From static web to metaverse: reinventing medical education in the post-pandemic era

Elucidating cognitive processes in cardiac arrest team leaders: a virtual reality-based cued-recall study of experts and novices

BACKGROUND

Team leadership during medical emergencies like cardiac arrest resuscitation is cognitively demanding, especially for trainees. These cognitive processes remain poorly characterized due to measurement challenges. Using virtual reality simulation, this study aimed to elucidate and compare communication and cognitive processes-such as decision-making, cognitive load, perceived pitfalls, and strategies-between expert and novice code team leaders to inform strategies for accelerating proficiency development.

METHODS

A simulation-based mixed methods approach was utilized within a single large academic medical center, involving twelve standardized virtual reality cardiac arrest simulations. These 10- to 15-minutes simulation sessions were performed by seven experts and five novices. Following the simulations, a cognitive task analysis was conducted using a cued-recall protocol to identify the challenges, decision-making processes, and cognitive load experienced across the seven stages of each simulation.

RESULTS

The analysis revealed 250 unique cognitive processes. In terms of reasoning patterns, experts used inductive reasoning, while novices tended to use deductive reasoning, considering treatments before assessments. Experts also demonstrated earlier consideration of potential reversible causes of cardiac arrest. Regarding team communication, experts reported more critical communications, with no shared subthemes between groups. Experts identified more teamwork pitfalls, and suggested more strategies compared to novices. For cognitive load, experts reported lower median cognitive load (53) compared to novices (80) across all stages, with the exception of the initial presentation phase.

CONCLUSIONS

The identified patterns of expert performance - superior teamwork skills, inductive clinical reasoning, and distributed cognitive strategiesn - can inform training programs aimed at accelerating expertise development.

Advancing education in interventional psychiatry: scoping review of simulation training and the future of virtual reality-based learning

Objectives

Interventional psychiatric procedures such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) have become increasingly important therapeutic options for managing severe or treatment-resistant mental illnesses. However, research suggests that gaps in training students in these techniques represent a rate-limiting step for their further dissemination and accessibility for the public. Studies have shown that the majority of psychiatry residents lack necessary competency and self-confidence in performing these treatments. Simulation based training has served as a gold standard for training procedural skills in medicine. Simulation-based training environments, particularly immersive reality technology (e.g., virtual reality [VR]), represent a promising novel avenue for trainees to develop the necessary skills for delivering these treatments. This scoping review discusses the current training in interventional psychiatry and how simulation-based training, specifically VR, can improve pedagogy in this area.

Methods

In this scoping review, a literature search was conducted on the PubMed database using specific search terms such as "simulat*", "training", "ECT", "TMS", "neuromodulation", and "interventional psychiatry". The search was limited to studies with language in English from 1980 to 2023.

Results

The initial search yielded 2094 articles, of which 4 evaluated the effectiveness of simulation approaches for ECT and were included in this review. No published studies were identified regarding VR-based education in ECT or rTMS.

Conclusions

This scoping review provides an overview of the current landscape of pedagogical methods in interventional psychiatry and highlights the identified gaps in both the existing literature and the potential application of simulation-based environments, including VR, within this field. Considering the ongoing shift in medical education towards competency-based training, this review discusses the needs and benefits of VR-based simulators as an avenue to enhance competency in interventional psychiatry. Leveraging existing experience in the use of VR-based simulators in procedural skill acquisition in surgery and anesthesia, as well as recommendations on how to translate this approach to clinical training in psychiatry, are also discussed.

Virtual Reality Simulation in Orthopedic Surgery Education Improves Immediate Procedural Skill and Knowledge Acquisition, But Evidence on Cost-Effectiveness and Skill Retention Remains Lacking

PURPOSE OF REVIEW

Virtual reality (VR) simulation in orthopedic education has gained recent interest in the literature. VR simulation provides a virtual space to practice surgical steps accurately, creating a user-controlled environment for novice surgical trainee skill development. Despite the reported benefits, VR is not routinely incorporated into orthopedic residency core curriculum. This study reviews and synthesizes contemporary data assessing the efficacy of VR simulation in orthopedic surgical training.

RECENT FINDINGS

Twenty-three studies across six subspecialty areas were included. Seven hundred and forty-eight participants trained on over nine different VR simulators. Control groups included no additional training, surgical technique guides, surgical videos, and benchtop simulators. Outcome measurements included procedure-specific checklists, objective grading scales, time-to-task completion, and accuracy of implant placement, among others. No outcomes directly focused on patient safety or involved live patients. Across disciplines, VR simulation training improved outcomes when compared to controls, conferring quicker procedure times, higher correct step completion, and more accurate implant placement, although not always statistically significant. Virtual reality is a tool employed by various industries that offers immersive, interactive, and realistic learning experiences. In orthopedics, VR has the potential to enhance skills, improve safety, and increase trainee confidence. In most of the included studies, trainees performed better in the VR simulation groups when compared to control education modalities, and participants readily embraced VR. However, there is mixed evidence on its use, and future studies are needed involving longitudinal VR education to better assess the actual impact on trainee skills, as well as performance in the operating room and its impact on patient outcomes.

The importance of human interaction for curriculum and school life satisfaction among Japanese medical graduates: A web-based survey study

BACKGROUND

This study aimed to assess the curriculum and school life of Japanese medical students on the verge of graduation.

METHODS

A web-based questionnaire survey was conducted to gauge the goals of graduating medical students across various themes: Subjective academic achievement in each curriculum, Length of each curriculum, Timing for summative examination preparation, and Satisfaction with total medical school life, accomplishments, extracurricular activities, and friendships.

