Open research questions in Innovations in Medical Education

What the literature leaves open

• Future research should explore the implementation of OBE across diverse linguistic and cultural contexts to enhance global applicability. Longitudinal and multisite studies are also recommended to assess the long-term impact of OBE implementation on learner Alias et al. Discover Education (2026) 5:119 Page 15 of 17 outcomes and institutional practices. Furthermore, the role of medical educators in driv- ing curriculum quality should be recognised and institutionalised. Policies that support continuing professional development, academic recognition, and tenure for educators involved in curriculum implementation may strengthen the sustainability of OBE ini- tiatives. Emphasis should also be placed on developing evidence-based monitoring and feedback systems aligned with institutional readiness and context-specific needs.

  Implementation of outcome (competency) based medical education: a scoping review of 30 years of evidence · 2026 · DOI

• To ensure long-term sustainability, future research should focus on evaluating implementation fidelity, incorporating educational theory into OBE frame- works, and generating evidence on actual learner outcomes. 8 Recommendations and take-home messages • National empirical research indicates an urgent need for further studies on the CQI monitoring framework across institutions.

  Implementation of outcome (competency) based medical education: a scoping review of 30 years of evidence · 2026 · DOI

• Future research should focus on developing the current study by developing, implementing and evaluating the proposed ESP course specification for students of medicine at TU.

  A Proposed ESP Course Specification for Students of Medicine at Taiz University · 2026 · DOI

• Based on empirical data and clinical teaching experience, this study proposes the following recommendations for implementing FA in PT courses with high practical demands: Design formative tasks aligned with students’ skill levels, and for complex tasks such as problem-oriented assessments, instructors should provide syllabi to balance evaluation complexity (14); strategically configure the frequency and weighting of assessments, advocating a “high-frequency, low-stakes” principle (47); integrate FA with psychological counseling or stress management programs by incorporating mental health support mechanisms to address systemic stressors (3); enhance professional training for instructors on FA (48); and conduct longitudinal studies to track long-term effects, evaluating the sustained impact of FA on clinical practice and professional development. These recommendations may serve as a reference for the application of FA in health science education. RZ: Data curation, Methodology, Formal analysis, Investigation, Writing – original draft. WW: Data curation, Investigation, Formal analysis, Writing – review & editing, Methodology. YH: Formal analysis, Methodology, Writing – review & editing. YL: Methodology, Investigation, Writing – review & editing, Formal analysis. YY: Writing – review & editing, Data curation, Investigation, Methodology, Formal analysis. MH: Data curation, Investigation, Writing – review & editing. AA: Writing – review & editing, Formal analysis, Data curation. JX: Data curation, Writing – review & editing, Investigation. RH: Investigation, Writing – review & editing, Data curation. JY: Formal analysis, Writing – review & editing, Data curation. KS: Data curation, Investigation, Writing – review & editing, Formal analysis. SJ: Formal analysis, Investigation, Writing – review & editing. TH: Investigation, Writing – review & editing, Data curation. ZG: Conceptualization, Methodology, Writing – review & editing, Investigation, Supervision. QL: Methodology, Investigation, Validation, Conceptualization, Writing – review & editing, Supervision.

  Longitudinal formative assessment reforms in manual therapy education: impacts on psychological wellbeing and course satisfaction · 2026 · DOI

• In the present study, the developmental process was limited to content validation, and other important psychometric properties, such as reliability, were not examined. The clinical applicability of the MNE tool was evaluated on a small sample, which may limit the generalizability of the findings. Additionally, data collection was performed by the primary researcher (A.K.), which could introduce observer bias. Future studies with a larger sample size and robust statistical methods are required to establish the reliability, validity (interrater reliability, or diagnostic accuracy), and clinical utility of the MNE tool. test–retest reliability, The exclusion of certain neurological examination com- ponents, such as tone, sensory assessment, and visual fields, may limit the ability of the MNE tool to localize neurological lesions. Further, the limited proportion of neurologists and neurosurgeons may have influenced the prioritization of certain examination components.

  Development and Content Validation of Mini Neurological Examination Tool for Rapid Assessment of Neurological Inpatients Using a Sequential Exploratory Design · 2026 · DOI

• Academic Value Unit (AVU) systems have emerged as frameworks to quantify these activities, but adoption remains limited due to inconsistent funding models, lack of standardized frameworks, and minimal evidence demonstrating outcomes such as faculty satisfaction, retention, or return on investment (ROI).

