Journal of Educational Evaluation for Health Professions

Research articles

Short-term knowledge gains and learner satisfaction after a basic radiology course for family medicine residents in a 3-dimensional virtual environment: a multi-cohort pretest–posttest study in Spain: Alberto Pino-Postigo, Rocio Lorenzo-Alvarez, Dolores Dominguez-Pinos, Eugenio Lázaro Navarro-Sanchis, Eduardo Ochando-Pulido, Miguel Jose-Ruiz Gomez, Francisco Sendra-Portero; J Educ Eval Health Prof. 2026;23:25. Published online August 7, 2026; DOI: https://doi.org/10.3352/jeehp.2026.23.25 [Epub ahead of print]

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Abstract PDF: Purpose
This study aimed to evaluate a structured basic radiology course for Family Medicine residents delivered in a 3-dimensional (3D) virtual environment (Second Life). We hypothesized that participation would be associated with higher post-course knowledge test scores and high learner satisfaction.
Methods
A quasi-experimental multi-cohort pretest–posttest study was conducted across 3 consecutive cohorts of Family Medicine residents in Spain in 2019. Ninety-six participants engaged in a 15-day course combining synchronous and asynchronous activities. Sixty-five participants provided paired pre- and post-intervention knowledge assessments, which were analyzed using paired t-tests. Learner satisfaction was evaluated using a structured questionnaire with Likert-scale items, numerical ratings (0–10), and open-ended responses. Pre- and post-test scores and ratings were compared using paired t-tests, and Mann-Whitney U tests were used for Likert-scale data. Qualitative data from open-ended responses were analyzed using thematic coding.
Results
Participants had significantly higher post-course knowledge test scores, increasing from 47.4±11.6 to 58.2±11.9 (mean difference, 10.8; P<0.001; paired-sample Cohen’s d [dz]=0.67). High agreement was observed across most satisfaction items, with median scores ranging from 4 to 5. Content relevance, usefulness for clinical practice, and instructor performance received the highest ratings. Lower scores were observed for peer interaction and platform usability.
Conclusion
A structured radiology course delivered in a 3D virtual environment was associated with higher immediate post-course knowledge test scores and high learner satisfaction among Family Medicine residents. The findings support the feasibility of repeated course delivery, although controlled studies are warranted.

Non-surgical residents’ experiences of relationships, identity, and burnout during residency in the United States: a qualitative study: Eileen Reed, Kimberly Montez, Leila Hamzi DeWitt, Chad David McCalla, Andrea Triplett, Shannon Hanson, Erealda Prendaj, Elizabeth Halvorson; J Educ Eval Health Prof. 2026;23:17. Published online June 16, 2026; DOI: https://doi.org/10.3352/jeehp.2026.23.17 [Epub ahead of print]

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Abstract PDF: Purpose
This study explored non-surgical residents’ and their domestic partners’ perceptions of how residency affected their lives and relationships through semi-structured interviews.
Methods
This qualitative study consisted of 10 semi-structured interviews with non-surgical residents at a single institution and 3 interviews with domestic partners. Residents from Child Neurology, Family Medicine, Internal Medicine, and Psychiatry were represented. The interviews were recorded, transcribed, and collaboratively coded using Atlas.ti ver. 22.0. Themes were identified using team-based thematic analysis.
Results
Analysis of the interviews yielded 4 themes: (1) residency training results in noticeable changes in personality traits; (2) residency affects life beyond the workplace; (3) residents and their domestic partners employ strategies to support relationship success during residency; and (4) residency program interventions may support well-being.
Conclusion
This study found that residency training was perceived to affect residents, domestic partners, and their relationships in both beneficial and challenging ways. Residents’ domestic partners remain a valuable yet underutilized resource for learning more about the residency experience.

Review

Strategies for remediating clinical reasoning skill deficits in underperforming residents: a scoping review: Jovian Philip Swatan, Fithriyah Cholifatul Ummah, Cecilia Felicia Chandra, Nooreen Adnan; J Educ Eval Health Prof. 2026;23:3. Published online February 5, 2026; DOI: https://doi.org/10.3352/jeehp.2026.23.3

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Clinical reasoning is a core competency in medical practice; however, deficits in this domain among residents are often difficult to identify and remediate because of its cognitive complexity and the absence of standardized assessment approaches. This scoping review aimed to map and analyze existing evidence on strategies to remediate clinical reasoning skill deficits in underperforming medical residents. Using the Arksey and O’Malley framework as refined by Levac and his colleagues, and reported in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we systematically searched PubMed, Scopus, MEDLINE, Web of Science, SpringerLink, ProQuest, and EBSCOhost for studies published between 2000 and 2024. Definitions of clinical reasoning, underperformance, and remediation were adopted from prior literature. Twenty studies met the inclusion criteria, comprising original research and literature reviews in multiple medical specialties. Methods for identifying clinical reasoning deficits included written, oral, and performance-based assessments, as well as routine workplace-based evaluations. Remediation strategies ranged from structured institutional programs to individualized, case-specific interventions, with coaching, deliberate practice, guided reflection, and structured thinking frameworks frequently employed. Two studies reported positive outcomes following completion of remediation for clinical reasoning deficits. Key enablers included psychological safety, learner engagement, and accessible faculty support, whereas barriers included learner resistance, inadequate baseline knowledge, faculty skill limitations, and institutional resource constraints. Effective remediation requires early identification, comprehensive diagnostic assessment, and tailored, coaching-based interventions supported by institutional commitment. Nonetheless, substantial variability in definitions, remediation protocols, and evaluation methods highlights the need for greater standardization and further research across diverse contexts to inform evidence-based frameworks for clinical reasoning remediation.

