Journal of Educational Evaluation for Health Professions

Research articles

Empathy and tolerance of ambiguity in medical students and doctors participating in art-based observational training at the Rijksmuseum in Amsterdam, the Netherlands: a before-and-after study: Stella Anna Bult, Thomas van Gulik; J Educ Eval Health Prof. 2025;22:3. Published online January 14, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.3

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Purpose
This research presents an experimental study using validated questionnaires to quantitatively assess the outcomes of art-based observational training in medical students, residents, and specialists. The study tested the hypothesis that art-based observational training would lead to measurable effects on judgement skills (tolerance of ambiguity) and empathy in medical students and doctors.
Methods
An experimental cohort study with pre- and post-intervention assessments was conducted using validated questionnaires and qualitative evaluation forms to examine the outcomes of art-based observational training in medical students and doctors. Between December 2023 and June 2024, 15 art courses were conducted in the Rijksmuseum in Amsterdam. Participants were assessed on empathy using the Jefferson Scale of Empathy (JSE) and tolerance of ambiguity using the Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) scale.
Results
In total, 91 participants were included; 29 participants completed the JSE and 62 completed the TAMSAD scales. The results showed statistically significant post-test increases for mean JSE and TAMSAD scores (3.71 points for the JSE, ranging from 20 to 140, and 1.86 points for the TAMSAD, ranging from 0 to 100). The qualitative findings were predominantly positive.
Conclusion
The results suggest that incorporating art-based observational training in medical education improves empathy and tolerance of ambiguity. This study highlights the importance of art-based observational training in medical education in the professional development of medical students and doctors.

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Understanding uncertainty and ambiguity in medicine and medical education: a narrative review with implications for training
Sarine Sarkis, Christian Raphael
Postgraduate Medical Journal.2026; 102(1207): 461. CrossRef
Observational training for surgical residents using visual arts in the museum
Thomas M. van Gulik, Stella A. Bult, Pien E.J. de Ruiter, Floortje Huizing, Alexander de Mol van Otterloo, Alexander Leijdesdorff, Sjoerd Lagarde
Surgery.2026; 190: 109843. CrossRef
Training the eye and diagnosing the canvas in the Museum ‘A perspective on art-based medical education’
T.M. van Gulik, S.A. Bult, P.E.J. de Ruiter, F. Huizing, A. Leijdesdorff, S. Lagarde, A. de Mol van Otterloo
Ethics, Medicine and Public Health.2026; 34: 101243. CrossRef
Developing a Feasible Arts and Humanities Course Using Visual Thinking Strategies and Haiku Writing: A Mixed-Methods Study
Hirohisa Fujikawa, Takayuki Ando, Junji Haruta
Medical Science Educator.2025; 35(6): 3105. CrossRef
Erb’s Palsy: Visual Diagnosis in Art before Medical History?
Pien E.J. de Ruiter, Stella A. Bult, Jeroen R. Dijkstra, Thomas M. van Gulik
Gynecologic and Obstetric Investigation.2025; 91(1): 26. CrossRef

Use of learner-driven, formative, ad-hoc, prospective assessment of competence in physical therapist clinical education in the United States: a prospective cohort study: Carey Holleran, Jeffrey Konrad, Barbara Norton, Tamara Burlis, Steven Ambler; J Educ Eval Health Prof. 2023;20:36. Published online December 8, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.36

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Abstract PDF Supplementary Material

Purpose
The purpose of this project was to implement a process for learner-driven, formative, prospective, ad-hoc, entrustment assessment in Doctor of Physical Therapy clinical education. Our goals were to develop an innovative entrustment assessment tool, and then explore whether the tool detected (1) differences between learners at different stages of development and (2) differences within learners across the course of a clinical education experience. We also investigated whether there was a relationship between the number of assessments and change in performance.
Methods
A prospective, observational, cohort of clinical instructors (CIs) was recruited to perform learner-driven, formative, ad-hoc, prospective, entrustment assessments. Two entrustable professional activities (EPAs) were used: (1) gather a history and perform an examination and (2) implement and modify the plan of care, as needed. CIs provided a rating on the entrustment scale and provided narrative support for their rating.
Results
Forty-nine learners participated across 4 clinical experiences (CEs), resulting in 453 EPA learner-driven assessments. For both EPAs, statistically significant changes were detected both between learners at different stages of development and within learners across the course of a CE. Improvement within each CE was significantly related to the number of feedback opportunities.
Conclusion
The results of this pilot study provide preliminary support for the use of learner-driven, formative, ad-hoc assessments of competence based on EPAs with a novel entrustment scale. The number of formative assessments requested correlated with change on the EPA scale, suggesting that formative feedback may augment performance improvement.