RESULTS

With a 67.8% response rate (80/118), the study found that subjective accomplishment in Clinical Clerkship (CC) was significantly lower than in other curriculums (P<0.05 each). Social medicine had significantly lower subjective accomplishment compared to basic medicine (P=0.040). Graduating students reported that the basic medicine curriculum was significantly longer than clinical medicine, CC, and general education (P < 0.05 each). Preparation timing for Pre-CC and Post-CC OSCE was significantly later compared to other summative tests (P < 0.05 each). Total satisfaction with medical school life correlated significantly with school friendships (P < 0.001), while subjective accomplishment and extracurricular activity did not.

CONCLUSION

Graduating medical students express lower subjective accomplishment in CC compared to other curriculums, suggesting a need for CC content improvement. Additionally, the study highlights the significant role of school friendships in influencing total medical school life satisfaction.

From Cadavers to Codes: The Evolution of Anatomy Education Through Digital Technologies

This review examines the shift from traditional anatomy education to the integration of advanced digital technologies. With rapid advancements in digital tools, such as 3D models, virtual dissections, augmented reality (AR) and virtual reality (VR), anatomy education is increasingly adopting digital environments to enhance learning. These tools offer immersive, interactive experiences, supporting active learning and knowledge retention. Mobile technology and cloud computing have further increased accessibility, allowing flexible, self-paced learning. Despite challenges like educator resistance and institutional barriers, the continued innovation and integration of digital tools have the potential to transform anatomy education and improve medical outcomes.

Rallying for Reflection: Pilot Use of Rubric to Facilitate Self-Reflection in Dental Education

INTRODUCTION

Despite its utility, peer feedback within higher education curricula has not demonstrated a consistent correlation with academic performance. Student self-reflection may be one factor of influence, as one's metacognitive assessment can alter feedback perception and processing. Yet, formal instruction on reflection remains rare. This single-subject study assesses the level of students' self-reflective capabilities through the adaptation and pilot use of a rubric based on Korthagen's ALACT reflection model.

MATERIALS AND METHODS

A total of 125 third-year dental students enrolled in a diagnostic sciences course received peer feedback on a case-based assignment. Subsequently, reviewees completed self-reflection on four domains of their performance (examination, diagnostic reasoning, treatment planning and resource utilisation). Two evaluators experienced in dental education adapted an ALACT-based rubric to score reflections and assess the frequency of complete self-reflection, most commonly missed elements and the incidence of neglecting peer feedback.

RESULTS

Of the 125 students, 60 (48%) submitted a complete self-reflection on at least one of four performance domains, with only 1 student (0.08%) submitting a complete self-reflection on all four. The most neglected area of reflection was the inclusion of a rationale for proposed future improvements, with on average 33/125 (26%) expressing the significance of their plans. Furthermore, 13/125 (10%) failed to address peer-suggested shortcomings.

CONCLUSIONS

Current findings demonstrate that student self-reflection is rarely performed to completion, which may impact the integration of peer feedback. We propose a framework for encouraging and evaluating self-reflection instruction and assessment, applicable within both didactic and clinical settings, as a means to set future clinicians up for success.

Developing and implementing Pediatric Nephrology Milestones 2.0 as an efficient tool for trainee evaluation and just-in-time feedback

In 2013, the Accreditation Council for Graduate Medical Education (ACGME) implemented Milestones 1.0 as a tool to assess trainee progress towards readiness for independent practice. Critiques of Milestones 1.0 suggested its complexity made the tool difficult to quickly understand and implement in a standardized fashion. This was particularly challenging among subspecialties due to inherent differences in clinical practice settings and make-up of procedural and patient care needs. In response, ACGME launched Milestones 2.0 in 2016 to harmonize competencies applicable to all subspecialties and develop new subspecialty specific competencies to facilitate precise feedback on subspecialty specific content domains. We describe how the Pediatric Nephrology Subspecialty Milestones were developed by a working group of pediatric nephrologists, fellows, and members of the ACGME. We highlight how this revision supports a growth-focused educational environment and equitable evaluation process. We describe how some institutions have used Milestones 2.0 to create just-in-time as well as summative feedback tools that quickly translate into individualized learning goals and guidance for programmatic improvements.

The impact of COVID-19 pre-university education on first-grade medical students. A performance study of students of a Department of Histology

The recent coronavirus disease (COVID-19) forced pre-university professionals to modify the educational system. This work aimed to determine the effects of pandemic situation on students' access to medical studies by comparing the performance of medical students. We evaluated the performance of students enrolled in a subject taught in the first semester of the medical curriculum in two pre-pandemic academic years (PRE), two post-pandemic years (POST), and an intermediate year (INT) using the results of a final multiple-choice exam. Consistency analysis among periods was performed using the Cronbach alpha coefficient (α), the difficulty index with random effects correction (DI), and the point-biserial correlation index (PB). The five exams were homogeneous and had similar α, DI, and PB difficultness. Performance significantly decreased in POST students compared with PRE students, with a correlation between performance and the academic years (PRE-POST). A significant decrease in the percentage of correct answers was detected in the academic years, with POST students showing lower results than PRE students, but not in the percentage of questions answered incorrectly. Significantly higher percentages of unanswered questions were found among POST students. These results confirm the negative impact of the POST pre-university educational system on the performance of students accessing medical school and suggest that POST students could have a higher degree of uncertainty. Specific education programs should be implemented during the first years of the medical curriculum to tailor this effect and increase students' self-confidence and knowledge, which may be associated with confidence.