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A scoping review of inquiry in medicine and nursing using Dewey’s perspective
Gustavo Valbuena, Bridget C. O’Brien, Marieke van der Schaaf, Kathleen Raskob, Patricia O’Sullivan
Advances in Health Sciences Education.2026;[Epub] CrossRef

Research article

Correlation between a motion analysis method and Global Operative Assessment of Laparoscopic Skills for assessing interns’ performance in a simulated peg transfer task in Jordan: a validation study: Esraa Saleh Abdelall, Shadi Mohammad Hamouri, Abdallah Fawaz Al Dwairi, Omar Mefleh Al- Araidah; J Educ Eval Health Prof. 2025;22:10. Published online March 6, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.10

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Abstract PDF Supplementary Material: Purpose
This study aims to validate the use of ProAnalyst (Xcitex Inc.), a software for professional motion analysts to assess the performance of surgical interns while performing the peg transfer task in a simulator box for safe practice in real minimally invasive surgery.
Methods
A correlation study was conducted in a multidisciplinary skills simulation lab at the Faculty of Medicine, Jordan University of Science and Technology from October 2019 to February 2020. Forty-one interns (i.e., novices and intermediates) were recruited and an expert surgeon participated as a reference benchmark. Videos of participants’ performance were analyzed through the ProAnalyst and Global Operative Assessment of Laparoscopic Skills (GOALS). Two results were s analyzed for correlation.
Results
The motion analysis scores by Proanalyst were correlated with those by GOALS for novices (r=–0.62925, P=0.009), and Intermediates (r= –0.53422, P=0.033). Both assessment methods differentiated the participants’ performance based on their experience level.
Conclusion
The motion analysis scoring method with Proanalyst provides an objective, time-efficient, and reproducible assessment of interns’ performance, and comparable to GOALS. It may require initial training and set-up; however, it eliminates the need for expert surgeon judgment.

Technical report

Increased accessibility of computer-based testing for residency application to a hospital in Brazil with item characteristics comparable to paper-based testing: a psychometric study: Marcos Carvalho Borges, Luciane Loures Santos, Paulo Henrique Manso, Elaine Christine Dantas Moisés, Pedro Soler Coltro, Priscilla Costa Fonseca, Paulo Roberto Alves Gentil, Rodrigo de Carvalho Santana, Lucas Faria Rodrigues, Benedito Carlos Maciel, Hilton Marcos Alves Ricz; J Educ Eval Health Prof. 2024;21:32. Published online November 11, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.32

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Purpose
With the coronavirus disease 2019 pandemic, online high-stakes exams have become a viable alternative. This study evaluated the feasibility of computer-based testing (CBT) for medical residency applications in Brazil and its impacts on item quality and applicants’ access compared to paper-based testing.
Methods
In 2020, an online CBT was conducted in a Ribeirao Preto Clinical Hospital in Brazil. In total, 120 multiple-choice question items were constructed. Two years later, the exam was performed as paper-based testing. Item construction processes were similar for both exams. Difficulty and discrimination indexes, point-biserial coefficient, difficulty, discrimination, guessing parameters, and Cronbach’s α coefficient were measured based on the item response and classical test theories. Internet stability for applicants was monitored.
Results
In 2020, 4,846 individuals (57.1% female, mean age of 26.64±3.37 years) applied to the residency program, versus 2,196 individuals (55.2% female, mean age of 26.47±3.20 years) in 2022. For CBT, there was an increase of 2,650 applicants (120.7%), albeit with significant differences in demographic characteristics. There was a significant increase in applicants from more distant and lower-income Brazilian regions, such as the North (5.6% vs. 2.7%) and Northeast (16.9% vs. 9.0%). No significant differences were found in difficulty and discrimination indexes, point-biserial coefficients, and Cronbach’s α coefficients between the 2 exams.
Conclusion
Online CBT with multiple-choice questions was a viable format for a residency application exam, improving accessibility without compromising exam integrity and quality.

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Chatbot Underperformance in Biology and Image-Based Questions in Medical Education
Joyce Santana Rizzi, Lorraine Silva Requena, Angelica Maria Bicudo, Pedro Tadao Hamamoto Filho, Renato Ferretti
Journal of CME.2025;[Epub] CrossRef

Research articles

Reliability of a workplace-based assessment for the United States general surgical trainees’ intraoperative performance using multivariate generalizability theory: a psychometric study: Ting Sun, Stella Yun Kim, Brigitte Kristin Smith, Yoon Soo Park; J Educ Eval Health Prof. 2024;21:26. Published online September 24, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.26

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Purpose
The System for Improving and Measuring Procedure Learning (SIMPL), a smartphone-based operative assessment application, was developed to assess the intraoperative performance of surgical residents. This study aims to examine the reliability of the SIMPL assessment and determine the optimal number of procedures for a reliable assessment.
Methods
In this retrospective observational study, we analyzed data collected between 2015 and 2023 from 4,616 residents across 94 General Surgery Residency programs in the United States that utilized the SIMPL smartphone application. We employed multivariate generalizability theory and initially conducted generalizability studies to estimate the variance components associated with procedures. We then performed decision studies to estimate the reliability coefficient and the minimum number of procedures required for a reproducible assessment.
Results
We estimated that the reliability of the assessment of surgical trainees’ intraoperative autonomy and performance using SIMPL exceeded 0.70. Additionally, the optimal number of procedures required for a reproducible assessment was 10, 17, 15, and 17 for postgraduate year (PGY) 2, PGY 3, PGY 4, and PGY 5, respectively. Notably, the study highlighted that the assessment of residents in their senior years necessitated a larger number of procedures compared to those in their junior years.
Conclusion
The study demonstrated that the SIMPL assessment is reliably effective for evaluating the intraoperative performance of surgical trainees. Adjusting the number of procedures based on the trainees’ training stage enhances the assessment process’s accuracy and effectiveness.

