skills, empathy, tolerance of ambiguity, systematic review, medical humanities, systematic, review

The curriculum was embedded in a transition-to-residency course and combined a 90-minute didactic session with a specialty-oriented simulation. Instruction reviewed the ethical foundations of informed consent, including autonomy, and the elements of valid consent: information, comprehension and voluntariness. It also addressed communication of treatment choices, risks, benefits and alternatives, engagement of patients and families, alignment of decisions with patient goals and values, documentation, and the use of clinical scenarios to practice the skills. Students had received no previous formal instruction on informed consent before the course. Within two weeks of the didactic session, students entered a specialty track aligned with their planned residency and received materials for independent study of a common procedure, including its indications, risks, complications and expected postoperative course.

Each simulation followed a structured sequence: a 10-minute faculty-student briefing, a 15-minute standardized-patient encounter, five minutes of individualized feedback and a 10-minute group debrief. During the encounter, students were expected to confirm the patient’s history, establish rapport, discuss the proposed procedure and obtain verbal and written informed consent. The scenarios were selected by specialty-track faculty leads from procedures commonly performed in their fields. The research analyzed three surgery-based procedures: laparoscopic cholecystectomy, joint replacement and caesarean section. Across the two academic years, 325 fourth-year students received the curriculum, including 252 entering medicine-based and 73 entering surgery-based residency pathways. Among the surgery-based group, 36 students completed the laparoscopic-cholecystectomy scenario, 21 completed the joint-replacement scenario and 16 completed the caesarean-section scenario.

Student performance was rated with a newly developed formative assessment containing 22 line items: 11 patient-centered and 11 procedure-centered communication skills. Each item was scored from 0 to 2, indicating that the behavior was not demonstrated, partially demonstrated or fully demonstrated. The tool included areas such as rapport-building, active listening, communicating the proposed procedure, teach-back, shared decision-making and inviting questions, while also reflecting the American College of Surgeons criteria for informed consent. Standardized patients completed the assessment immediately after the encounter and used it to guide individualized verbal feedback. The standardized patients and their trainers received training from the senior author in using the assessment and delivering feedback. Because the tool was newly created, its reliability and validity had not yet been established when the study was conducted.

The investigators converted the ratings into percentages and used paired-sample t-tests to compare patient-centered and procedure-centered performance within each procedure group. One-way analysis of variance compared the three groups on total, patient-centered and procedure-centered scores, with a p-value below 0.05 considered statistically significant. Among all 73 surgery-bound students, the procedure-centered communication mean was 84.0%, compared with 79.1% for patient-centered communication; the difference was statistically significant, with t(72) = −2.975 and p = 0.004. Procedure-centered scores also exceeded patient-centered scores in the caesarean-section group, at 79.2% versus 77.7%, with p = 0.005, and in the laparoscopic-cholecystectomy group, at 87.0% versus 77.9%, with p < 0.001. The joint-replacement group showed no significant within-group difference between the two categories, with p = 0.329.

Mean total scores were similar across the three procedures: 82.5% for laparoscopic cholecystectomy, 80.7% for joint replacement and 80.5% for caesarean section. The analysis detected no significant difference among procedure groups in total scores, with F(2,70) = 0.277, p = 0.759 and η² = 0.008. Differences were also not significant for patient-centered scores, with p = 0.367, or procedure-centered scores, with p = 0.083. The joint-replacement group had the highest descriptive patient-centered average at 82.3%, compared with 77.9% for laparoscopic cholecystectomy and 77.7% for caesarean section. Laparoscopic cholecystectomy students had the highest descriptive procedure-centered average at 87.0%, compared with 79.2% in each of the other groups. These descriptive differences did not establish a statistically reliable advantage for any procedure. Overall performance was also similar between students who received the didactic session in class and those who viewed it on demand in the second academic year, although the study did not report a detailed statistical comparison of the two delivery modes.

Item-level results identified three behaviors below 60% in every procedure group: checking whether the patient wanted a family member or friend present for the discussion, soliciting the patient’s goals for treatment, and checking for understanding. Performance also varied by procedure. Joint-replacement students scored below 60% on discussing surgical risks and discussing alternatives to the procedure, while laparoscopic-cholecystectomy students scored below 60% on demonstrating respect for the patient as a person. All remaining items exceeded 60% within the reported groups. The authors said the pattern may reflect insufficient instruction, limited student skills or features of the assessment instrument, but the study did not distinguish among those explanations. Their findings indicate that the assessment identified specific behaviors that were consistently weak in this cohort and could be targeted in subsequent instruction and practice.

Students’ end-of-course evaluations were more positive than the item-level performance results. In the anonymous transition-to-residency survey, 86.8% strongly agreed or agreed that the simulation prepared them to obtain informed consent for common procedures during internship, and 100% strongly agreed or agreed that they felt comfortable obtaining informed consent. These questions measured student reaction, corresponding to Level 1 of the Kirkpatrick evaluation framework. They were not independent tests of competence, observations of unsupervised clinical performance or measures of skill retention. The survey findings therefore show that students generally regarded the curriculum as useful and reported feeling prepared, while the standardized-patient ratings show that performance was not uniform across every assessed communication behavior. The study also did not measure whether the curriculum caused the observed scores, because no pretest or baseline assessment was collected.

The study has several limitations that constrain how broadly its findings can be applied. It included two cohorts of graduating fourth-year students from a single medical school, and the analyzed sample was limited to students entering surgical pathways and practicing three surgical procedures. The results may not generalize to other institutions, medical students with different prior training, non-surgical procedures such as blood transfusion or residents in other specialties. Although the participating students had received no formal informed-consent instruction before the course, the researchers assumed baseline knowledge after their clerkships and did not administer a pre-assessment. Performance after graduation was unavailable, so the study could not determine whether students transferred or retained the assessed skills during internship. In addition, the formative assessment tool required further validation and reliability testing, including future work on its factor structure. The curriculum was evaluated as an educational intervention in one setting, and the results do not demonstrate improved patient outcomes, fewer litigation risks or independent clinical competence in every residency environment.

Within those limits, the research offers a detailed educational model for examining one of the professional activities expected of new physicians. The program combined explicit teaching, independent study of a relevant procedure, a standardized-patient encounter, behavior-by-behavior assessment, immediate individualized feedback and group reflection. Its most consistent quantitative finding was the higher observed performance in procedure-centered than patient-centered communication, accompanied by low scores for checking understanding, eliciting treatment goals and asking whether patients wanted support from family or friends. The study also showed that students’ reports of comfort did not guarantee equal performance on every item. Future work identified by the investigators will refine the assessment tool, evaluate its reliability and gather validity evidence, while performance during internship will need separate evaluation. Until those data are available, the curriculum is best understood as a promising, highly rated educational approach with measurable simulation performance and clearly identified communication gaps, rather than proof of readiness for unsupervised consent discussions in clinical practice.