  Academic Value Units in Emergency Medicine: Current State and a Framework for Recognizing and Sustaining Academic Contributions · 2026 · DOI

• Digital technologies offer scalable, flexible alternatives, yet the extent, educational design, and strength of evidence supporting digital CST remain unclear.

  Use of Digital Technology for Developing Communication Skills in Undergraduate and Postgraduate Medical Education: Scoping Review · 2026 · DOI

• This study highlights that the practical implementation of PT-BET in real, exam-like situations is feasible. In addition, both subjective data and objective assessments were collected, which increased the validity of the results. Repeated measurements over several semesters allowed changes over time to be tracked. The standardized PT- BET and feedback structure also contributed to the reli- ability of the results and their transferability to other student groups. Despite the promising results, several limitations have to be considered. As the study did not include a control group within the same semester, this limits the ability to draw causal conclusions from the observed results. By its very nature, this design is susceptible to threats to internal validity, particularly maturation effects and regression to the mean. Therefore, it cannot therefore be determined whether the observed improvements are attributable to the PT-BET intervention, the regular course of the semester, the effects of repeated exposure, increased familiarity with physiological content, cohort effects, or post-pandemic normalization processes. How- ever, we did not consider it to be ethically justifiable to deprive students of the potential benefits of PT-BET. The measurement instruments were recorded subjectively, and the Likert scales (1–5 or 1–6) used only allowed for limited differentiation of subtle differences. Variations among tutors and group dynamics may have influenced performance assessments. However, this heterogeneity reflects authentic teaching conditions. The persistence of the observable effects despite this inherent variance therefore indicates a certain robustness and generaliz- ability of the intervention. The distribution of grades in the midterm exam and in the oral part of the M1 may also have been influenced by external factors such as varying exam requirements by different lecturers or variation between cohorts. In this context, comparisons of exams and grades across different M1 cohorts (2018, 2021, 2024, 2025) should be interpreted with caution, as these cohorts are not directly comparable. Potential confounding factors include differences in examiners, changes in the difficulty level of exams, cohort-specific performance differences, pandemic-related disruptions, and curriculum changes. Consequently, these compari- sons should be viewed as exploratory and descriptive and should not be interpreted as evidence of causal relation- ships. Importantly, the M1 examination outcomes rep- resent cohort-level data including both participants and non-participants of the PT-BET intervention. Finally, no demographic characteristics were recorded, and the results refer exclusively to the students’ cohort of Essen.

  M1ündlich – S(t)imulation of competency-oriented learning in physiology · 2026 · DOI

• Future studies could examine the extent to which the effects of PT-BET persist in the long term and how they affect different groups of students. Since PT-BET has only been used in the preclinical section of medical stud- ies so far, future research could examine the extent to which the format is also effective in later stages of study, for example with the background to effectively practice physician-patient communication. It would also be valu- able to compare the format with alternative teaching methods, such as exercises led by faculty members or lec- ture-based and exercise-oriented formats. In addition, it could be investigated which components are particularly decisive for reducing stress and building trust in order to optimize training programs in a targeted way.

  M1ündlich – S(t)imulation of competency-oriented learning in physiology · 2026 · DOI

• A strength of this qualitative study is the inclusion of for- mer participants from the pedagogical internship track across multiple starting groups since its introduction in 2018, providing a comprehensive representation of the program over time. Furthermore, the use of respondent validation strengthened the credibility of the findings, as participants confirmed the accuracy of the thematic interpretation. A potential limitation of this study is that several of the authors are involved in the pedagogical internship track, with preunderstandings and investment in its success, potentially influencing the results, reducing trustworthi- ness. However, to mitigate the potential bias our research team was deliberately set up to include both insider and outsider perspectives. The interviews were conducted Ramo et al. BMC Medical Education (2026) 26:910 by a peer to the respondents, himself a participant in the program, allowing access to shared tacit knowledge with the respondents. Two of the authors are program direc- tors, responsible for the design and management of the program, providing institutional knowledge to the analy- sis. Finally, the last author is a senior non-physician edu- cational researcher with no previous involvement in the program, allowing an outsider perspective and a position to challenge assumptions. We find the insider–outsider dynamic in the researcher team a strength for the validity of our results. Additional limitations include the focus on former participants only, excluding perspectives from current interns or other professional groups. Furthermore, as the interviews were conducted in Swedish and later trans- lated into English, some nuances in meaning may have been lost. While the qualitative approach enabled an in-depth and context-rich understanding, future stud- ies could expand on these findings by including mul- tiple institutions that have similar initiatives, other professional groups, or complementary quantitative approaches.