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Standards for reporting quantitative research in health professions education: a synthesis of recommendations
Yoon Soo Park, Jonathan M Amiel, Gustavo A Patino, Laura Weiss Roberts, Colin P West
Academic Medicine.2026; 101(8): 959. CrossRef
General Surgery Residents Competence and Autonomy in Core Vascular Surgery Procedures
Taylor M. Carter, M. Libby Weaver, Ting Sun, Brigitte Smith
Journal of Surgical Education.2025; 82(3): 103415. CrossRef

Development and validity evidence for the resident-led large group teaching assessment instrument in the United States: a methodological study: Ariel Shana Frey-Vogel, Kristina Dzara, Kimberly Anne Gifford, Yoon Soo Park, Justin Berk, Allison Heinly, Darcy Wolcott, Daniel Adam Hall, Shannon Elliott Scott-Vernaglia, Katherine Anne Sparger, Erica Ye-pyng Chung; J Educ Eval Health Prof. 2024;21:3. Published online February 23, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.3

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Abstract PDF Supplementary Material

Purpose
Despite educational mandates to assess resident teaching competence, limited instruments with validity evidence exist for this purpose. Existing instruments do not allow faculty to assess resident-led teaching in a large group format or whether teaching was interactive. This study gathers validity evidence on the use of the Resident-led Large Group Teaching Assessment Instrument (Relate), an instrument used by faculty to assess resident teaching competency. Relate comprises 23 behaviors divided into 6 elements: learning environment, goals and objectives, content of talk, promotion of understanding and retention, session management, and closure.
Methods
Messick’s unified validity framework was used for this study. Investigators used video recordings of resident-led teaching from 3 pediatric residency programs to develop Relate and a rater guidebook. Faculty were trained on instrument use through frame-of-reference training. Resident teaching at all sites was video-recorded during 2018–2019. Two trained faculty raters assessed each video. Descriptive statistics on performance were obtained. Validity evidence sources include: rater training effect (response process), reliability and variability (internal structure), and impact on Milestones assessment (relations to other variables).
Results
Forty-eight videos, from 16 residents, were analyzed. Rater training improved inter-rater reliability from 0.04 to 0.64. The Φ-coefficient reliability was 0.50. There was a significant correlation between overall Relate performance and the pediatric teaching Milestone (r=0.34, P=0.019).
Conclusion
Relate provides validity evidence with sufficient reliability to measure resident-led large-group teaching competence.

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The effect of simulation training on midwifery students’ skills, satisfaction with learning, anxiety, and self-efficacy in neonatal heel prick blood collection
Seval Cambaz Ulaş, Seçil Köken Durgun, Yonca Çi̇çek Okuyan
BMC Medical Education.2025;[Epub] CrossRef

Medical residents and attending physicians’ perceptions of feedback and teaching in the United States: a qualitative study: Madeleine Matthiesen, Michael S. Kelly, Kristina Dzara, Arabella Simpkin Begin; J Educ Eval Health Prof. 2022;19:9. Published online April 26, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.9

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Purpose
Residents and attendings agree on the importance of feedback to resident education. However, while faculty report providing frequent feedback, residents often do not perceive receiving it, particularly in the context of teaching. Given the nuanced differences between feedback and teaching, we aimed to explore resident and attending perceptions of feedback and teaching in the clinical setting.
Methods
We conducted a qualitative study of internal medicine residents and attendings from December 2018 through March 2019 at the Massachusetts General Hospital to investigate perceptions of feedback in the inpatient clinical setting. Residents and faculty were recruited to participate in focus groups. Data were analyzed using thematic analysis to explore perspectives and barriers to feedback provision and identification.
Results
Five focus groups included 33 total participants in 3 attending (n=20) and 2 resident (n=13) groups. Thematic analysis of focus group transcripts identified 7 themes which organized into 3 thematic categories: (1) disentangling feedback and teaching, (2) delivering high-quality feedback, and (3) experiencing feedback in the group setting. Residents and attendings highlighted important themes in discriminating feedback from teaching. They indicated that while feedback is reactive in response to an action or behavior, teaching is proactive and oriented toward future endeavors.
Conclusion
Confusion between the critical concepts of teaching and feedback may be minimized by allowing them to each have their intended impact, either in response to prior events or aimed toward those yet to take place.