Subject of Research: Evaluation of an informed-consent curriculum and formative assessment for final-year medical students entering surgical residencies

Article Title: Evaluation of an informed consent (EPA11) curriculum and feedback in the transition to residency course for surgical residencies

Article References: Cash, C. A., & Hagopian, E. J. (2026). Evaluation of an informed consent (EPA11) curriculum and feedback in the transition to residency course for surgical residencies. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 202. https://doi.org/10.1007/s44186-026-00604-5

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00604-5

Keywords: informed consent, medical education, standardized patients, surgical training, simulation, formative assessment, communication skills, residency preparation, shared decision-making, medical students, Evaluation, informed

Communication skills training sits at the heart of every medical curriculum, and for good reason: effective patient-provider communication is fundamental to high-quality care. In the pre-clinical years, students rarely see real patients, so they rehearse with standardized patients — trained actors who portray specific cases. The problem is logistical and psychological. Standardized patient sessions are expensive and scarce, and for novices they can be genuinely stressful. Students are observed by peers and a trainer, often on camera, and a simulated consultation demands that they simultaneously retrieve biomedical knowledge, structure a conversation, and deploy a diverse toolkit of listening skills. Cognitive load theory suggests this combination can overwhelm working memory, leaving little capacity for actual learning.

Large language models appeared to offer an escape hatch. A generative AI ‘patient’ can hold open-ended, unscripted conversations, allowing unlimited private rehearsal in a low-stakes environment. Earlier studies showed such tools are feasible and that students enjoy them, but most relied on before-and-after designs without control groups, leaving the causal question open. The Amsterdam team — medical educators, communication trainers, a physician and a student assistant — set out to answer it properly.

Their tool was engineered with care. Built on the university’s secure AI platform running GPT-4o, it used a retrieval-augmented generation (RAG) framework: rather than letting the model improvise, the system pulled relevant details from a structured case file containing the patient’s demographics, medical history, medication use, social situation and symptoms. A behavioral prompt instructed the AI to behave like a standardized patient, for example by not volunteering more information than the student asked for. The case was designed to match the type and difficulty of the one students would face in class, and the prompt was refined iteratively over three months with pilot testing on 18 students.

The experiment exploited the natural split in the class schedule. Students taking their first standardized patient class in the first week of the three-week block formed the control group (182 students), while those scheduled in the following two weeks formed the intervention group (201 students) and were offered voluntary access to the AI patient alongside the standard e-learning. After their class, students completed a 31-item questionnaire measuring four primary outcomes: nervousness, preparedness, self-efficacy and self-perceived competence, all on seven-point scales. The researchers used Mann–Whitney U tests with Benjamini-Hochberg correction for false discovery rate, and their primary analysis was by intention-to-treat, comparing everyone allocated to the intervention with everyone in the control group regardless of actual use.

The results were unambiguous in their nullity. Of 180 students who completed the questionnaire, 49 of the 96 in the intervention group had actually used the AI patient — and most of them, 35, had done so only once. In the intention-to-treat analysis, every composite effect size was near zero, with Cliff’s delta ranging from −0.05 to 0.04 and all 95 percent confidence intervals including zero. The per-protocol comparison of actual users against controls fared no better, with deltas between −0.12 and 0.07. Not one of the 19 individual questionnaire items showed a statistically significant difference after correction. Median nervousness scores were identical at 4.0 in both groups.

The authors are candid about the statistical caveats. The per-protocol comparison included only 49 users, well below the 70 per group their power calculation required, meaning the study could only have detected effects of Cliff’s delta 0.29 or larger — the upper end of a small effect approaching medium. Smaller genuine benefits may have slipped through. But contextual factors loom larger. The presence of fellow students, a trainer and a camera creates social evaluation pressure that may independently drive anxiety, overshadowing any calming effect of prior text-based practice. And there is a deeper modality mismatch: an asynchronous, keyboard-driven conversation simply does not rehearse the real-time turn-taking, nonverbal reading and emotional responsiveness a face-to-face encounter demands.

The qualitative data sharpen that interpretation. Among users, the most appreciated aspect was simply the chance to rehearse — 14 of 34 respondents valued having practiced before meeting the standardized patient. But the improvement requests converged on fidelity and feedback: seven students found the AI’s answers too short, repetitive or unvaried, four wanted a voice or a visible face rather than text, four wanted more varied cases, and three noted the absence of any feedback after the conversation. Practice without correction, the authors observe, is repetition but not deliberate practice. Even the reasons for non-use are instructive: of 19 non-users who explained themselves, six cited lack of time and six cited technical or login problems — access barriers, not rejection of the concept.

Perhaps the most unsettling finding concerns self-assessment. Both groups rated their competence strikingly high, at levels inconsistent with what lecturers observe in earlier cohorts. The authors point to a well-documented phenomenon: novice learners systematically overestimate their abilities, and self-assessed competence correlates poorly with observed performance across health professions education. Ceiling effects and social desirability bias likely inflated the scores further. This is precisely why the team argues that future evaluations of AI patients should use blinded observer ratings with validated communication scales rather than self-report — and why an AI tutor that provides automated feedback could help calibrate inflated self-perceptions.

The study’s conclusion is neither a eulogy nor an endorsement. A single, voluntary, text-based session with a generative AI patient did not measurably reduce nervousness or improve self-assessed competence before a first standardized patient encounter. But 71 percent of users considered the tool a valuable addition to standard preparation, 63 percent wanted to use it again, and the format itself raised no red flags. The authors’ prescription is concrete: mandatory minimum engagement, multiple patient cases, automated feedback, and higher-fidelity multimodal interaction with voice and avatars. Repeated, effortful practice is what drives learning, they note — and if better-designed AI patients can sustain that practice at scale, the benefits that failed to appear here may yet emerge. The broader potential, they add, extends well beyond history-taking, to shared decision-making, team meetings and clinical reasoning.

Subject of Research: Effect of a generative AI virtual patient on medical students' communication skills preparation

Article Title: Use of a GenAI-patient for medical communication training for undergraduate medical students—a quasi-experimental study

Article References: Jongkind, R., Pool, J., Verberne, E., Meinema, J., Geerlings, S., & Henselmans, I. (2026). Use of a GenAI-patient for medical communication training for undergraduate medical students—a quasi-experimental study. Frontiers in Education, 11, Article 1933319. https://doi.org/10.3389/feduc.2026.1933319

Image Credits: AI Generated

DOI: 10.3389/feduc.2026.1933319

Keywords: generative AI, medical education, virtual patient, standardized patients, communication skills, GPT-4o, retrieval-augmented generation, self-efficacy, cognitive load theory, quasi-experimental study, simulation-based learning, medical students

The research, conducted at Hakkari University during the 2025–2026 academic year, involved 76 nursing students divided into an experimental group of 38 third-year students and a control group of 38 fourth-year students. The experimental group received a four-session role play–based SUD education program, with each session lasting 45 to 60 minutes in the nursing skills laboratory. Students rotated through three roles—patient, nurse, and observer—portraying individuals with various SUD histories, practicing active listening and motivational interviewing techniques, and providing structured peer feedback.

Researchers measured outcomes using the Toronto Empathy Questionnaire (TEQ), the Communication Skills Inventory (CSI), and the Attitudes Toward Mental Illness Scale—Substance Related Subscale (ATMI-SRS). Linear mixed models with restricted maximum likelihood estimation served as the primary analysis, supported by ANCOVA and mixed ANOVA, with a Bonferroni-adjusted significance level of α = 0.017.