MetaRehabVerse: The Great Opportunity to Put the Person's Functioning and Participation at the Center of Healthcare

BACKGROUND AND OBJECTIVE

The metaverse refers to a digital realm accessible via internet connections using virtual reality and augmented reality glasses for promoting a new era of social rehabilitation. It represents the next-generation mobile computing platform expected to see widespread utilization in the future. In the context of rehabilitation, the metaverse is envisioned as a novel approach to enhance the treatment of human functioning exploiting the "synchronized brains" potential exacerbated by social interactions in virtual scenarios.

RESULTS

The metaverse emerges as an ideal domain for adapting the principles of the-International Classification of Functioning. Its intrinsic capacity to simulate interactions within virtual environments shared by multi-users, while providing a profound sense of presence and comprehensive perception, should facilitate learning and experiential understanding. Technical and conceptual aspects are currently under definition, including the interplay with artificial intelligence, definition of social metrics performance, and the utilization of blockchain technology for economic purposes.

CONCLUSION

Building upon these foundations, this paper explores potential areas of metaverse applications in rehabilitation and examines how they may facilitate the pillars outlined in the World Health Organization's Rehabilitation 2030 call for action.

How the Metaverse Is Shaping the Future of Healthcare Communication: A Tool for Enhancement or a Barrier to Effective Interaction?

The metaverse is emerging as a transformative force in healthcare communication, integrating virtual reality (VR), augmented reality (AR), artificial intelligence (AI), and extended reality to enhance doctor-patient interactions, interprofessional collaboration, medical education, and surgical planning. By providing immersive, interactive, and data-driven environments, the metaverse could facilitate real-time consultations, remote surgical assistance, and simulation-based training, overcoming traditional geographical and logistical barriers. Despite these advancements, skepticism persists regarding the metaverse's true benefit in fostering meaningful human interaction. Some critics argue that virtual interfaces risk alienating communication, eroding the depth of doctor-patient relationships rather than strengthening them. The concern remains that digital mediation might replace rather than enhance human presence, diminishing the nuances of empathy and trust inherent in face-to-face interactions. Economic constraints, technological disparities, and the potential reduction in direct human interaction can complicate widespread adoption. Some perspectives suggest that, if strategically implemented, the metaverse could foster a more human, authentic, and profound doctor-patient relationship by reducing administrative burdens and allowing physicians to focus more on patient care. While the metaverse holds promise for revolutionizing digital healthcare, its long-term success depends on responsible implementation, equitable access, and strategic integration into existing healthcare frameworks. In this paper, we aim to critically evaluate both sides of this debate, synthesizing existing evidence to clarify the role of the metaverse in future healthcare communication.

Choose Your Own Adventure: Using Twine for Gamified Interactive Learning in Veterinary Anaesthesia

Veterinary anaesthesia requires theoretical knowledge and quick decision-making skills. Traditional education may not adequately prepare students, while simulation-based learning enhances engagement and skill development. This study evaluates the effectiveness of a Twine-based web system in improving experiential learning, engagement, knowledge retention, and decision-making skills in veterinary anaesthesia students. Five interactive clinical cases were developed using Twine, simulating realistic anaesthesia scenarios with decision points and gamified elements, such as scoring systems and resource management. These modules were accessible on various devices via the web. Following a workshop for second- to fourth-year students of the Degree in Veterinary Sciences, an anonymous survey assessed the module's effectiveness. Quantitative data were analysed descriptively, while qualitative feedback was processed through a hybrid AI-human thematic analysis. Out of 849 invited students, 367 responded (42% response rate). Feedback was highly positive; 90.8% found it effective for training, and 97.0% agreed it improved knowledge. User-friendliness was rated as "easy" or "very easy" by 94.6%. Regarding overall satisfaction, 96.7% of students described the workshop as "good" or "excellent". Some participants suggested improvements in mobile device compatibility and the need for additional resources to understand the concepts better. Twine's interactive format fosters experiential learning while reducing reliance on live animals, aligning with modern ethical standards. Its accessibility via web and translation-enabled browsers enhances its reach. Future research should examine Twine's impact on clinical skills retention and adaptability in various educational contexts, providing a flexible approach to veterinary anaesthesia education through gamified learning.

Research on the application of collaborative teaching between ultrasonographers and vascular surgeons in the training of vascular surgery residents

This study aims to explore the significant role of collaborative teaching between ultrasonographers and vascular surgeons in the training of vascular surgery residents in China. By comparing and analyzing the learning outcomes, clinical practice abilities, and patient feedback data of vascular surgery residents under traditional teaching methods versus collaborative teaching methods, combined with questionnaire surveys and statistical analysis, it was found that collaborative teaching significantly improved the training effect of vascular surgery residents. The results of this study provide new insights for medical education training, emphasizing the importance of interdisciplinary collaborative teaching in the training of vascular surgery residents.

Metaverse technologies in acute care medical education: A scoping review

Background

The concept of the metaverse is a virtual world that immerses users, allowing them to interact with the digital environment. Due to metaverse's utility in collaborative and immersive simulation, it can be advantageous for medical education in high-stakes care settings such as emergency, critical, and acute care. Consequently, there has been a growth in educational metaverse use, which has yet to be characterized alongside other simulation modalities literature. This scoping review aims to provide a comprehensive overview of all research describing metaverse use in education for emergency, critical, and acute care.

Methods

We used Arksey and O'Malley's framework with the Levac et al. modifications to conduct a scoping review by searching these five databases (MEDLINE, EMBASE, ERIC, Web of Science, and Education Source). The framework comprises six steps: (1) identifying the research question; (2) identifying relevant literature; (3) study selection; (4) data extraction; (5) collating, summarizing, and reporting data; and (6) consultation with key informants. Relevant themes and trends were extracted and mapped for reporting.