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Training Radiology Residents in Teaching Skills: Using the Kern Curriculum Model to Develop a Pilot, Residents-as-Teachers Curriculum
Caroline R Paul, Jeffrey Alpert, Alexander El-Ali, Monica Sheth, Jeffrey Wilhite, Nancy Fefferman
Cureus.2026;[Epub] CrossRef
Evaluating Verbal Feedback in Medical Education: Utilization of a Feedback Model to Develop a Standardized Rubric for Evaluation
Madeline F. E. Parr, Pratichi Goenka, Shahidul Islam, Alice Fornari, Adrita Khan
Journal of Evaluation in Clinical Practice.2026;[Epub] CrossRef
Resident Assessment of Clinician Educators According to Core ACGME Competencies
Bailey A. Pope, Patricia A. Carney, Mary C. Brooks, Doug R. Rice, Ashly A. Albright, Stephanie A. C. Halvorson
Journal of General Internal Medicine.2024; 39(3): 377. CrossRef
Radiologist preferences for faculty development initiatives to improve resident feedback in the era of competency-based medical education
Laura Wong, Ethan Sacoransky, Wilma Hopman, Omar Islam, Andrew D. Chung, Benjamin Y. M. Kwan
Medical Education Online.2024;[Epub] CrossRef
Through the Looking Glass: Comparing Hospitalists' and Internal Medicine Residents' Perceptions of Feedback
Andrew V Raikhel, Helene Starks, Gabrielle Berger, Jeffrey Redinger
Cureus.2024;[Epub] CrossRef

Trainees’ perceptions and expectations of formal academic mentoring during the COVID-19 pandemic in Indonesian cardiology residency programs: Sunu Budhi Raharjo, Rita Mustika, Aida Lydia, Mefri Yanni, Heru Sulastomo, Rahma Tsania Zhuhra, Celly Anantaria Atmadikoesoemah; J Educ Eval Health Prof. 2021;18:19. Published online August 9, 2021; DOI: https://doi.org/10.3352/jeehp.2021.18.19

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Purpose
During medical residency programs, physicians develop their professional identities as specialists and encounter high expectations in terms of achieving competencies. The responsibilities of medical trainees include caring for patients, balancing work with personal life, and weathering stress, depression, and burnout. Formal academic mentoring programs strive to ease these burdens. The coronavirus disease 2019 (COVID-19) pandemic has altered the trainee–academic mentor relationship, and solutions are needed to address these challenges. The present study aimed to evaluate the formal academic mentoring process through trainees’ perceptions and expectations of formal mentoring programs during COVID-19 in Indonesian cardiology residency programs.
Methods
This cross-sectional study used a self-administered online questionnaire to capture trainees’ perceptions and expectations regarding academic mentoring programs in 3 cardiology residency programs in Indonesia from October to November 2020. The questionnaire was developed before data collection. Perceptions of the existing mentoring programs were compared with expectations.
Results
Responses were gathered from 169 out of 174 residents (response rate, 97.3%). Most trainees reported having direct contact with COVID-19 patients (88.82%). They stated that changes had taken place in the mode and frequency of communication with their academic advisors during the pandemic. Significant differences were found between trainees’ perceptions of the existing mentoring programs and their expectations for academic mentoring programs (P<0.001).
Conclusion
Despite the challenges of interacting with their academic mentors, trainees still perceived academic mentors as a vital resource. Study programs need to consider trainees’ expectations when designing academic mentoring programs.

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A scoping review of mentorship in Graduate Medical Education: a proposed conceptual framework
Dima Abdelmannan, Rasha Buhumaid, Hira Salman, Wail A. Abdulrahman Hasan Ba Madhaf, Hafidh Mohammad Khamis AlRajaby, Nabil Zary, Shaista Salman Guraya
Frontiers in Medicine.2025;[Epub] CrossRef
Cardiovascular Care and Research in the Asia-Pacific Region during the COVID-19 Pandemic: Insights from Early and Mid-career Physicians
Mitsuaki Sawano, Misato Chimura, Jonathan Yap, Derek Pok Him Lee, Mayank Dalakoti, Lucky Cuenza, F Aaysha Cader, Satoshi Honda, Atsushi Mizuno
Journal of Asian Pacific Society of Cardiology.2024;[Epub] CrossRef
A systematic scoping review of mentoring support on professional identity formation
Lalit Kumar Radha Krishna, Hannah Yi Fang Kwok, Nila Ravindran, Xuan Yu Tan, Jasper Soh, Darius Wei Jun Wan, Varsha Rajalingam, Jun Kiat Lua, Elizabeth Yong Mei Leong, Tiat Yan Low, Aiden Wei-Jun Chan, Chong Jin Nicholas Lim, Yen Kit Ng, Arthena Anushka T
BMC Medical Education.2024;[Epub] CrossRef
Impact of the COVID-19 pandemic on career intention amongst undergraduate medical students: a single-centre cross-sectional study conducted in Hubei Province
Xue-lin Wang, Ming-xiu Liu, Shuai Peng, Lei Yang, Chen Lu, Shi-cong Shou, Jian-ru Wang, Jun-yi Sun, Jia-qi Wang, Yan Hu, Jun Zhao, Peng Duan
BMC Medical Education.2022;[Epub] CrossRef

Changes in the working conditions and learning environment of medical residents after the enactment of the Medical Resident Act in Korea in 2015: a national 4-year longitudinal study: Sangho Sohn, Yeonjoo Seo, Yunsik Jeong, Seungwoo Lee, Jeesun Lee, Kyung Ju Lee; J Educ Eval Health Prof. 2021;18:7. Published online April 20, 2021; DOI: https://doi.org/10.3352/jeehp.2021.18.7