The results were striking. The experimental group showed a 57% reduction in stigmatizing attitudes, falling from a mean of 13.34 to 5.74 on the ATMI-SRS, while the control group managed only a 15% reduction, from 13.21 to 11.21. The time × group interaction coefficient was β = −5.61 (p < 0.001, d = 1.62). Empathy scores in the experimental group surged from 32.84 to 50.45 on the TEQ (β = 11.92, p < 0.001, d = 1.74), and communication skills climbed from 114.79 to 140.39 on the CSI (β = 20.06, p < 0.001, d = 1.67).

Notably, the intervention effect on stigma reduction was larger among students with higher baseline stigmatizing attitudes. Conditional effects analysis revealed that the model-estimated posttest difference between groups grew from −4.27 points at the 25th percentile of baseline stigma to −6.81 points at the 75th percentile, suggesting that role play may be especially powerful for students who enter training with the strongest biases.

The findings converge across multiple analytical approaches. A supplementary two-way mixed ANOVA confirmed significant time × group interactions for all three outcomes, and a robustness check using binomial generalized estimating equations (GEE) on the dichotomous ATMI-SRS items yielded an odds ratio of 0.32 (95% CI 0.20–0.50), indicating lower odds of endorsing stigma items over time in the experimental group relative to controls.

However, the authors caution that the quasi-experimental design carries substantial limitations. The experimental and control groups consisted of different academic-year cohorts—third-year versus fourth-year students—meaning that academic year was completely confounded with intervention group. The control group also demonstrated considerably higher baseline empathy (49.00 vs. 32.84, d = 2.20), raising the possibility of regression-to-the-mean effects inflating the experimental group’s gains. No blinding procedures were employed, and the same individuals who delivered the intervention also assessed outcomes.

The observed effect sizes (d = 1.62–1.74) substantially exceed the typical range of d = 0.30 to 0.80 reported in nursing education interventions, prompting the authors to call for replication using randomized controlled designs with blinded assessment before drawing firm causal conclusions. The study was also conducted at a single university with 38 students per group, limiting generalizability.

Despite these constraints, the convergence of findings across linear mixed models, ANCOVA, mixed ANOVA, conditional effects analysis, and binomial GEE provides preliminary evidence that structured role play may represent a promising experiential educational approach for addressing stigma, empathy, and self-reported communication skills in SUD-related nursing education. The authors recommend multi-site randomized controlled trials with larger samples, longitudinal follow-up, and investigation of whether improvements translate into observable clinical practice and better patient outcomes.

Substance use disorder remains one of the most stigmatized health conditions encountered in clinical settings, and the attitudes that healthcare trainees carry into practice are often formed long before they meet their first patient. Prior research has documented that nursing students, like other health-professions students, may absorb stereotypical beliefs about people who use drugs from broader societal and media narratives, and that these beliefs can persist even as students advance through their education. Because nurses represent the largest segment of the healthcare workforce and typically spend the most direct time with patients, unaddressed stigma among nursing graduates has practical consequences: it can shape how patients are approached, how pain and withdrawal symptoms are interpreted, and whether individuals with SUD feel safe enough to disclose substance use and accept referral to treatment.

The theoretical rationale for using role play in this context draws on established principles of experiential learning. Rather than receiving information passively, students in role play–based programs must inhabit a perspective, respond in real time to an interaction partner, and then reflect on that experience during structured debriefing. This cycle of enactment and reflection is thought to engage affective processing in ways that lectures on addiction cannot, potentially loosening automatic associations that underlie stigmatizing responses. The four-session structure used in the Hakkari study—rotating students through patient, nurse, and observer roles—follows this logic. Playing the patient role in particular is intended to give students a visceral sense of how judgment, dismissiveness, or moralizing language feels from the receiving end, while the observer role allows them to notice communication patterns in peers that they may not recognize in themselves.

The choice of outcome measures in the study reflects the multidimensional nature of the problem. The Toronto Empathy Questionnaire captures an affective-cognitive trait that has repeatedly been linked in the broader literature to reduced negative beliefs about mental illness, and prior work among medical and dental students has suggested that targeted training, including psychiatry coursework, is associated with higher empathy. The Communication Skills Inventory addresses the applied dimension, since even well-intentioned clinicians can struggle with the practical mechanics of engaging a patient who may be ambivalent about change, guarded about disclosure, or experiencing withdrawal. The Attitudes Toward Mental Illness Scale—Substance Related Subscale isolates the stigma component specific to substance-related conditions rather than mental illness generally, which matters because stigma toward SUD tends to be more severe than stigma toward many other psychiatric diagnoses and is often framed in moral rather than medical terms.

The statistical approach deserves some explanation for readers less familiar with longitudinal designs. Linear mixed models allow repeated measurements from the same person to be analyzed while accounting for the correlation among those measurements, and they handle the pretest–posttest structure of the study without requiring complete data from every participant. The Bonferroni adjustment, setting the significance threshold at α = 0.017 across three primary outcomes, is a conservative correction that reduces the risk of false-positive findings when multiple hypotheses are tested simultaneously. The convergence of this primary analysis with ANCOVA, mixed ANOVA, and the binomial generalized estimating equations robustness check strengthens confidence that the observed patterns are not artifacts of a single modeling choice, even though it cannot overcome the design limitations inherent in non-randomized allocation.

The finding that students with higher baseline stigma showed larger reductions is particularly noteworthy from an educational standpoint. Interventions often produce ceiling effects among participants who already hold favorable attitudes, leaving the students most in need of change relatively untouched. If role play genuinely reaches students with the strongest initial biases, as the conditional effects analysis suggests, then embedding such methods early in nursing curricula could target the population where stigma reduction efforts matter most. This pattern is consistent with the idea that experiential perspective-taking works by directly challenging entrenched assumptions rather than simply reinforcing attitudes students already hold.

At the same time, the magnitude of the reported effects warrants careful interpretation. Effect sizes above 1.6 standard deviations are rare in educational research, and the confounding of academic year with intervention status means that differences in coursework exposure, clinical experience, and maturity between third- and fourth-year students could contribute to the observed gaps. The substantially higher baseline empathy in the control group also complicates interpretation, because groups that start at different points may drift toward different endpoints for reasons unrelated to the intervention. These are precisely the kinds of threats to validity that randomized designs with concurrent cohorts and blinded outcome assessment are designed to eliminate, which is why the authors frame their results as preliminary rather than definitive.

The broader context supports continued investigation. Systematic reviews of stigma-reduction training in health professions have emphasized that many existing programs are brief, theoretical, and rarely evaluated with rigorous comparative designs or long-term follow-up, leaving open the question of whether attitude changes persist once students enter actual clinical environments. Simulation and community-informed approaches targeting opioid use disorder have shown similar promise in helping students recognize and challenge their own biases, suggesting that role play sits within a family of experiential methods that may share common mechanisms. Whether the gains observed in a skills laboratory translate into observable behavior at the bedside—measured, for example, through standardized patient encounters, clinical instructor ratings, or patient-reported experiences of care—remains the critical next question.