Results

The search yielded 8175 citations, which ultimately led to data extraction from 65 articles. Studies evaluated metaverse programs for the learning and assessment of both technical skills (management of code blue, sepsis, stroke, etc.) and nontechnical skills (e.g., interprofessional collaboration, communication, critical decision making). Barriers to metaverse implementation include technical challenges and difficulty evaluating educational effectiveness.

Conclusions

The results of this scoping review highlight the current applications of metaverse as an educational tool, its identified strengths and weaknesses, and further comparison between metaverse and other educational modalities such as high-fidelity simulation. This work provides direction for future primary and secondary research that can aid educational programmers and curriculum planners in maximizing metaverse potential in emergency, critical, and acute medical education.

Program Director and Nephrology Fellow's Perceptions of Home Hemodialysis Education in the United States

Key Points

Our survey reports the existence of home hemodialysis (HHD) curricula, including didactic, outside HHD courses, shared decision-making training, and continuity clinics. Fellows attending outpatient clinics were more likely to be confident in their ability and prepared to manage HHD patients. The critical barrier to HHD education identified by program directors and fellows was insufficient patients.

Background

Public policy focuses on increasing the prevalence of home dialysis. Home hemodialysis (HHD) education and comfort with the procedure are significant barriers to increasing prevalence. This study examines nephrology fellowship didactic curriculum, training program infrastructure, and barriers identified by both program directors and trainees.

Methods

An anonymous, online survey was developed to assess HHD curriculum in US nephrology fellowship programs. During academic year 2023–2024, all US nephrology program directors (n =150) were surveyed and asked to forward survey link to their fellows and to indicate the number to whom they forwarded the link.

Results

Fifty-five (55/150; 37%) US nephrology program directors responded to the survey; 80% completed it. Thirty-seven (37/55, 67%) forwarded the link to their fellows. Fellow response rate was 53/237 (22%); 50/53 completed it (94%). Seventy-five percent of the program directors reported either having an HHD curriculum or were developing one. Program directors reported that didactic lectures (87%) were the most frequently available curriculum component, whereas fellows report education on counseling (72%) was most frequent. Sixty percent of fellows and 86% of program directors reported fellow attendance at HHD longitudinal/continuity clinic (routinely or as part of a block rotation). Both peritoneal dialyses and fellows identified insufficient patients as a key barrier to implementing HHD curriculum. Fellows who attended outpatient HHD clinic felt more confident and prepared in HHD-related competencies.

Conclusions

The HHD curriculum exists as didactic lectures, attendance at outside HHD courses, and ESKD-shared decision-making at training programs. Most programs also have continuity clinics. Our findings highlight the presence of curriculum although inconsistent. Fellows who worked in clinic were more likely to be confident and more prepared to manage HHD patients. In addition, fellows with longitudinal clinic felt better prepared than those attending block rotations. Training programs should consider incorporating HHD longitudinal clinical rotations, although this may require creativity to achieve.

The adoption of a superhero bacteria: Escherichia coli and its adventures in microbiology education

Here, we present a case study of undergraduate biomedical students engaging in the Adopt a Bacterium active methodology. The study was designed and authored by students, associating heroes, and antiheroes with Escherichia coli to highlight its dual role in human health. By integrating elements of geek culture, we developed multimedia educational content, including social media posts, interactive chalkboard presentation, gamified seminar, and a comic book. This creative approach enabled a deeper understanding of microbiological concepts, improving communication skills, and stimulating engagement beyond the classroom. Our experience highlights the potential of integrating storytelling and visual media into science education to enhance motivation, autonomy, and practical/theoretical skills, alongside teamwork and science-based communication. Furthermore, we recognized that scientific dissemination involves making science accessible, empowering us to learn and share knowledge with future generations, thereby fostering a ripple effect in scientific literacy. By transforming abstract microbiological concepts into accessible and relatable narratives, the Adopt a Bacterium demonstrates the power of active methodologies in education and public engagement.

Current trends and perspectives of scoliosis research society travel fellows

PURPOSE

This study aims to measure the impact of the Scoliosis Research Society's travel fellowship on a spinal surgeon's career.

METHODS

A non-incentivized survey was sent to 78 previous SRS junior travel fellows from 1993 to 2021. The questionnaire assessed fellowship influence on academic and administrative positions, professional society memberships, and commercial relationships. The trend of these quantitative measures was created according to a compounded annual growth rate (CAGR) calculation of the reported values. The Scopus database was queried for all fellows' publication counts and h-index before the fellowship, as well as 3 years, 5 years, and currently after the fellowship. A control cohort of matched surgeons who did not participate in travel fellowships was used to compare research productivity measures relative to travel fellows.

RESULTS

This study had a 73% response rate. Over the periods of 3-5 years after the fellowship, and up to the present, the mean publication count increased by 31.0%, 31.6%, and 46.4%, respectively. Over the same interval, the mean h-index increased by 19.5%, 17.3%, and 11.3%, respectively. From the year of their respective fellowship to present day, the fellows observed a mean CAGR of + 3.2% in academic positions, + 6.7% in administrative positions, + 2.3% in society memberships, and + 4.7% in commercial relations. Previous fellows concurred the fellowship changed their clinical practice (42.1% Strongly Agree, 36.8% Agree), expanded their network (71.9% Strong Agree, 24.6% Agree), expanded their research (33.3% Strongly Agree, 54.4% Agree), and improved their surgical technique (33.3% Strongly Agree, 49.1% Agree).