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Shifting Anatomy Away From a Time‐Based Model: Competency‐Based Education Insights for Anatomy Educators
Jeb Helms, Skye Donovan
Clinical Anatomy.2026; 39(1): 60. CrossRef
Clinical Anatomy in a Physical Therapist Competency-Based Education Course: Challenges and Solutions
Jeb Helms, Lindsay Conn, Austin Sheldon, Carl DeRosa, Kelly Macauley
Journal of Physical Therapy Education.2026; 40(1): 23. CrossRef
The Anatomy of Assessment: Competency-Based Educational Outcomes in a Doctor of Physical Therapy Anatomy Course
Michael Morgan, Jeb Helms, Taylor Lane
Journal of Rehabilitation Practices and Research.2026;[Epub] CrossRef
Developing consensus on competency-based educational standards in orthopaedic manual physical therapy fellowship training: findings from a modified Delphi: part 3: communication and education
Megan Donaldson, Ngozi Akotaobi, Jake Awruch, Jennifer Bent, Derek Clewley, Kyle Covington, Chad E. Cook, Nathan Hutting, William H. Kolb, Kenneth Learman, Paul Mintken, Mark Shepherd, Brett Windsor, Damian Keter
Journal of Manual & Manipulative Therapy.2026; : 1. CrossRef
From Competency to Entrustment: An Innovative Curricular Model for Physical Therapist Education
Priscilla Weaver, Kelly Macauley, Carl DeRosa, Lindsay Conn, Jeb Helms, Jessica Bender, John Hoops, Karen Mueller, Austin Sheldon, Cathy Stucker, Brett Windsor, Debbie Zagray
Journal of Physical Therapy Education.2026;[Epub] CrossRef

Application of an objective structured clinical examination to evaluate and monitor interns’ proficiency in hand hygiene and personal protective equipment use in the United States: Ying Nagoshi, Lou Ann Cooper, Lynne Meyer, Kartik Cherabuddi, Julia Close, Jamie Dow, Merry Jennifer Markham, Carolyn Stalvey; J Educ Eval Health Prof. 2019;16:31. Published online October 15, 2019; DOI: https://doi.org/10.3352/jeehp.2019.16.31

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Abstract PDF Supplementary Material

Purpose
This study was conducted to determine whether an objective structured clinical examination (OSCE) could be used to evaluate and monitor hand hygiene and personal protective equipment (PPE) proficiency among medical interns in the United States.
Methods
Interns in July 2015 (N=123, cohort 1) with no experience of OSCE-based contact precaution evaluation and teaching were evaluated in early 2016 using an OSCE for hand hygiene and PPE proficiency. They performed poorly. Therefore, the new interns entering in July 2016 (N=151, cohort 2) were immediately tested at the same OSCE stations as cohort 1, and were provided with feedback and teaching. Cohort 2 was then retested at the OSCE station in early 2017. The Mann-Whitney U-test was used to compare the performance of cohort 1 and cohort 2 on checklist items. In cohort 2, performance differences between the beginning and end of the intern year were compared using the McNemar chi-square test for paired nominal data.
Results
Checklist items were scored, summed, and reported as percent correct. In cohort 2, the mean percent correct was higher on the posttest than on the pretest (92% vs. 77%, P<0.0001), and the passing rate (100% correct) was also significantly higher on the posttest (55% vs. 16%). At the end of intern year, the mean percent correct was higher in cohort 2 than in cohort 1 (95% vs. 90%, P<0.0001), and 55% of cohort 2 passed (a perfect score) compared to 24% in cohort 1 (P<0.0001).
Conclusion
An OSCE can be utilized to evaluate and monitor hand hygiene and PPE proficiency among interns in the United States.