For nursing programs considering curricular change, the study offers a concrete and relatively low-cost template: a small number of structured sessions, clear role assignments, practice with specific techniques such as active listening and motivational interviewing, and peer feedback, all deliverable within existing laboratory facilities. As multi-site randomized trials accumulate, the field will be better positioned to determine whether role play–based education should become a standard component of pre-licensure preparation for addiction care, and whether the empathy, communication, and attitude improvements it appears to produce endure across the transition from classroom to professional practice.

Subject of Research: Nursing Education Research

Article Title: The effect of role play-based education on nursing students’ stigmatizing attitudes, empathy levels, and communication skills toward the care of individuals with substance use disorder

Article References: Ataman Bor, N., Berşe, S., Akçoban, S., & Avcı, E. (2026). The effect of role play-based education on nursing students’ stigmatizing attitudes, empathy levels, and communication skills toward the care of individuals with substance use disorder. Frontiers in Public Health, 14, Article 1941630. https://doi.org/10.3389/fpubh.2026.1941630

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1941630

Keywords: nursing education, substance use disorder, stigma, empathy, communication skills, role play, simulation, quasi-experimental study, Türkiye, Frontiers in Public Health, effect, role

Sexual health is a core component of preventive medicine, yet clinicians around the world frequently report discomfort, embarrassment, or simple lack of preparation when raising topics such as sexual history taking, condom use, sexually transmitted infections, and sexual dysfunction. In many low- and middle-income countries, including Tanzania, formal curricula often touch on sexual health only briefly, leaving graduates to improvise in consultations where cultural norms make sexual topics especially sensitive. The research team, led by Gift G. Lukumay and colleagues, set out to test whether a carefully structured training program could measurably improve how future doctors and nurses actually communicate during sexual health encounters.

The trial enrolled 312 undergraduate medical and nursing students at Muhimbili University of Health and Allied Sciences, of whom 310 provided analyzable data. Most participants, 73.5 percent, were in their final year of study, and the mean age was 24.29 years with a standard deviation of 2.51. Women made up 22.6 percent of the sample, a distribution that reflects the composition of the participating cohorts. Notably, 60 percent of students reported having received some prior sexual health training, which the researchers took into account when interpreting baseline performance.

The study used a parallel-group, single-blind randomized controlled design. Students were allocated to either the intervention arm or a comparison arm, and baseline competence scores were statistically similar across the two groups before any training began. The intervention combined several educational techniques: didactic teaching to establish core knowledge, small-group discussions to surface attitudes and cultural considerations, role-play exercises to rehearse difficult conversations, and practice sessions with standardized patients. Standardized patients, sometimes called simulated patients, are trained laypeople who portray patients consistently and can rate student performance using structured checklists, providing an objective and repeatable measure of communication skill.

Because standardized patients rated the consultations, the single-blind design was central to the trial’s credibility. The assessors were not part of the teaching team in a way that would bias scoring, and each student was evaluated with the same checklist instrument at two time points: baseline and six-month follow-up. This structure allowed the researchers to separate genuine skill growth from the natural effects of progressing through clinical coursework, since both groups continued their regular education during the study period.

The results were clear. At the six-month follow-up, communication competence improved in both groups, but the gains were substantially larger in the intervention group. Mixed analysis of variance revealed a significant effect of time, with a p value below .001, indicating that scores rose overall, and a significant time-by-group interaction, with p equal to .002, showing that the trajectory of improvement differed between the arms. In practical terms, the structured training did not merely accelerate learning temporarily; it produced a durable advantage that persisted half a year after the program ended.

Exploratory analyses at the level of individual checklist items added nuance to the headline finding. Students who received the intervention scored higher on most of the specific sexual health communication competencies assessed, with the strongest advantages appearing in the patient-engagement domains: building rapport, demonstrating empathy, and gathering information effectively during the consultation. These are precisely the skills that determine whether a patient feels safe enough to disclose sexual concerns, and they are notoriously difficult to teach through lectures alone. Interestingly, one competency showed no significant difference between groups: the use of clear and understandable language. The authors suggest this may reflect a ceiling effect, since even students in the comparison arm could draw on general communication habits learned elsewhere in their training.

The trial was registered with ClinicalTrials.gov under identifier NCT06428058 on 30 November 2023, and the published protocol details strengthen confidence in the reported outcomes. Randomization, a pre-specified primary outcome, and blinded assessment all align with contemporary standards for educational intervention trials. The use of standardized patient ratings is particularly significant for sensitive topics, where self-reported confidence often diverges sharply from observed performance. Students may believe they are comfortable discussing sex while patients experience the interaction very differently; SP-based checklists capture the latter.

Why does this matter beyond Tanzania? Sexual health communication is a bottleneck in HIV prevention, STI control, and reproductive health services worldwide. When clinicians avoid the topic, patients go untested, untreated, and uninformed. When clinicians raise it awkwardly, patients disengage. The Tanzanian trial demonstrates that a culturally adapted curriculum, one that respects local norms while systematically rehearsing the conversation, can move the needle on observable competence in a resource-conscious academic setting. The combination of didactic content, peer discussion, role-play, and standardized patient practice is inexpensive relative to the potential public health payoff, and the assessment method can be replicated wherever trained simulated patients are available.

The authors conclude that structured sexual health training incorporating standardized patients significantly improved communication competence during simulated consultations, particularly in the domains that involve engaging the patient. They argue that their findings support incorporating culturally adapted sexual health training into healthcare education and using standardized patient assessments to evaluate communication competence in sensitive clinical contexts. For educators designing curricula, the message is that communication about sex is a teachable clinical skill, not an innate talent, and that deliberate practice with realistic patients is the most reliable way to build it. For students, the message is that the discomfort they feel is not a permanent condition but a trainable one, and that six months after a structured program, the difference is visible to the very people who will one day sit across from them in the consultation room.

Subject of Research: Impact of structured sexual health training incorporating standardised patients on health professions students’ sexual health communication competence: A single-blind randomised controlled trial in Tanzania

Article Title: Impact of structured sexual health training incorporating standardised patients on health professions students’ sexual health communication competence: A single-blind randomised controlled trial in Tanzania

Article References: Lukumay, G. G., Kakoko, D., Rosser, B. R. S., & Ross, M. W. (2026). Impact of structured sexual health training incorporating standardised patients on health professions students’ sexual health communication competence: A single-blind randomised controlled trial in Tanzania. PLOS One, 21(10), e0360630. https://doi.org/10.1371/journal.pone.0360630

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360630

Keywords: sexual health, medical education, standardized patients, Tanzania, randomized controlled trial, communication skills, PLOS One, Impact, structured, sexual, health, training

The research team, led by Judith B. Vick of Yale University School of Medicine and Karen M. Goldstein of the Durham VA Health Care System, searched MEDLINE, Embase, and CINAHL Complete for studies published between 2018 and 2026, supplementing these with pre-2018 trials identified in earlier systematic reviews. To be included, studies had to involve adult patients or care partners, deliver teach-back within a single encounter, include a comparator group, and report proximal or intermediate patient outcomes as defined in the team’s conceptual model. Two independent investigators screened every citation at the title/abstract and full-text levels and assessed risk of bias, ultimately synthesizing 18 randomized controlled trials involving 1,985 participants.