CONCLUSION

Robust feedback from previous fellows suggests a traveling fellowship has a meaningful impact on a surgeon's research productivity and career achievements.

Looking Back on Digital Medical Education Over the Last 25 Years and Looking to the Future: Narrative Review

BACKGROUND

The last 25 years have seen enormous progression in digital technologies across the whole of the health service, including health education. The rapid evolution and use of web-based and digital techniques have been significantly transforming this field since the beginning of the new millennium. These advancements continue to progress swiftly, even more so after the COVID-19 pandemic.

OBJECTIVE

This narrative review aims to outline and discuss the developments that have taken place in digital medical education across the defined time frame. In addition, evidence for potential opportunities and challenges facing digital medical education in the near future was collated for analysis.

METHODS

Literature reviews were conducted using PubMed, Web of Science Core Collection, Scopus, Google Scholar, and Embase. The participants and learners in this study included medical students, physicians in training or continuing professional development, nurses, paramedics, and patients.

RESULTS

Evidence of the significant steps in the development of digital medical education in the past 25 years was presented and analyzed in terms of application, impact, and implications for the future. The results were grouped into the following themes for discussion: learning management systems; telemedicine (in digital medical education); mobile health; big data analytics; the metaverse, augmented reality, and virtual reality; the COVID-19 pandemic; artificial intelligence; and ethics and cybersecurity.

CONCLUSIONS

Major changes and developments in digital medical education have occurred from around the start of the new millennium. Key steps in this journey include technical developments in teleconferencing and learning management systems, along with a marked increase in mobile device use for accessing learning over this time. While the pace of evolution in digital medical education accelerated during the COVID-19 pandemic, further rapid progress has continued since the resolution of the pandemic. Many of these changes are currently being widely used in health education and other fields, such as augmented reality, virtual reality, and artificial intelligence, providing significant future potential. The opportunities these technologies offer must be balanced against the associated challenges in areas such as cybersecurity, the integrity of web-based assessments, ethics, and issues of digital privacy to ensure that digital medical education continues to thrive in the future.

Metaverse-based simulation: a scoping review of charting medical education over the last two decades in the lens of the 'marvelous medical education machine'

BACKGROUND

Over the past two decades, the use of Metaverse-enhanced simulations in medical education has witnessed significant advancement. These simulations offer immersive environments and technologies, such as augmented reality, virtual reality, and artificial intelligence that have the potential to revolutionize medical training by providing realistic, hands-on experiences in diagnosing and treating patients, practicing surgical procedures, and enhancing clinical decision-making skills. This scoping review aimed to examine the evolution of simulation technology and the emergence of metaverse applications in medical professionals' training, guided by Friedman's three dimensions in medical education: physical space, time, and content, along with an additional dimension of assessment.

METHODS

In this scoping review, we examined the related literature in six major databases including PubMed, EMBASE, CINAHL, Scopus, Web of Science, and ERIC. A total of 173 publications were selected for the final review and analysis. We thematically analyzed these studies by combining Friedman's three-dimensional framework with assessment.

RESULTS

Our scoping review showed that Metaverse technologies, such as virtual reality simulation and online learning modules have enabled medical education to extend beyond physical classrooms and clinical sites by facilitating remote training. In terms of the Time dimension, simulation technologies have made partial but meaningful progress in supplementing traditional time-dependent curricula, helping to shorten learning curves, and improve knowledge retention. As for the Content dimension, high-quality simulation and metaverse content require alignment with learning objectives, interactivity, and deliberate practice that should be developmentally integrated from basic to advanced skills. With respect to the Assessment dimension, learning analytics and automated metrics from metaverse-enabled simulation systems have enhanced competency evaluation and formative feedback mechanisms. However, their integration into high-stakes testing is limited, and qualitative feedback and human observation remain crucial.

CONCLUSION

Our study provides an updated perspective on the achievements and limitations of using simulation to transform medical education, offering insights that can inform development priorities and research directions for human-centered, ethical metaverse applications that enhance healthcare professional training.

Metaverse-powered basic sciences medical education: bridging the gaps for lower middle-income countries

BACKGROUND

Traditional medical education often lacks contextual experience, hindering students' ability to effectively apply theoretical knowledge in real-world scenarios. The integration of the metaverse into medical education holds great enormous promise for addressing educational disparities, particularly in lower-middle-income countries (LMICs) accompanied by rapid technological advancements. This commentary paper aimed to address the potential of the metaverse in enhancing basic sciences education within the constraints faced by universities in LMICs. We also addressed learning design challenges by proposing fundamental design elements and a suggested conceptual framework for developing metaverse-based teaching methods.The goal is to assist educators and medical practitioners in comprehensivley understanding key factors in immersive teaching and learning.

DISCUSSION

By immersing medical students in virtual scenarios mimicking real medical settings and patient interactions, the metaverse enables practice in clinical decision-making, interpersonal skills, and exposure to complex medical situations in a controlled environment. These simulations can be customized to reflect local healthcare challenges, preparing medical students to tackle specific community needs. Various disciplines, including anatomy, physiology, pharmacy, dentistry, and pathology, have begun leveraging the metaverse to offer immersive learning experiences, foster interdisciplinary collaborations, and facilitate authentic assessments. However, financial constraints pose a significant barrier to widespread adoption, particularly in resource-limited settings like LMICs. Addressing these challenges is crucial to realizing the full potential of metaverse technology in medical education.