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Purpose
In 2015, the South Korean government legislated the Act for the Improvement of Training Conditions and Status of Medical Residents (Medical Resident Act). This study investigated changes in the working and learning environment pre- and post-implementation of the Medical Resident Act in 2017, as well as changes in training conditions by year post-implementation.
Methods
An annual cross-sectional voluntary survey was conducted by the Korean Intern Resident Association (KIRA) between 2016 and 2019. The learning and working environment, including extended shift length, rest time, learning goals, and job satisfaction, were compared by institution type, training year, and specialty.
Results
Of the 55,727 enrollees in the KIRA, 15,029 trainees took the survey, and the number of survey participants increased year by year (from 2,984 in 2016 to 4,700 in 2019). Overall working hours tended to decrease; however, interns worked the most (114 hours in 2016, 88 hours in 2019; P<0.001). Having 10 hours or more of break time has gradually become more common (P<0.001). Lunch breaks per week decreased from 5 in 2017 to 4 in 2019 (P<0.001). Trainees’ sense of educational deprivation due to physician assistants increased from 17.5% in 2016 to 25.6% in 2018 (P<0.001). Awareness of tasks and program/work achievement goals increased from 29.2% in 2016 to 58.3% in 2018 (P<0.001). Satisfaction with the learning environment increased over time, whereas satisfaction with working conditions varied.
Conclusion
The Medical Resident Act has brought promising changes to the training of medical residents in Korea, as well as their satisfaction with the training environment.

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Strategies to Promote Psychological Safety in Residency Training in Asian Countries with High Power Distance Cultures: A Scoping Review
Dewi Anggraeni Kusumoningrum, Neera R. Jain, Craig S. Webster
Teaching and Learning in Medicine.2026; : 1. CrossRef
Impact of Residents’ Mass Resignation in Cardiovascular Surgery: A System Sustainability Perspective
June Yeop Lee, Hyoung Woo Chang, Sang Yoon Kim, Joon Chul Jung, Jae Hang Lee, Sanghon Park, Jun Sung Kim, Kay-Hyun Park
Interdisciplinary CardioVascular and Thoracic Surgery.2026;[Epub] CrossRef
Impact of mass resident physician resignation on inpatient mortality and admissions in Korea
Joon Young Choi, Hyonsoo Joo, Ju Sang Kim, Eung Gu Lee, Hyeong Jun Cho, Yeonhee Park, Chang Dong Yeo, Soon Kyu Lee, Donghoon Kang, Sang Hun Eum, Kwan Yong Lee, Tai Joon An
Public Health.2026; 254: 106225. CrossRef
The global surgical workforce crisis: narrative review of the role of surgical educator development and technological innovations
Tomohito Saito, Yuka Yamaoka, Moemu Shirai, Shiho Hattori, Aki K. Kobayashi, Takahiro Utsumi, Natsumi Maru, Hiroshi Matsui, Yohei Taniguchi, Tomohiro Murakawa
Surgery Today.2026;[Epub] CrossRef
When is “convenient time” for residents?: a trial of Resident Study Log as asynchronous learning tool for residents
Tadayuki Hashimoto, Shoko Ariyoshi, Taira Ariyoshi, Ryosuke Horitani, Mohammad Adrian Hasdianda, Kanapa Kornsawad, Shunsuke Kosugi, Makoto Kikukawa, Tomio Suzuki
Medical Education Online.2025;[Epub] CrossRef
Educational environment changes toward resident duty hour restrictions in Japan
Kazuya Nagasaki, Yuji Nishizaki, Taro Shimizu, Yu Yamamoto, Kiyoshi Shikino, Koshi Kataoka, Hiroyuki Kobayashi, Yasuharu Tokuda
Scientific Reports.2025;[Epub] CrossRef
Medical Students' Views on Physician Working Hour Regulations in Japan—A Cross‐Sectional Study
Hirohisa Fujikawa, Junji Haruta
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Supervising physicians’ perceptions on physician work-hour regulations in Japan: a nationwide cross-sectional study
Hirohisa Fujikawa, Hidetaka Tamune, Yuji Nishizaki, Kiyoshi Shikino, Taro Shimizu, Yu Yamamoto, Miwa Sekine, Kazuya Nagasaki, Hiroyuki Kobayashi, Yasuharu Tokuda
BMC Medical Education.2025;[Epub] CrossRef
Why Did All the Residents Resign? Key Takeaways From the Junior Physicians’ Mass Walkout in South Korea
Jinwook Park, Chang Ho Shin, Joo-Young Lee
Journal of Graduate Medical Education.2024; 16(4): 402. CrossRef
Laypeople's Perspective on Physician Work-Hour Restrictions in Japan: A Cross-Sectional Study
Hirohisa Fujikawa, Junji Haruta
Journal of Patient Experience.2024;[Epub] CrossRef
Developing and Establishing a Wound Dressing Team: Experience and Recommendations
Sik Namgoong, Seunghee Baik, Seung-Kyu Han, Ji-Won Son, Jae-Yeon Kim
Journal of Korean Medical Science.2023;[Epub] CrossRef
The effects of resident work hours on well‐being, performance, and education: A review from a Japanese perspective
Kazuya Nagasaki, Hiroyuki Kobayashi
Journal of General and Family Medicine.2023; 24(6): 323. CrossRef
Developing prompts from large language model for extracting clinical information from pathology and ultrasound reports in breast cancer
Hyeon Seok Choi, Jun Yeong Song, Kyung Hwan Shin, Ji Hyun Chang, Bum-Sup Jang
Radiation Oncology Journal.2023; 41(3): 209. CrossRef
Shortening shift’s length—Should we ask the residents if this is what they want?
Yehuda Hershkovitz, Adi Rasco, Orna Tal, David C. Mohr
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The Number of Monthly Night Shift Days and Depression Were Associated with an Increased Risk of Excessive Daytime Sleepiness in Emergency Physicians in South Korea
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Training in statistical analysis reduces the framing effect among medical students and residents in Argentina: Raúl Alfredo Borracci, Eduardo Benigno Arribalzaga, Jorge Thierer; J Educ Eval Health Prof. 2020;17:25. Published online September 1, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.25