  Developing early-career clinical educators – a qualitative study of a pedagogical internship track for junior doctors in Sweden · 2026 · DOI

• For educators and institutions: 1. Develop discipline-specific assessment blueprints for pharmacology that map competencies NMC methods and cognitive levels. to assessment 2. Pilot WPBA tools (mini-CEX, DOPS, CbD) during clinical pharmacology rotations and practical sessions; collect validity and feasibility data. 3. Implement station-based OSPE/OSCE stations for prescription writing, ADR reporting, counseling with standardized checklists.

  Competency-Based Assessment in Pharmacology Education: Global Evidence and Indian Perspectives · 2026 · DOI

• to ensure assessments align with competencies, cognitive levels, and learning outcomes. A well-constructed blueprint maps competencies to assessment methods and weightings, helping reduce improving content sampling error and validity. Blueprinting enhances content validity by ensuring appropriate sampling across and competencies. Recent practical guidance and studies demonstrate blueprinting’s role in creating defensible theory and practical papers in medical and pharmacology education. Furthermore, assessment drives learning, and blueprinting ensures that what is assessed reflects what is intended to be learned. In pharmacology, typical blueprint domains include knowledge factual (pharmacokinetics/pharmacodynamics), selection, (drug reasoning therapeutic dosing), prescription writing, ADR recognition, and communication skills. Studies show that blueprinting increases the representativeness of and facilitates transparent score interpretation for stakeholders. assessments in in the direct enable WPBA clinical broader benefits (WPBA) discussion application Workplace-Based Assessment (WPBA) in Para-clinical Contexts WPBA tools—mini-CEX, DOPS, and case- (CbD)—are widely based and education reported increasingly advocated for CBME. These methods observation, formative feedback, and assessment of applied competencies. Foundational reviews describe and implementation principles, emphasizing faculty training and structured feedback. Additionally, the primary purpose of WPBA is to provide feedback to trainees to guide learning and improve performance.

  Competency-Based Assessment in Pharmacology Education: Global Evidence and Indian Perspectives · 2026 · DOI

• This scoping review used a pragmatic search strategy and did not attempt exhaustive systematic searching or formal quality appraisal. While it prioritized policy transferable documents, evidence, some relevant primary studies may have been missed. The rapid evolution of CBME and AI tools also means recent developments (post-February 2026) may not be fully captured. reviews, and assessment CONCLUSION Competency-based in pharmacology education is both necessary and achievable. A blended assessment approach—underpinned by clear blueprints, station-based assessments, WPBA adapted to para-clinical tasks, and strong faculty development—offers the best path to ensure graduates are competent prescribers and policy medication stewards. India’s International Journal of Science and Healthcare Research (www.ijshr.com) 102 Volume 11; Issue: 2; April-June 2026 Hitesh Mishra et al. Competency-based assessment in pharmacology education: global evidence and Indian perspectives frameworks create momentum; the next steps are discipline-specific implementation, validation studies, and capacity building.

  Competency-Based Assessment in Pharmacology Education: Global Evidence and Indian Perspectives · 2026 · DOI

• is lessons—especially WPBA within a programmatic framework could therefore enhance both validity and educational impact, moving assessment from episodic evaluation toward continuous learning. Indian policy momentum (NMC modules, CBME guidelines) provides an enabling environment, but translation into consistent practice requires clear, discipline-specific blueprints, validated assessment instruments for para-clinical tasks, and multicenter research to generate psychometric evidence.

  Competency-Based Assessment in Pharmacology Education: Global Evidence and Indian Perspectives · 2026 · DOI

• Empirical evidence: Recent Indian studies show variable but growing uptake of in CBME-aligned pharmacology. include blueprinting exercises for theory papers and small-scale WPBA pilots adapted to pharmacology practicals.

  Competency-Based Assessment in Pharmacology Education: Global Evidence and Indian Perspectives · 2026 · DOI

• with discrepancies). new orders to resolve • Case-Based Discussion (CbD): CbD offers a powerful method to probe a student's deeper cognitive processes and therapeutic reasoning. By discussing a documented case or clinical scenario, educators can assess the student's ability logically analyze patient factors, to apply pharmacological principles to select therapy, anticipate drug interactions, and justify their management decisions.