CONCLUSION

The metaverse offers a promising solution for enhancing medical education by providing immersive, context-rich learning experiences. This paper proposes a conceptual framework and fundamental design elements to aid faculty educators and medical practitioners in effectively incorporating metaverse technology into their teaching methods, thus improving educational outcomes in LMICs.

Navigating ethical considerations in the use of artificial intelligence for patient care: A systematic review

AIM

To explore the ethical considerations and challenges faced by nursing professionals in integrating artificial intelligence (AI) into patient care.

BACKGROUND

AI's integration into nursing practice enhances clinical decision-making and operational efficiency but raises ethical concerns regarding privacy, accountability, informed consent, and the preservation of human-centered care.

METHODS

A systematic review was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thirteen studies were selected from databases including PubMed, Embase, IEEE Xplore, PsycINFO, and CINAHL. Thematic analysis identified key ethical themes related to AI use in nursing.

RESULTS

The review highlighted critical ethical challenges, such as data privacy and security, accountability for AI-driven decisions, transparency in AI decision-making, and maintaining the human touch in care. The findings underscore the importance of stakeholder engagement, continuous education for nurses, and robust governance frameworks to guide ethical AI implementation in nursing.

DISCUSSION

The results align with existing literature on AI's ethical complexities in healthcare. Addressing these challenges requires strengthening nursing competencies in AI, advocating for patient-centered AI design, and ensuring that AI integration upholds ethical standards.

CONCLUSION

Although AI offers significant benefits for nursing practice, it also introduces ethical challenges that must be carefully managed. Enhancing nursing education, promoting stakeholder engagement, and developing comprehensive policies are essential for ethically integrating AI into nursing.

IMPLICATIONS FOR NURSING

AI can improve clinical decision-making and efficiency, but nurses must actively preserve humanistic care aspects through ongoing education and involvement in AI governance.

IMPLICATIONS FOR HEALTH POLICY

Establish ethical frameworks and data protection policies tailored to AI in nursing. Support continuous professional development and allocate resources for the ethical integration of AI in healthcare.

AI's pivotal impact on redefining stakeholder roles and their interactions in medical education and health care

Artificial Intelligence (AI) has the potential to revolutionize medical training, diagnostics, treatment planning, and healthcare delivery while also bringing challenges such as data privacy, the risk of technological overreliance, and the preservation of critical thinking. This manuscript explores the impact of AI and Machine Learning (ML) on healthcare interactions, focusing on faculty, students, clinicians, and patients. AI and ML's early inclusion in the medical curriculum will support student-centered learning; however, all stakeholders will require specialized training to bridge the gap between medical practice and technological innovation. This underscores the importance of education in the ethical and responsible use of AI and emphasizing collaboration to maximize its benefits. This manuscript calls for a re-evaluation of interpersonal relationships within healthcare to improve the overall quality of care and safeguard the welfare of all stakeholders by leveraging AI's strengths and managing its risks.

Practical tips for teaching medicine in the metaverse

The metaverse is based on immersive technologies such as virtual and augmented reality, body tracking, tactile sensation, etc. A growing number of studies are demonstrating the potential of the metaverse as an attractive resource for learning medicine. However, in practice, medical teachers and students often encounter significant challenges when utilizing the underlying technologies, potentially leading to frustrating learning experiences. A significant part of the teaching time is often devoted to troubleshooting technical issues with the metaverse, and the medical content itself taking a backseat until students become proficient in navigating the metaverse environment. Therefore, it is essential to fit the metaverse's underlying technologies specifically for medical education, minimizing technical hurdles for both teachers and students. In this paper, we deal with this challenge and we present a collection of practical tips that serves as a guide for medical educators making decisions in this emerging field, where they may lack prior experience. Drawing on our observation with a cohort of 776 medical students, we conclude how to effectively identify, design, or implement educational applications tailored for efficient medical learning through the metaverse. Our work may support teachers considering metaverse learning platforms for their classrooms and it is a beneficial reference for the medical education community during the initial stages of implementing the metaverse for teaching.

Gender and Sexuality Awareness in Medical Education and Practice: Mixed Methods Study

BACKGROUND

The integration of gender and sexuality awareness in health care is increasingly recognized as vital for patient outcomes. Despite this, there is a notable lack of comprehensive data on the current state of physicians' training and perceptions in these areas, leading to a gap in targeted educational interventions and optimal health care delivery.

OBJECTIVE

The study's aim was to explore the experiences and perceptions of attending and resident physicians regarding the inclusion of gender and sexuality content in medical school curricula and professional practice in Israel.

METHODS

This cross-sectional survey targeted a diverse group of physicians across various specializations and experience levels. Distributed through Israeli Medical Associations and professional networks, it included sections on experiences with gender and sexuality content, perceptions of knowledge, the impact of medical school curricula on professional capabilities, and views on integrating gender medicine in medical education. Descriptive and correlational analyses, along with gender-based and medical status-based comparisons, were used, complemented, and enhanced by qualitative analysis of participants' replies.

RESULTS

The survey, encompassing 189 respondents, revealed low-to-moderate exposure to gender and sexuality content in medical school curricula, with a similar perception of preparedness. A need for more comprehensive training was widely recognized. The majority valued training in these areas for enhancing professional capabilities, identifying 10 essential gender-related knowledge areas. The preference for integrating gender medicine throughout medical education was significant. Gender-based analysis indicated variations in exposure and perceptions.

CONCLUSIONS

The study highlights a crucial need for the inclusion of gender and sexuality awareness in medical education and practice. It suggests the necessity for curriculum development, targeted training programs, policy advocacy, mentorship initiatives, and research to evaluate the effectiveness of these interventions. The findings serve as a foundation for future directions in medical education, aiming for a more inclusive, aware, and prepared medical workforce.