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Staying proper with your personal protective equipment: How to don and doff
Cameron R. Smith, Terrie Vasilopoulos, Amanda M. Frantz, Thomas LeMaster, Ramon Andres Martinez, Amy M. Gunnett, Brenda G. Fahy
Journal of Clinical Anesthesia.2023; 86: 111057. CrossRef
Virtual Reality Medical Training for COVID-19 Swab Testing and Proper Handling of Personal Protective Equipment: Development and Usability
Paul Zikas, Steve Kateros, Nick Lydatakis, Mike Kentros, Efstratios Geronikolakis, Manos Kamarianakis, Giannis Evangelou, Ioanna Kartsonaki, Achilles Apostolou, Tanja Birrenbach, Aristomenis K. Exadaktylos, Thomas C. Sauter, George Papapagiannakis
Frontiers in Virtual Reality.2022;[Epub] CrossRef
Effectiveness and Utility of Virtual Reality Simulation as an Educational Tool for Safe Performance of COVID-19 Diagnostics: Prospective, Randomized Pilot Trial
Tanja Birrenbach, Josua Zbinden, George Papagiannakis, Aristomenis K Exadaktylos, Martin Müller, Wolf E Hautz, Thomas Christian Sauter
JMIR Serious Games.2021; 9(4): e29586. CrossRef
Rapid Dissemination of a COVID-19 Airway Management Simulation Using a Train-the-Trainers Curriculum
William J. Peterson, Brendan W. Munzer, Ryan V. Tucker, Eve D. Losman, Carrie Harvey, Colman Hatton, Nana Sefa, Ben S. Bassin, Cindy H. Hsu
Academic Medicine.2021; 96(10): 1414. CrossRef
Empirical analysis comparing the tele-objective structured clinical examination and the in-person assessment in Australia
Jonathan Zachary Felthun, Silas Taylor, Boaz Shulruf, Digby Wigram Allen
Journal of Educational Evaluation for Health Professions.2021; 18: 23. CrossRef
Employment of Objective Structured Clinical Examination Tool in the Undergraduate Medical Training
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
Journal of the Scientific Society.2021; 48(3): 145. CrossRef
Comparison of students' performance of objective structured clinical examination during clinical practice
Jihye Yu, Sukyung Lee, Miran Kim, Janghoon Lee
Korean Journal of Medical Education.2020; 32(3): 231. CrossRef

Dreyfus scale-based feedback increased medical students’ satisfaction with the complex cluster part of a interviewing and physical examination course and improved skills readiness in Taiwan: Shiau-Shian Huang, Chia-Chang Huang, Ying-Ying Yang, Shuu-Jiun Wang, Boaz Shulruf, Chen-Huan Chen; J Educ Eval Health Prof. 2019;16:30. Published online October 11, 2019; DOI: https://doi.org/10.3352/jeehp.2019.16.30

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Abstract PDF Supplementary Material: Purpose
In contrast to the core part of the clinical interviewing and physical examination (PE) skills course, corresponding to the basic, head-to-toe, and thoracic systems, learners need structured feedback in the cluster part of the course, which includes the abdominal, neuromuscular, and musculoskeletal systems. This study evaluated the effects of using Dreyfus scale-based feedback, which has elements of continuous professional development, instead of Likert scale-based feedback in the cluster part of training in Taiwan.
Methods
Instructors and final-year medical students in the 2015–2016 classes of National Yang-Ming University, Taiwan comprised the regular cohort, whereas those in the 2017–2018 classes formed the intervention cohort. In the intervention cohort, Dreyfus scale-based feedback, rather than Likert scale-based feedback, was used in the cluster part of the course.
Results
In the cluster part of the course in the regular cohort, pre-trained standardized patients rated the class climate as poor, and students expressed low satisfaction with the instructors and course and low self-assessed readiness. In comparison with the regular cohort, improved end-of-course group objective structured clinical examination scores after the cluster part were noted in the intervention cohort. In other words, the implementation of Dreyfus scale-based feedback in the intervention cohort for the cluster part improved the deficit in this section of the course.
Conclusion
The implementation of Dreyfus scale-based feedback helped instructors to create a good class climate in the cluster part of the clinical interviewing and PE skills course. Simultaneously, this new intervention achieved the goal of promoting medical students’ readiness for interviewing, PE, and self-directed learning.