Teach-back itself is deceptively simple. Rather than asking patients whether they understood, a question that almost always yields a polite yes, the clinician says something like: I want to make sure I explained this well; can you tell me in your own words what you will do when you get home? If the patient’s restatement reveals gaps, the clinician re-teaches the material and checks again. The technique draws on cognitive science principles, including cognitive load theory, which holds that working memory can be overwhelmed by complex new information, and that active recall helps consolidate learning far better than passive listening.

The review’s first major finding concerned knowledge acquisition. Nine randomized controlled trials assessed whether teach-back improved what patients actually learned, but conceptual inconsistencies across the studies, differences in how knowledge was defined and measured, precluded meta-analysis. Across those trials, the researchers found no clear pattern of effect on knowledge, and they rated the certainty of evidence as very low using the GRADE framework, the Grading of Recommendations Assessment, Development and Evaluation system that weighs risk of bias, inconsistency, indirectness, and imprecision.

The picture brightened for self-efficacy, the psychological construct describing a person’s belief in their own capability to perform behaviors and reach goals. In a meta-analysis of five randomized controlled trials encompassing 416 participants, teach-back interventions produced a large increase in self-efficacy relative to usual care, with a standardized mean difference of 2.40 and a 95 percent confidence interval of 0.37 to 4.44. The certainty of evidence was rated very low, and the confidence interval was strikingly wide, ranging from small to very large effect sizes, with substantial heterogeneity across trials.

Adherence to health behaviors showed a similar pattern. Seven randomized controlled trials with 571 participants assessed whether teach-back improved patients’ self-reported adherence to recommended behaviors such as medication taking, dietary changes, or self-care routines. The pooled standardized mean difference was 1.04, with a 95 percent confidence interval of 0.45 to 1.64, indicating a large effect, and the certainty of evidence was rated low. As with self-efficacy, the confidence intervals were wide and heterogeneity was substantial, meaning the true effect could plausibly fall anywhere from modest to very large.

These findings carry real technical significance for how behavioral interventions are evaluated. Standardized mean differences express effects in units of pooled standard deviation, allowing trials that used different measurement scales to be combined. An SMD of 2.40 for self-efficacy is enormous by clinical research standards, where effects above 0.8 are conventionally labeled large. Yet the very width of the confidence intervals, spanning from 0.37 to 4.44, signals that the evidence base remains thin and variable, a caution the authors emphasize rather than bury.

The self-efficacy result also resonates with a deep theoretical lineage. Albert Bandura’s 1977 unifying theory of behavioral change positioned self-efficacy as the central mechanism through which interventions alter health behavior, and decades of research have confirmed that confidence in one’s ability predicts whether people actually attempt and sustain behaviors like medication adherence or self-management of chronic disease. If teach-back reliably builds that confidence, even without clearly boosting factual knowledge, it may operate through a different pathway than the information-transfer model that has dominated patient education.

Why might teach-back fail to improve knowledge while improving confidence and adherence? One possibility is that the knowledge trials measured learning too inconsistently for any true effect to emerge, with some studies using validated instruments and others using ad hoc quizzes. Another is that teach-back’s real value lies not in transferring more information but in creating a feedback loop: when patients restate instructions, clinicians can correct misunderstandings, and patients experience a sense of mastery and partnership that fuels motivation. The technique may also reduce anxiety and increase surgical cooperation, as one included trial of elderly ophthalmology surgery patients suggested, effects that knowledge scores alone would miss.

The review, funded by the Department of Veterans Affairs Health Systems Research Evidence Synthesis Program, arrives at a moment when health systems, including the Agency for Healthcare Research and Quality and the Institute for Healthcare Improvement, actively promote teach-back in toolkits and training programs. The authors’ conclusion is measured: they did not identify a clear benefit of teach-back on knowledge acquisition, but they did find evidence that teach-back improves self-efficacy and self-reported, short-term adherence to health behaviors. For clinicians, the message is that this simple conversational move, asking patients to teach the instruction back, may matter less for what patients know and more for what they believe they can do, a distinction that could reshape how the field studies and deploys communication techniques in the years ahead.

Subject of Research: Teach-back communication effectiveness in clinical settings

Article Title: Teach-Back in Clinical Communication: A Systematic Review and Meta-analysis

Article References: Vick, J. B., Pace, R., Klimek-Johnson, P., Rushton, S., Roberts, M., Lewinski, A., Neiman, J. H., Chen, D., Joseph, L., Der, T., Gordon, A. M., Jacobs, M., Crossgrove, R., Hoenig, H., Cantrell, S., Sims, C., Namasingh, N., Thornlow, D., Alishahi, A., … Goldstein, K. M. (2026). Teach-Back in Clinical Communication: A Systematic Review and Meta-analysis. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10678-y

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10678-y

Keywords: teach-back, clinical communication, systematic review, meta-analysis, patient education, self-efficacy, health behavior adherence, Journal of General Internal Medicine, Clinical, Communication, Systematic, Review

The study, led by Dr. Jessica R. Lichter of the Icahn School of Medicine at Mount Sinai and NYC Health + Hospitals/Elmhurst, took place at a public safety-net hospital affiliated with an academic medical center. The research team recruited internal medicine residents at the postgraduate year two and three levels, the stages at which trainees increasingly handle serious conversations with patients and families on their own. Thirty-one of 41 eligible residents enrolled in the study, and 25 completed all phases of the protocol, providing the dataset for the final analysis.

The intervention centered on ChatMD, a novel AI chatbot designed to simulate realistic code status discussions. The platform was conceived and developed by Dr. Lichter together with Dr. Alex Beutel, an independent technical contributor whose work on the project was conducted outside his employment at OpenAI. ChatMD plays the role of a hospitalized patient confronting decisions about resuscitation preferences, allowing trainees to rehearse the delicate blend of medical explanation, empathy, and shared decision-making that these conversations demand, without the logistical burden of arranging standardized patient sessions.

All participants began with a shared lecture on the elements of effective code status discussions, ensuring a common foundation before randomization. Residents assigned to the intervention then completed one hour of supervised practice with ChatMD, followed by a faculty-led debriefing modeled on established simulation debriefing principles, and an additional hour of independent practice with the chatbot. Residents in the control group continued with their usual clinical training during the study period. Roughly eight weeks later, with a standard deviation of about two weeks, all enrolled residents completed a standardized patient encounter designed to test their code status discussion skills in a realistic setting.

The standardized patient encounters were graded by assessors blinded to which arm each resident had been assigned, using a modified version of a previously validated checklist. On overall code status discussion performance, intervention residents scored 72.5 percent compared with 66.0 percent among controls. The gap was wider on skills specific to code status conversations, where the intervention group achieved 71.4 percent against 57.6 percent for the control group. However, with the small sample size inherent to a pilot feasibility study, neither difference reached statistical significance, with p-values of 0.35 and 0.15 respectively.