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Purpose
The framing effect refers to a phenomenon wherein, when the same problem is presented using different representations of information, people make significant changes in their decisions. This study aimed to explore whether the framing effect could be reduced in medical students and residents by teaching them the statistical concepts of effect size, probability, and sampling for use in the medical decision-making process.
Methods
Ninety-five second-year medical students and 100 second-year medical residents of Austral University and Buenos Aires University, Argentina were invited to participate in the study between March and June 2017. A questionnaire was developed to assess the different types of framing effects in medical situations. After an initial administration of the survey, students and residents were taught statistical concepts including effect size, probability, and sampling during 2 individual independent official biostatistics courses. After these interventions, the same questionnaire was randomly administered again, and pre- and post-intervention outcomes were compared among students and residents.
Results
Almost every type of framing effect was reproduced either in the students or in the residents. After teaching medical students and residents the analytical process behind statistical concepts, a significant reduction in sample-size, risky-choice, pseudo-certainty, number-size, attribute, goal, and probabilistic formulation framing effects was observed.
Conclusion
The decision-making of medical students and residents in simulated medical situations may be affected by different frame descriptions, and these framing effects can be partially reduced by training individuals in probability analysis and statistical sampling methods.

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Conceptualizing surgical ageism to address age-based discrimination
Alessandro Cucchetti, Giammauro Berardi, Giuseppe Maria Ettorre, Giorgio Ercolani
Updates in Surgery.2025;[Epub] CrossRef
Numeracy Education for Health Care Providers: A Scoping Review
Casey Goldstein, Nicole Woods, Rebecca MacKinnon, Rouhi Fazelzad, Bhajan Gill, Meredith Elana Giuliani, Tina Papadakos, Qinge Wei, Janet Papadakos
Journal of Continuing Education in the Health Professions.2024; 44(1): 35. CrossRef

Can incoming United States pediatric interns be entrusted with the essential communication skills of informed consent?: Nicholas Sevey, Michelle Barratt, Emma Omoruyi; J Educ Eval Health Prof. 2020;17:18. Published online June 29, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.18

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Purpose
According to the entrustable professional activities (EPA) for entering residency by the Association of American Medical Colleges, incoming residents are expected to independently obtain informed consent for procedures they are likely to perform. This requires residents to not only inform their patients but to ensure comprehension of that information. We assessed the communication skills demonstrated by 372 incoming pediatric interns between 2007 and 2018 at the University of Texas Health Science Center at Houston, obtaining informed consent for a lumbar puncture.
Methods
During a simulated case in which interns were tasked with obtaining informed consent for a lumbar puncture, a standardized patient evaluated interns by rating 7 communication-based survey items using 5-point Likert scale from “poor” to “excellent.” We then converted the scale to a numerical system and calculated intern proficiency scores (sum of ratings for each resident) and average item performance (average item rating across all interns).
Results
Interns received an average rating of 21.6 per 28 maximum score, of which 227 interns (61.0%) achieved proficiency by scoring 21 or better. Notable differences were observed when comparing groups before and after EPA implementation (76.97% vs. 47.0% proficient, respectively). Item-level analysis showed that interns struggled most to conduct the encounter in a warm and friendly manner and encourage patients to ask questions (average ratings of 2.97/4 and 2.98/4, respectively). Interns excelled at treating the patient with respect and actively listening to questions (average ratings of 3.16, each). Both average intern proficiency scores and each average item ratings were significantly lower following EPA implementation (P<0.001).
Conclusion
Interns demonstrated moderate proficiency in communicating informed consent, though clear opportunities for improvement exist such as demonstrating warmth and encouraging questions.

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Evaluating large language models for simplifying non-English medical consent with clinician involvement
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Use of graded responsibility and common entrustment considerations among United States emergency medicine residency programs: Jason Lai, Benjamin Holden Schnapp, David Simon Tillman, Mary Westergaard, Jamie Hess, Aaron Kraut; J Educ Eval Health Prof. 2020;17:11. Published online April 20, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.11

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Purpose
The Accreditation Council for Graduate Medical Education (ACGME) requires all residency programs to provide increasing autonomy as residents progress through training, known as graded responsibility. However, there is little guidance on how to implement graded responsibility in practice and a paucity of literature on how it is currently implemented in emergency medicine (EM). We sought to determine how EM residency programs apply graded responsibility across a variety of activities and to identify which considerations are important in affording additional responsibilities to trainees.
Methods
We conducted a cross-sectional study of EM residency programs using a 23-question survey that was distributed by email to 162 ACGME-accredited EM program directors. Seven different domains of practice were queried.
Results
We received 91 responses (56.2% response rate) to the survey. Among all domains of practice except for managing critically ill medical patients, the use of graded responsibility exceeded 50% of surveyed programs. When graded responsibility was applied, post-graduate year (PGY) level was ranked an “extremely important” or “very important” consideration between 80.9% and 100.0% of the time.
Conclusion
The majority of EM residency programs are implementing graded responsibility within most domains of practice. When decisions are made surrounding graded responsibility, programs still rely heavily on the time-based model of PGY level to determine advancement.