Perceptions of team-based learning using the Team-Based Learning Student Assessment Instrument: an exploratory analysis amongst pharmacy and biomedical students in the United Kingdom: Prabha Parthasarathy, Bugewa Apampa, Andrea Manfrin; J Educ Eval Health Prof. 2019;16:23. Published online August 21, 2019; DOI: https://doi.org/10.3352/jeehp.2019.16.23

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Abstract PDF Supplementary Material

Purpose
This study aimed to evaluate students’ perception of team-based learning (TBL) amongst a cohort exposed to this methodology for the first time at a university in the United Kingdom.
Methods
Between November and December 2018, 26 first-year Master of Pharmacy and 90 second-year Biomedical Science students of the School of Life Sciences, University of Sussex, United Kingdom were invited to participate and requested to complete a questionnaire that contained quantitative and qualitative questions. The quantitative component was based on the Team-Based Learning Student Assessment Instrument (TBL-SAI). It additionally contained questions about key student characteristics.
Results
The response rate was 60% (70 of 116); of the participants, 74% (n=52) were females and 26% (n=18) males. The percentage of agreement in the TBL-SAI suggested a favourable response to TBL. The overall mean score for the TBL-SAI was 115.6 (standard deviation, 5.6; maximum score, 140), which was above the threshold of 102, thus suggesting a preference for TBL. Statistically significant differences were not found according to demographic characteristics. Students who predicted a final grade of ≥70% strongly agreed that TBL helped improve their grades. Some students highlighted issues with working in teams, and only 56% of students agreed that they could learn better in a team setting.
Conclusion
This study shows that students exposed to TBL for the first time favoured several aspects of TBL. However, more focused strategies including team-building activities and expert facilitation skills could potentially tackle resistance to working in teams.

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Aprendizaje basado en equipos como estrategia de trabajo en las aulas
Abraham Bernárdez-Gómez, María Luisa Belmonte-Almagro
Revista Brasileira de Educação.2026;[Epub] CrossRef
Validating the Turkish version of the team-based learning assessment scale: a psychometric evaluation
Sevim Şen Olgay, Şevval Çağan Kişin
BMC Medical Education.2025;[Epub] CrossRef
Introducing Group Open-Book Exams as a Learning and Assessment Strategy in the Clinical Biochemistry Course for Medical Students
Basmah Eldakhakhny, Aliaa A Alamoudi, Hoda Gad, Yousef Almoghrabi, Taghreed Shamrani, Hussam Daghistani, Abdulhadi Bima, Ghada Ajabnoor, Fayza Alfayez, Ayman Elsamanoudy
Cureus.2024;[Epub] CrossRef
The effect of repeated online Team-Based Learning on undergraduate nursing students: a quasi-experimental study
Valeria Vannini, Sara Alberti, Orietta Valentini, Paola Ferri
Teaching and Learning in Nursing.2024; 19(4): e610. CrossRef
Enhancing Learning, Classroom Engagement, and Attitude through Team-Based Learning among Vietnamese Nursing Students: A Quasi-Experimental Study
Lan Duong Thi Ngoc, Trang Dao Nguyen Dieu, An Le Van, Binh Ho Duy, Vu Pham Thi Thuy, Son Nguyen Truong, Phuc Dang Thi Thanh, Hoa Duong Duc, Anh Nguyen Ngoc Quynh
Pacific Rim International Journal of Nursing Research.2024; 28(4): 885. CrossRef
Team-Based Learning in oral pathology teaching: Analysis of students' perception and impact on academic performance
Lívia Gomes Véras Farias, Augusto César Leal da Silva Leonel, Danyel Elias da Cruz Pérez, Fábio Barbosa de Souza, Thayane Keyla de Souza Gomes, Elaine Judite de Amorim Carvalho
EDUCATION SCIENCES AND SOCIETY.2023; (2): 345. CrossRef
Service learning and the medical student affective domain
Deborah Bartz, Andrea Pelletier, Erik K. Alexander, Nora Y. Osman, Natasha R. Johnson
The Clinical Teacher.2022; 19(3): 247. CrossRef
Applying team-based learning in a transnational post registration bachelor of nursing program in Singapore
Rob Burton, Thea van de Mortel, Victoria Kain
BMC Nursing.2021;[Epub] CrossRef
Integrating Team-Based Learning Modules to Improve Civil Engineering Students’ Technical Writing Skills
Shenghua Wu, Shenghua Zha, Sue Mattson
Journal of Civil Engineering Education.2020;[Epub] CrossRef
A conceptual model for students’ satisfaction with team-based learning using partial least squares structural equation modelling in a faculty of life sciences, in the United Kingdom
Andrea Manfrin, Bugewa Apampa, Prabha Parthasarathy
Journal of Educational Evaluation for Health Professions.2019; 16: 36. CrossRef

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