Exploring Research Trends on Digital Health in Nursing Science in Korea: A Topic Modeling Approach

Digital health technology is utilized in contemporary nursing practice and education. This review explored the scope of digital health applications and major trends in nursing research involving digital health in Korea using topic modeling. Our analysis of data using the Latent Dirichlet Allocation model identified four distinct research topics: nursing education using digital technologies (35.17%), hospital-based nursing practice using digital technologies (19.88%), digital technologies for health education (25.75%), and development of digital technologies to support self-management of chronic conditions (19.20%). Our findings reveal trends, current issues, and gaps in digital health nursing research.

Influence of information anxiety on core competency of registered nurses: mediating effect of digital health literacy

BACKGROUND

In the information age of health care, nurses often face information overload, leading to negative emotions, e.g., anxiety that may impede the adoption of evidence-based practice and clinical decision-making process. Nurses with higher digital health literacy can effectively process and manage information. Despite this, no research has explored the relationship between information anxiety, digital health literacy, and core competency among nurses. Therefore, this study aims to investigate the mediating effects of digital health literacy on information anxiety and core competency among nurses.

METHODS

From July to October 2023, the data for this cross-sectional study were collected. The study surveyed a total of 608 nurses from three tertiary hospitals in Fujian Province, and the survey instruments included a sociodemographic information questionnaire, Chinese revision version of the Digital Health Literacy Instrument (CR-DHLI), Information Anxiety Scale (IAS), and Competency Inventory for Registered Nurses (CIRN). Descriptive statistics and Pearson correlation analysis were conducted using SPSS 29.0, and the mediating effect of digital health literacy was examined using Mplus.

RESULTS

The mean score of nurses' information anxiety, digital health literacy, and core competency was 3.03 ± 0.91, 2.46 ± 0.56, 2.72 ± 0.88, respectively. And the mediation model of information anxiety on core competency for nurses showed a good model fit index (χ²/df = 2.207, CFI = 0.985, TLI = 0.982, RMSEA = 0.045, SRMR = 0.035). Digital health literacy was positively correlated with nurses' core competency but negatively correlated with information anxiety. The results of path analysis revealed that information anxiety had negative and significant direct effects on NCC (β = -0.119, P = 0.004) and DHL (β = -0.297, P < 0.001). DHL had a positive effect on NCC (β = 0.306, P < 0.001). Digital health literacy played a partial mediating role, accounting for 43.54% of the relationship between information anxiety and nurses' core competency.

CONCLUSIONS

Information anxiety among nurses was at relatively high levels, which had a negative impact on the core competency of nurses. This issue requires attention from nursing managers. The mediating role of digital health literacy in the relationship between information anxiety and core competency among nurses has been established. Nursing managers should strengthen the evaluation of nurses' DHL and devise effective support strategies to enhance DHL, thus improving the core competence of nurses in information age.

Hybrid teaching after COVID-19: advantages, challenges and optimization strategies

BACKGROUND

In the post-pandemic era of higher education, hybrid teaching has emerged as a prevalent approach and is anticipated to persist as a defining trend in the future teaching reforms worldwide. However, despite its widespread adoption, certain limitations have become apparent. The objective of this study is to identify the genuine factors that impact students' performance, explore strategies that teachers can employ to enhance their teaching effectiveness and enhance students' academic self-efficacy.

METHODS

The study was performed among undergraduate medical students enrolled in Physiology course at Harbin Medical University in 2020 and 2022. Since 2020, influenced by the COVID-19 pandemic, a hybrid teaching method based on an established offline teaching model called BOPPPS was implemented. A questionnaire was performed in both 2020 and 2022 to evaluate students' satisfaction and efficiency of our hybrid teaching. A comparison was also carried out on the final examination scores of students majoring in Pharmacy and Clinical Pharmacy across the years 2020 to 2022.

RESULTS

The final examination scores of students in 2022 were significantly lower than those in 2020 and 2021 both in Pharmacy and Clinical Pharmacy majors. There was also a decrease of the score in students of Clinical Pharmacy in 2021 compared to 2020. The questionnaire indicated that over half (52.0%) of the students in 2022 preferred offline teaching method, in contrast to 39.1% in 2020. There were obvious changes in students from 2020 to 2022 about the disadvantages of hybrid teaching, the improvement of students' learning ability and the duration of students' autonomous learning. Through cross statistical analysis, online learning styles, learning ability improvement and students' learning burden have been identified as the primary factors influencing their preference for future teaching method.

CONCLUSIONS

Hybrid teaching is still a necessary trend in the future teaching reform base on its multiple advantages. However, in order to improve the teaching outcomes and foster students' participation and learning initiatives, it is imperative to undertake additional reforms in the future teaching process.

Residency training programs in anesthesiology, intensive care and emergency medicine: from curriculum to practice

Residency programs in anesthesiology and intensive care (AIC), and emergency medicine (EM) continually evolve to ensure well-prepared trainees for these critical fields of healthcare. The objective of this study was to collect comprehensive feed-back from AIC and EM residents, comprising opinions and attitudes on: curriculum and structure of the residency program; scope of training environment, opportunities and complexity; training guidance and mentorship; teaching approach. An anonymous online cross-sectional survey was conducted among AIC and EM trainees during December 2023-January 2024 and June 2023-July 2023, respectively. Two hundred and thirty-five answers were collected: 137 (73/64 female/male) and 98 (55/43 female/male) respondents from the AIC and EM programs, respectively. Overall feed-back was equivalent for both residency programs, with differences related to the distinct characteristics of each medical specialty. The main issues identified across the programs were the need to improve and diversify the teaching approaches, with trainees' strong desire for more professional guidance, mentoring, and constant feed-back. The findings would inform decision-making beyond current residency programs in these critical care specialties, highlighting the need to design solutions for interactive and highly immersive educational experiences, such as simulation, augmented reality or virtual reality.