The researchers complemented the quantitative results with a qualitative analysis of resident feedback, using established thematic analysis methods. Intervention residents consistently valued ChatMD for what educators call deliberate practice: the opportunity to repeat a difficult conversation multiple times, experiment with different phrasings, and receive immediate feedback without fear of harming a real patient. Many reported increased confidence in approaching code status discussions on the wards. At the same time, residents identified areas for improvement, particularly the emotional realism of the chatbot’s responses and the depth of the feedback it provided, pointing to clear directions for the next generation of the tool.

The stakes of this training problem are well documented in the medical literature. Prior studies have shown that hospital code status discussions are often rushed, inconsistently conducted, and frequently fail to incorporate patient values, contributing to do-not-resuscitate orders that may not reflect genuine patient preferences. Earlier educational interventions, including mastery learning programs for hospitalists and curricula for trainees, have demonstrated that these skills can be taught, but such programs typically require trained faculty, standardized patients, and protected time, resources that many institutions struggle to sustain. An AI-based simulator that residents can access independently could, in principle, extend this kind of training far beyond what traditional methods allow.

The trial also sits within a rapidly expanding body of work on artificial intelligence in medical education. Recent reports have described AI-simulated patient interactions for improving medical interview skills and multimodal communication training with AI-assisted video analysis for physicians caring for older adults. A 2023 scoping review catalogued a growing range of AI tools supporting communication skills training across the health professions. At the same time, researchers have flagged cautionary considerations, including the tendency of large language models toward sycophancy, or excessive agreement with users, which could undermine the realism of a simulated patient who should sometimes push back or express distress. The Macy Foundation innovation reports on AI in medical education have emphasized both the promise and the integration challenges facing such technologies.

The study team has been transparent about the limitations inherent in a pilot design. The sample of 25 completers was too small to detect anything but large effects, and the non-significant findings should be read as signals of promise rather than proof of efficacy. The single-site setting at a safety-net hospital, while valuable for testing feasibility in a resource-constrained environment, raises questions about generalizability. The eight-week interval between training and assessment is a strength in that it tested retention rather than immediate recall, but longer-term durability of skills remains unexamined. The authors themselves frame the results as supporting continued development of AI-based simulation for code status training rather than as a call for immediate adoption.

Nevertheless, the direction of the findings is notable. The largest observed difference was in the skills most specific to code status conversations, exactly the domain where a purpose-built chatbot might be expected to add value beyond general clinical experience. And the qualitative enthusiasm of residents for on-demand, judgment-free practice suggests that the mechanism of change, deliberate repetition with feedback, is one that AI tools are uniquely positioned to deliver. As the technology matures and larger trials become feasible, AI-simulated patients could become a routine complement to standardized patient encounters, giving every trainee the hours of practice that mastering one of medicine’s hardest conversations requires. For now, this pilot trial offers an early, carefully measured glimpse of what that future might look like.

Subject of Research: AI-based simulation training for code status discussion skills among internal medicine residents

Article Title: Artificial Intelligence-Based Simulation to Improve Code Status Discussions Among Internal Medicine Residents: A Pilot Randomized Trial

Article References: Lichter, J. R., Beutel, A., Trottier, D., Forsyth, B., & Kanevsky, J. (2026). Artificial Intelligence-Based Simulation to Improve Code Status Discussions Among Internal Medicine Residents: A Pilot Randomized Trial. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10761-4

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10761-4

Keywords: artificial intelligence, medical education, code status discussions, internal medicine residents, simulation, chatbot, palliative care, communication skills, randomized trial, advance care planning, graduate medical education, standardized patients

The urgency of the problem is difficult to overstate. Firearm injuries have surpassed motor vehicle crashes as the leading cause of death among U.S. children, and the Surgeon General declared firearm violence a public health crisis in 2024. Yet despite these alarming trends, physicians rarely intervene through patient counseling or policy advocacy, likely because few receive any formal training during their education. The OHSU team, led by Dr. Katherine A. Iossi, recognized that if physicians are expected to play a role in preventing firearm injuries, medical schools must equip students with the tools to do so before they enter clinical practice.

The session, developed in collaboration with public health professionals, was integrated into the existing second-year medical student curriculum at OHSU. It comprised three carefully sequenced components: didactic instruction outlining firearm injury epidemiology and evidence-based clinical and policy interventions, facilitated small-group discussions, and role-playing exercises to practice clinical and policy advocacy skills. The design drew on established curriculum development frameworks and incorporated the BulletPoints Project’s 3A’s Framework for firearm safety counseling, along with the structured advocacy pitch model for policy engagement.

The didactic portion grounded students in the epidemiology of firearm injuries, covering the spectrum of harm from suicide and homicide to accidental injury, and presenting evidence-based interventions such as lethal means safety counseling and secure firearm storage. Students then moved into facilitated small-group discussions, where they explored the ethical dimensions of firearm injury prevention and examined the concept of the physician’s “lane,” a reference to the ongoing debate about whether firearm safety falls within the scope of medical practice. The discussions were structured to create psychological safety, allowing students to voice uncertainty and engage with the topic without fear of judgment.

The role-playing component represented the most innovative element of the session. Students practiced clinical counseling scenarios, such as discussing secure firearm storage with a patient at risk for suicide, and rehearsed policy advocacy pitches aimed at translating clinical evidence into legislative action. This experiential approach reflects a growing body of evidence that communication skills are best acquired through deliberate practice rather than passive instruction, and it mirrors the simulation-based methods used to teach other sensitive clinical encounters.

To evaluate the program, the researchers administered a retrospective pre-post survey to participating students, achieving a response rate of 71.4 percent with 105 respondents. The results revealed statistically significant increases in all study variables between the pre- and post-periods, with p-values below 0.001. Students reported meaningful gains in perceived knowledge, confidence, and intention to engage in firearm injury prevention efforts. Approximately half of respondents, 48.6 percent, reported at least some experience with firearms, including having a family or cultural background involving firearms, highlighting the diversity of perspectives students bring to the topic.

Respondents viewed the firearm injury prevention education as timely, educationally valuable, and important to their future practice. The findings suggest that even a brief, well-structured session can shift medical students’ attitudes and self-efficacy in a domain where clinical engagement has historically been low. The researchers note that self-efficacy plays a mediating role in professional identity formation, meaning that early exposure to firearm injury prevention could influence how students see themselves as physicians throughout their careers.

The program’s significance extends beyond a single institution. Prior educational interventions in this domain have been limited and fragmented, ranging from web-based curricula to case-based training for residents, but few have combined clinical counseling with policy advocacy in a single session for preclinical medical students. The OHSU team’s approach, which explicitly frames firearm injury prevention as both a clinical and policy responsibility, addresses consensus-driven priorities for firearm injury education among medical professionals identified by national summits on the topic.

The researchers acknowledge limitations inherent in their evaluation design, including the retrospective self-report method and the single-institution setting. Response bias remains a possibility, and the long-term retention of knowledge and skills was not assessed. Nevertheless, the study provides a replicable template for other medical schools seeking to integrate firearm injury prevention into their curricula, and the de-identified data is available from the corresponding author upon request to facilitate further research.