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Effects of virtual reality training on decreasing the rates of needlestick or sharp injury in new-coming medical and nursing interns in Taiwan: Szu-Hsien Wu, Chia-Chang Huang, Shiau-Shian Huang, Ying-Ying Yang, Chih-Wei Liu, Boaz Shulruf, Chen-Huan Chen; J Educ Eval Health Prof. 2020;17:1. Published online January 20, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.1

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Abstract PDF Supplementary Material

Purpose
Senior nursing and medical interns’ lack of familiarity and confidence with respect to practicing universal precaution for the prevention of occupational needlestick or sharp injuries may harm themselves. Trainees’ self-reported needlestick or sharp injury rate was known to be especially high during the first 2 months of internship in Taiwan. This prospective cohort study aimed to assess the effect of newly developed virtual reality (VR) game, which uses Gagne’s learning model to improve universal precaution for needlestick or sharp injury prevention and decrease the rates of needle stick or sharp injuries in new-coming medical and nursing interns in Taiwan.
Methods
From 2017 to 2019, the VR system was developed and applied in training of 59 new-coming nursing and 50 medical interns. Occupational needlestick or sharp injury prevention was sought to be achieved through a game of right and wrong choices for safe or unsafe universal precaution behaviors.
Results
In comparison with medical interns, a higher proportion of nursing interns had past experiences of deep occupational needlestick or sharp injury. Before VR training, the familiarity and confidence for needlestick or sharp injury prevention were higher among nursing interns than medical interns. Trainees with past experiences of deep needlestick or sharp injury exhibited better performance on the accuracy rate and time needed to complete 20 decisions than those without past experiences in VR practice. All trainees showed an improved performance after VR training. A high proportion of trainees reported that the VR-based training significantly decreased their anxiety about needlestick or sharp injury prevention.
Conclusion
This self-developed VR game system using Gagne’s flow improved universal precaution for needlestick or sharp injury prevention and reduced the needlestick or sharp injury rates in the first 2 months of nursing and medical internship.

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Ophthalmology training and competency levels in caring for patients with ophthalmic complaints among United States internal medicine, emergency medicine, and family medicine residents: Christopher Daniel Gelston, Jennifer Landrigan Patnaik; J Educ Eval Health Prof. 2019;16:25. Published online August 29, 2019; DOI: https://doi.org/10.3352/jeehp.2019.16.25

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Abstract PDF Supplementary Material

Purpose
To evaluate ophthalmic educational training and confidence in caring for patients with ophthalmic complaints among internal, emergency, and family medicine residents in the United States.
Methods
A 41-item cross-sectional survey was sent to the directors of 529 internal medicine, 237 emergency medicine, and 629 family medicine residency programs, who distributed it to residents in those programs. The survey included the number of ophthalmic education hours residents received. Respondents were asked to rate their confidence in performing an ophthalmic exam and treating patients with ocular conditions using a 5-point Likert scale ranging from “not confident” to “very confident.”
Results
In total, 92.5% of internal medicine, 66.8% of emergency medicine, and 74.5% of family medicine residents received less than 10 hours of ophthalmic education during residency. Most respondents (internal medicine, 59.1%; emergency medicine, 76.0%; family medicine, 65.7%) reported that patients with ocular complaints constituted 1%–5% of visits. Mean±standard deviation confidence levels in performing an eye exam and treating patients with ophthalmic conditions were highest in emergency medicine residency programs (2.9±0.7), followed by family medicine (2.3±0.6) and internal medicine (2.2±0.6). A higher reported number of ophthalmic education hours in residency was associated with greater confidence among emergency (P<0.001), family (P<0.001), and internal (P=0.005) medicine residents.
Conclusion
Internal, emergency, and family medicine residents receive limited ophthalmic education, as reflected by their overall low confidence levels in performing an ophthalmic exam and treating patients with ocular complaints. An increase in ophthalmic educational hours during their residencies is recommended to improve upon this knowledge gap.

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Research Articles

Correlation of burnout syndrome with specific coping strategies, behaviors, and spiritual attitudes among interns at Yale University, New Haven, USA: Benjamin R. Doolittle, Donna M. Windish; J Educ Eval Health Prof. 2015;12:41. Published online August 1, 2015; DOI: https://doi.org/10.3352/jeehp.2015.12.41

32,648 View
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Abstract PDF

Purpose
This study aimed to determine the correlation of burnout syndrome with specific coping strategies, behaviors, and spiritual attitudes among interns in internal medicine, primary care, and internal medicine/pediatrics residency programs at two institutions. Methods: Intern physicians completed anonymous voluntary surveys prior to starting the internship in June 2009 and in the middle of the internship in February 2010. Three validated survey instruments were used to explore burnout, coping, and spiritual attitudes: the Maslach Burnout Inventory, the COPE Inventory, and the Hatch Spiritual Involvement and Beliefs Scale. The interns were in programs at the Yale University School of Medicine and a Yale-affiliated community hospital, New Haven, Connecticut, USA. Results: The prevalence of self-identified burnout prior to starting the internship was 1/66 (1.5%) in June 2009, increasing to 10/53 (18.9%) in February 2010 (P<0.0001). From June 2009 to February 2010, the prevalence of high emotional exhaustion increased from 30/66 (45.5%) to 45/53 (84.9%) (P<0.0001), and that of high depersonalization increased from 42/66 (63.6%) to 45/53 (84.9%) (P=0.01). Interns who employed the strategies of acceptance and active coping were less likely to experience emotional exhaustion and depersonalization (P<0.05). Perceptions of high personal accomplishment was 75.5% and was positively correlated with total scores on the Hatch Spiritual Involvement and Beliefs Scale, as well as the internal/fluid and existential/meditative domains of that instrument. Specific behaviors did not impact burnout. Conclusion: Burnout increased during the intern year. Acceptance, active coping, and spirituality were correlated with less burnout. Specific behaviors were not correlated with burnout domains.