The potential of artificial intelligence to revolutionize health care delivery, research, and education in cardiac electrophysiology

The field of electrophysiology (EP) has benefited from numerous seminal innovations and discoveries that have enabled clinicians to deliver therapies and interventions that save lives and promote quality of life. The rapid pace of innovation in EP may be hindered by several challenges including the aging population with increasing morbidity, the availability of multiple costly therapies that, in many instances, confer minor incremental benefit, the limitations of healthcare reimbursement, the lack of response to therapies by some patients, and the complications of the invasive procedures performed. To overcome these challenges and continue on a steadfast path of transformative innovation, the EP community must comprehensively explore how artificial intelligence (AI) can be applied to healthcare delivery, research, and education and consider all opportunities in which AI can catalyze innovation; create workflow, research, and education efficiencies; and improve patient outcomes at a lower cost. In this white paper, we define AI and discuss the potential of AI to revolutionize the EP field. We also address the requirements for implementing, maintaining, and enhancing quality when using AI and consider ethical, operational, and regulatory aspects of AI implementation. This manuscript will be followed by several perspective papers that will expand on some of these topics.

Strengthening neurosurgical training programs in Sub-saharan Africa: a medical student's perspective

This article provides a nuanced exploration of the state and exigencies of neurosurgical training in sub-Saharan Africa (SSA), viewed through the discerning lens of a medical student. The region has a pronounced scarcity of neurosurgical services, further compounded by sociocultural intricacies and infrastructural inadequacies, resulting in elevated mortality and morbidity rates. The insufficiency of neurosurgeons, facilities, and training centers, particularly in remote areas, exacerbates this predicament. The imperative to fortify neurosurgical training programs is underscored, necessitating a multifaceted approach inclusive of international collaborations and innovative strategies. The challenges impeding neurosurgical training program implementation range from constrained infrastructure to faculty shortages and financial constraints. Recommendations encompass infrastructural investments, faculty development initiatives, and augmented community engagement. An exploration of neurosurgical training programs across diverse African regions reveals commendable strides and imminent deficits, warranting heightened international collaboration. Furthermore, technological innovations, including virtual reality, robotics, and artificial intelligence, are posited as transformative conduits for augmenting neurosurgical training in SSA. The article concludes with a sagacious compendium of recommendations, encompassing standardized curricula, mentorship paradigms, and stringent evaluation mechanisms, all combining efficaciously fortifying neurosurgical insight in SSA and producing transformative improvements in healthcare outcomes.

Factors affecting the adoption of metaverse in healthcare: The moderating role of digital division, and meta-culture

This research aims to find out the factors affecting the adoption of Metaverse in healthcare. This study explores the effect of perceived ease of use, perceived usefulness, and trust on adopting Metaverse in healthcare by keeping digital division and metaculture as moderating variables. The philosophical foundation is rooted in the positivism paradigm, the methodology is quantitative, and the approach used is deductive. Data was collected in Pakistan and China through judgmental sampling from 384 respondents. Partial Least Square Structural Equation Modelling (PLS-SEM) was used to analyze the collected data. The findings validate the relationship between perceived ease of use and the adoption of metaverse with β-value 0.236, t-value 5.207 and p-value 0.000, the relationship between perceived usefulness and the adoption of metaverse with β-value 0.233, t-value 4.017 and p-value 0.000, and the relationship between trust and adoption of a metaverse with β-value 0.192, t-value 3.589 and p-value 0.000. Results also show that the digital divide moderates the relation between perceived ease of use and adopting the metaverse having β-value 0.078, t-value 1.848 and p-value 0.032. Similarly, the findings also show that the digital divide does not moderate the relationships of perceived usefulness and trust with adopting the metaverse. Moreover, the meta culture also does not moderate the relationships of perceived ease of use, usefulness, and trust with adopting the metaverse. The study contributes to theoretical research on adopting a metaverse in healthcare by examining various factors necessary for its development. It also provides guidelines for the developers and adopters of suitable metaverse technology.

The application of metaverse in occupational health

Background

The metaverse, as a new digital interactive platform, is garnering significant attention and exploration across industries due to technological advancements and societal digital transformation. In occupational health, there is immense potential for leveraging the metaverse to enhance work environments and occupational health management. It offers companies more efficient and intelligent solutions for occupational health management while providing employees with safer and more comfortable work environments.

Methods

A comprehensive literature search was conducted using PubMed, Web of Science, IEEE Xplore, and Google Scholar databases to identify relevant studies published between January 2015 and March 2024. The search terms included "metaverse," "virtual reality," "occupational health," "workplace safety," "job training," and "telemedicine." The selected articles were analyzed, and key findings were summarized narratively.

Results

The review summarizes the broad application prospects of metaverse technology in immersive training, occupational risk identification and assessment, and occupational disease monitoring and diagnosis. However, applying the metaverse in occupational health also faces challenges such as inadequate technical standards, data privacy issues, human health hazards, high costs, personnel training, and lagging regulations.

Conclusion

Metaverse offers new possibilities for addressing the numerous challenges faced in occupational health and has broad application prospects. In the future, collaborative efforts from multiple stakeholders will be necessary to promote the sustainable development of metaverse technology in occupational health and better protect workers' occupational health.