As the firearm injury epidemic continues to claim tens of thousands of lives annually, the OHSU session offers a concrete example of how medical education can respond. By teaching students to counsel patients on firearm safety and to advocate for evidence-based policies, the program challenges the notion that physicians must remain silent on this issue. The title of the session, “It’s in Our Lane,” captures the researchers’ central message: firearm injury prevention is not a political distraction but a clinical and professional obligation that belongs squarely within the practice of medicine.

Subject of Research: A medical education program training students in firearm injury prevention clinical counseling and policy advocacy skills

Article Title: It’s in Our Lane: A Firearm Injury Prevention Clinical and Policy Advocacy Skill Development Session for Medical Students

Article References: Iossi, K. A., Kane, R. M., Teichman, R., Manley, K., Martinson, T., Carlson, K. F., Carney, P. A., & Burnett, J. R. (2026). It’s in Our Lane: A Firearm Injury Prevention Clinical and Policy Advocacy Skill Development Session for Medical Students. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10716-9

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10716-9

Keywords: firearm injury prevention, medical education, physician advocacy, public health, curriculum development, health policy, communication skills, medical students, Lane, Firearm, Injury, Prevention

The research team, led by Fery Muhamad Firdaus of Universitas Negeri Yogyakarta alongside colleagues from the University of Mataram and Universiti Putera Malaysia, set out to untangle three constructs that education researchers have long suspected are intertwined: communication skills, teacher immediacy, and mathematical cognitive abilities. The concept of immediacy traces back to psychologist Albert Mehrabian, who in 1969 defined it as behavior that increases the perceived psychological closeness between communicator and recipient. In classrooms, immediacy manifests as eye contact, smiling, open body language, and reduced physical distance, all of which prior studies have linked to greater student engagement and motivation.

What makes this study unusual is its focus on teachers rather than students. The researchers asked whether the immediacy behaviors teachers display also shape the teachers’ own cognitive processing of mathematical content. Their theoretical reasoning drew on Bandura’s social learning theory, which holds that teachers with strong communication skills become effective models, and on Piaget’s cognitive theory, which emphasizes that social interaction supports cognitive development. Through explaining concepts to others, the argument goes, teachers refine and consolidate their own understanding, engaging in active cognitive work rather than passive delivery.

To test these ideas rigorously, the team recruited 235 teachers, 187 from Indonesia and 48 from Malaysia, using convenience sampling through online channels and institutional contacts. Participants ranged in teaching experience from 2 to 20 years and were all actively teaching mathematics. The sample included 101 men and 134 women, with 190 holding bachelor’s degrees and 45 holding master’s degrees. Data were collected via online questionnaires, with instruments adapted from previously validated measures: an 18-item communication skills scale across five dimensions with an average reliability of 0.87, a 23-item teacher immediacy scale adapted from Wilson and Locker with a reliability of 0.92, and a five-item mathematical cognitive instrument developed by the researchers with a reliability of 0.82.

Before running any hypothesis tests, the researchers subjected all three instruments to confirmatory factor analysis, a statistical technique that verifies whether survey items genuinely cluster into the constructs they are meant to measure. The results were strong. Teacher communication skills showed a Comparative Fit Index of 0.924 and a Tucker-Lewis Index of 0.912, both exceeding the conventional threshold of 0.90, with a Root Mean Square Error of Approximation of 0.060 and a Standardized Root Mean Square Residual of 0.049. Teacher immediacy fit slightly better at CFI 0.935 and TLI 0.924, while the mathematical cognitive construct displayed near-perfect fit with a CFI of 1.000 and an RMSEA of 0.000. Average Variance Extracted values of 0.61, 0.56, and 0.68 confirmed convergent validity, and Heterotrait-Monotrait Ratios ranging from 0.51 to 0.77 stayed below the 0.85 ceiling, confirming that the three constructs are statistically distinct.

With the measurement model validated, the team turned to the central question. Linear regression revealed that communication skills significantly influence mathematical cognitive abilities, with the model producing an F statistic of 1698.101 and a p-value below 0.001. The unstandardized coefficient of 0.8885 means that a one-unit increase in communication skills is associated with a 0.8885-unit increase in cognitive skills, holding other variables constant. In plain terms, teachers who explain complex mathematical concepts clearly, listen actively, and provide constructive feedback tend to show firmer command of the underlying mathematics themselves, since organizing a clear explanation draws on the same cognitive skills used to understand it.

Mediation analysis using the SPSS PROCESS macro then tested whether teacher immediacy serves as a bridge between communication and cognition. The first path, from communication skills to immediacy, yielded a coefficient of 0.5548 with p below 0.001, indicating that teachers with stronger communication skills exhibit noticeably higher immediacy behaviors. The second path, from immediacy to cognitive skills, produced a coefficient of 0.0602 with p equal to 0.0073. Because both paths are significant, immediacy partially mediates the relationship: it adds a positive indirect influence, but the direct effect of communication skills remains far larger in magnitude, as reflected in the much bigger regression coefficient.

The moderation analysis delivered the study’s most counterintuitive result. The interaction term between communication skills and immediacy carried a coefficient of minus 0.0020 with p below 0.001, a small but statistically significant negative effect. This means that the positive influence of communication skills on cognitive abilities weakens slightly as teacher immediacy increases. In other words, communication has its strongest association with mathematical cognition among teachers with lower levels of immediacy, while the relationship is somewhat attenuated among the warmest teachers. The researchers caution that because the interaction coefficient is small in magnitude, the slopes diverge only slightly even though the difference is statistically significant, and simple slope analyses confirmed that communication remains the dominant influence across all levels of immediacy.

Among the demographic covariates, gender did not significantly moderate the relationship, with p equal to 0.12, suggesting that the communication-cognition link does not meaningfully differ between male and female teachers. Educational level, however, did moderate the relationship at p equal to 0.03, as did institutional origin at p equal to 0.04. Yet the descriptive comparisons produced a surprise: teachers with bachelor’s degrees scored higher on average in both cognitive skills, 59.76 versus 54.24, and communication skills, 59.58 versus 53.40, than those with master’s degrees. The authors suggest this counterintuitive pattern may reflect differences in curriculum focus between degree programs, or the smaller subsample of master’s degree holders, and they emphasize the need for careful interpretation rather than broad generalization.

Comparisons between the two countries revealed that Indonesian teachers scored higher on average in both cognitive skills, 59.60 versus 54.83, and communication skills, 59.35 versus 54.34, than their Malaysian counterparts, though the authors stress that the much smaller Malaysian subsample of 48 teachers reduces statistical power and demands caution. The discussion notes that the two education systems differ in pedagogical culture: Indonesia has often emphasized more traditional, teacher-centered methods, while Malaysia has pushed harder toward student-centered and interactive approaches. The study’s practical message is clear for policymakers in both nations: targeted training in communication skills should be the priority for strengthening teachers’ mathematical cognition, with immediacy behaviors cultivated as a supportive complement rather than a substitute. The authors acknowledge the cross-sectional design and convenience sampling as limitations, and call for further research into how curriculum design, professional experience, and institutional context shape the interplay between communication, warmth, and mathematical thinking.