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Evaluation of hospital-learning environment for pediatric residency in eastern region of Saudi Arabia: Waleed H. BuAli, Abdul Sattar Khan, Mohammad Hussain Al-Qahtani, Shaikha aldossary; J Educ Eval Health Prof. 2015;12:14. Published online April 18, 2015; DOI: https://doi.org/10.3352/jeehp.2015.12.14

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Abstract PDF

Purpose
No study had been conducted to assess the hospitals’ environment for learning purposes in multicenter sites in Saudi Arabia. It aims to evaluate the environment of hospitals for learning purposes of pediatric residents. Methods: We applied Postgraduate Hospital Educational Environment Measure (PHEEM) to measure the learning environment at six teaching hospitals in the Eastern Region of Saudi Arabia from September to December 2013. Results: The number of respondents was 104 (86.7%) out of 120 residents and 37 females and 67 male residents have responded. The residents’ response scored 100 out of 160 maximum score in rating of PHEEM that showed overall learning environment is favorable for training. There were some items in the social support domain suggesting improvements. There was no significant difference between male and female residents. There was a difference among the participant teaching hospitals (p<0.05). Conclusion: The result pointed an overall positive rating. Individual item scores suggested that their social life during residency could be uninspiring. They have the low satisfactory level and they feel racism, and sexual discrimination. Therefore, there is still a room for improvement.

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Plastic and Reconstructive Surgery - Global Open.2026; 14(5): e7763. CrossRef
Measuring Clinical Learning Environment Across Three Residency Programs Using a Postgraduate Hospital Educational Environment Measure (PHEEM) Scale at a Tertiary Care Hospital in the United Arab Emirates
Nouf AlBisher, Fayeza AlAmeri, Dolhyt Detera, Humariya Heena
Cureus.2025;[Epub] CrossRef
Examining the Psychometric Properties of Post-graduate Hospital Educational Environment Measure for Saudi Pediatric Trainees: Principal Component Analysis
Khouloud Abdulrhman Alsofyani, Saud Bahaidarah, Abdulaziz Boker
Iranian Journal of Pediatrics.2024;[Epub] CrossRef
Scoping review of the application of the Postgraduate Hospital Educational Environment Measure (PHEEM) in medical residency
Patrícia Lofêgo Gonçalves, Ana Paula Moscon Marçal, Renata de Almeida França, Vania dos Santos Nunes Nogueira
Revista Brasileira de Educação Médica.2024;[Epub] CrossRef
Revisão de escopo da aplicação do Postgraduate Hospital Educational Environment Measure (PHEEM) na residência médica
Patrícia Lofêgo Gonçalves, Ana Paula Moscon Marçal, Renata de Almeida França, Vania dos Santos Nunes Nogueira
Revista Brasileira de Educação Médica.2024;[Epub] CrossRef
Evaluating the educational environment among Saudi board dental residents at King Abdulaziz Medical City in Riyadh using PHEEM tool
Maram Ali M. Alwadi, Lama Ahmed Alosail, Deema Abdullah Alroweilly, Alanoud Musaad AlJubair, Arwa Ameen Talakey
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Academic Pediatrics.2023; 23(6): 1288. CrossRef
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Fatimah Saeed AlAhmari, Alaa Aloqail, Shahad Almansour, Mohammad Bagha
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Health-related quality of life and happiness within an internal medicine residency training program: a longitudinal follow-up study: Abhasnee Sobhonslidsuk, Ammarin Thakkinstian, Patchareeya Satitpornkul; J Educ Eval Health Prof. 2015;12:3. Published online February 24, 2015; DOI: https://doi.org/10.3352/jeehp.2015.12.3

34,661 View
171 Download
3 Web of Science
2 Crossref

Abstract PDF

Purpose
While undergoing a hospital residency training program, residents often suffer anxiety and stress. This study aims to evaluate the change in health-related quality of life and happiness among internal medicine residents, and identify prognostic factors. Methods: Thirty-eight residents in the Ramathibodi Hospital internal medicine training program completed the World Health Organization Quality of Life-BREF and happiness Measures questionnaires at three time points: commencement, day 100, and the end of the second year of training. Confidence, expectations, anxiety, and general health were rated. Analyses were performed with mixed linear regression. Results: Financial problems were reported for 16 residents (42.1%). At baseline, most residents had moderate-to-very high confidence, expectations, and general health but also moderate-to-very high anxiety. The health-related quality of life score was highest in the social domain followed by the environmental, psychological, and physical domains. Their psychological, physical, social, and environmental scores significantly decreased after enrollment. Their happiness and general health scores were significantly reduced after enrollment. The training program duration was negatively associated with all domains. Residents with greater confidence had higher health-related quality of life scores in the physical, psychological, and environmental domains. Moreover, their general health was positively associated with the social and environmental domains. Conclusion: A reduction in health-related quality of life and happiness under the internal medicine residency program is reported. High confidence and good physical health may counterbalance the decline in health-related quality of life and happiness.

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Specialty impact on residents’ perceived quality of life, stress, and job satisfaction: a comparative study
Bo Young Kim, Inah Yoon, Seong John Han, Suk-Kyung Hong, Sehoon Choi, Hyo-Jin Kwon, Eun Key Kim
Annals of Surgical Treatment and Research.2023; 105(4): 188. CrossRef
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Winnie S Chow, Jan Schmidtke, Adrian Loerbroks, Thomas Muth, Peter Angerer
International Journal of Environmental Research and Public Health.2018; 15(7): 1462. CrossRef

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