Subject of Research: Effects of communication skills and teacher immediacy on the mathematical cognitive abilities of elementary school teachers in Indonesia and Malaysia

Article Title: Communication skills and teacher immediacy effects on mathematical cognitive abilities among elementary educators in Indonesia and Malaysia

Article References: Firdaus, F. M., Maulyda, M. A., Kurniawati, & Razali, F. B. (2026). Communication skills and teacher immediacy effects on mathematical cognitive abilities among elementary educators in Indonesia and Malaysia. Discover Education, 5(1), Article 1190. https://doi.org/10.1007/s44217-026-02328-6

Image Credits: AI Generated

DOI: 10.1007/s44217-026-02328-6

Keywords: teacher immediacy, communication skills, mathematics education, elementary teachers, Indonesia, Malaysia, mediation analysis, cognitive abilities, Communication, skills, teacher, immediacy

Video review has become a widely used method for teaching communication skills across undergraduate and postgraduate medical education. By watching recordings of their own consultations, trainees can observe behaviors that are nearly invisible in the moment, such as interruptions, missed cues from patients, or awkward transitions between phases of the clinical encounter. Yet the technique depends on having a shared vocabulary between the observer and the trainee. Without a structured framework, feedback can drift into vague impressions, and residents may struggle to translate general praise or criticism into concrete changes in behavior. In Japan, the researchers note, few assessment tools have been developed specifically to support video-based reflection in general practice residency training, particularly through clearly described development processes that other educators could scrutinize or replicate.

The team chose an unusual but pragmatic development strategy: rapid prototyping combined with the nominal group technique, a structured consensus method in which experts generate, discuss, and rank ideas in successive rounds. Rather than attempting to design a definitive instrument in a single pass, the researchers treated the tool itself as a prototype to be tested, revised, and refined against real clinical material. This approach mirrors practices familiar from software engineering, where iterative cycles of building, testing, and feedback replace the hope of getting everything right on the first attempt. In medical education, where assessment instruments must balance theoretical grounding with practical usability in busy training environments, such iterative refinement can reveal problems that purely theoretical design would miss.

The first stage involved a systematic sweep of the existing literature. The researchers reviewed established communication assessment instruments and educational frameworks, using the Kalamazoo Consensus Statement, an influential international consensus document on doctor-patient communication, as a key reference point. From twelve existing instruments and frameworks, including well-known tools such as the MAAS-Global rating list for consultation skills, the Calgary-Cambridge Observation Guide, the Four Habits Coding Scheme, the Arizona Clinical Interview Rating Scale, and the SEGUE framework, they extracted a total of 127 individual evaluation items. This extraction step ensured that the new tool would stand on the accumulated evidence of decades of communication skills research rather than on the preferences of a single group of developers.

Those 127 items then entered the consensus machinery of the nominal group technique. Two sessions with experts in general practice were convened to generate, refine, and consolidate the raw material. Through this process and subsequent expert review, the 127 items were distilled into 41 behavioral descriptors, each phrased to describe an observable action that could be identified on a video recording. The reduction from 127 to 41 reflects a central tension in assessment design: an instrument with too many items becomes unwieldy for routine use, while one with too few sacrifices the granularity needed for meaningful feedback. Behavioral descriptors, which anchor each item to something a reviewer can actually see or hear, are considered essential for formative assessment, where the goal is not to grade the trainee but to guide improvement.

To test whether the surviving items mattered to practicing physicians, the team conducted a web-based survey involving 93 physicians. Respondents rated the importance of each of the 41 items and indicated the stage of training at which the corresponding competency would be expected to be attained. The survey confirmed the importance of all 41 items, providing quantitative support that the consensus process had not filtered out anything practitioners considered peripheral. The question about training stage added a developmental dimension, allowing the tool to distinguish between skills expected early in residency and those that mature later, an important consideration for formative assessment that aims to meet trainees where they are.

With the item set validated, the researchers reorganized the 41 descriptors into 15 domains aligned with the structure of the medical interview itself. This organization means that a reviewer watching a recorded consultation can move through the tool in the same sequence as the encounter unfolds, from opening the consultation and gathering information through to explanation, planning, and closing. The final product is a rubric-based assessment tool with three developmental levels, allowing supervisors to characterize a resident’s performance on each item as progressing along a defined trajectory rather than simply present or absent. Rubrics of this kind serve a dual purpose: they standardize observation across different reviewers, and they give trainees an explicit picture of what growth looks like.

Critically, the prototyping did not stop at the drafting table. The team conducted iterative refinement using video recordings of actual outpatient consultations by residents, with appropriate consent obtained from both residents and patients and all data handled with strict attention to confidentiality and anonymization. Testing the draft items against genuine clinical encounters, rather than simulated scenarios, exposed the practical realities of video review: consultations in general practice are messy, brief, and shaped by the unpredictability of real patients. The study received ethics approval from the Mie University Ethics Review Committee and was conducted in accordance with the principles of the Declaration of Helsinki, with written informed consent from participants in the group sessions and an approved consent procedure for the survey.

The authors are careful about what the tool has and has not yet demonstrated. GP-VRAT provides a shared framework for observation and feedback and may support reflective learning through video review, but its feasibility, reliability, validity, and educational usefulness in practice remain to be examined in further studies. Reliability, in the psychometric sense, refers to whether different observers using the tool reach similar judgments on the same recording; validity concerns whether the tool actually measures the communication constructs it claims to measure; and educational usefulness encompasses whether its use genuinely changes resident behavior over time. These are the standard hurdles any new assessment instrument must clear, and the developers present GP-VRAT as a starting point rather than a finished verdict.

The significance of the work extends beyond Japan. General practice and primary care training programs worldwide grapple with the same challenge of assessing communication in authentic settings, and the transparent description of the development process, from literature extraction through consensus sessions, survey validation, and video-based prototyping, offers a template other educators can adapt. As video recording becomes increasingly routine in clinical training environments, tools like GP-VRAT may determine whether those recordings become genuine engines of reflective learning or merely an archive of awkward moments. For now, the researchers have provided the framework; the next chapters of evidence will come from the training rooms where residents and supervisors put it to work.

Subject of Research: Development of a video review assessment tool for communication skills training in general practice residency

Article Title: Development of the General Practice Video Review Assessment Tool (GP-VRAT): a rapid prototyping approach to formative assessment of communication skills in residency training

Article References: Goto, M., Kondo, S., Onishi, H., Sekimoto, M., & Wakabayashi, H. (2026). Development of the General Practice Video Review Assessment Tool (GP-VRAT): a rapid prototyping approach to formative assessment of communication skills in residency training. BMC Medical Education. https://doi.org/10.1186/s12909-026-10435-z

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10435-z

Keywords: GP-VRAT, video review, communication skills, general practice residency, formative assessment, medical education, nominal group technique, rapid prototyping, reflective learning, Kalamazoo Consensus Statement, rubric-based assessment, primary care