  Competency-Based Assessment in Pharmacology Education: Global Evidence and Indian Perspectives · 2026 · DOI

• lend abstract subjects para-clinical competencies bedside themselves that extend beyond undergraduate training. It also promotes a culture of accountability, where competence is demonstrated through performance rather than assumed based on time spent in training. In this way, CBME not only improves immediate educational outcomes but also contributes to the long- term goal of enhancing patient safety and quality of care. However, face practical constraints for workplace-based assessment (WPBA) and skills observation compared with clinical disciplines.[7] One of the most fundamental difficulties lies in into translating measurable and observable outcomes within a para-clinical discipline. Unlike clinical interactions subjects, where direct to naturally observation, pharmacology competencies— such as therapeutic reasoning, rational prescribing, and pharmacovigilance—are often cognitive and context-dependent. This makes it challenging to design assessment that are both authentic and strategies to leading many feasible, institutions continue traditional written relying on examinations despite CBME mandates. [8] A closely related challenge is the limited integration between pharmacology teaching and real clinical environments. CBME emphasizes workplace-based assessment and contextual learning, yet pharmacology is frequently taught in isolation during the early training.

  Competency-Based Assessment in Pharmacology Education: Global Evidence and Indian Perspectives · 2026 · DOI

• Our database scan only captured ES projects submitted for ethics and APQIP review. Informal ES projects occur often among staff and were not captured here. Furthermore, some formal ES work is assessed by University of Toronto ethics review boards, thereby bypassing WCH databases. Nevertheless, the submission Figure 3. Types of physician and trainee audiences in education scholarship submissions Physician and medical trainee audiences in Women’s College Hospital education scholarship (ES) submissions to the Research Ethics Board (REB) and Assessment Process for Quality Improvement Projects (APQIP) (IPHP = interprofessional healthcare providers) Figure 4. Method types in education scholarship projects Methods used in education scholarship (ES) submissions to the Women’s College Hospital Research Ethics Board (REB) and Assessment Process for Quality Improvement Projects (APQIP) Finally, submissions targeting healthcare providers and support staff primarily focused on general faculty/staff members (50%, 7/14), with 29% focusing specifically on nurses and 21% on other interprofessional providers.

  Mapping the landscape of education scholarship at Women’s College Hospital: Insights from ethics and quality improvement submissions · 2026 · DOI

• Several limitations warrant discussion. While attendance data did not show a statistically significant correlation with exam performance, this likely reflects incomplete measure- ment of true engagement. Deidentified total attendance for each session was tracked through QR code sign-ins at in- person and online sessions; This data is self-reported and may not reflect students’ use of asynchronous materials such as recordings, slides, and shared study guides. How- ever, follow-up attendance tracking conducted outside the formal study period—during a week in which access to course materials required attendance—demonstrated that 106 of 120 students accessed the SI slides. Although lim- ited to a single week and occurring outside the primary study window, these findings, when considered alongside subjective student polling, suggest that SI sessions were highly utilized across cohorts, regardless of session atten- dance. Future studies should quantify total NPT utilization rather than attendance alone to better assess exposure to materials and overall SI content engagement. Additionally, attendance data was collected inconsistently throughout our study period, resulting in weeks with no recorded data. This makes within cohort analysis of attendance effects on academic performance difficult. Future studies should investigate whether attendance of SI sessions would result in significant differences in assessment outcomes within a cohort. Second, inter-cohort comparisons risk confounding from differences in baseline academic preparedness or curricular evolution. However, review of institutional data revealed comparable incoming MCAT scores among the three stud- ied classes, suggesting similar academic aptitude. The reported average MCAT score for the classes of 2026, 2027, and 2028 is 513, unchanged from each class year, while the reported undergraduate science GPA for the classes of 2026, 2027, and 2028 are 3.80, 3.81, and 3.82 respectively. None- theless, unmeasured variables such as instructor variability or minor changes in assessment design may have influenced performance outcomes. An additional consideration is that while the curriculum of Creighton Health Sciences Campus follows that of the Omaha (main) campus, it has undergone modifications over the subsequent years since its inception. Curricular or faculty changes over time may also have con- tributed to performance variability. Third, the reported data showcases the mean scores for quizzes, final exams, and overall block grades. Means of quantitative data sets have the potential to be impacted by outliers in the data set, where extremes of Medical Science Educator1 3 high scores and extremes of low scores could skew the data in their particular direction. The authors acknowl- edge this potential effect within the data sample and understand that for current claims of NPT having a neu- tral and/or positive impact on pre-clinical academic per- formance, a larger data set must be collected to further support the claim. Lastly, while NPT provides substantial benefits, it is not intended to replace faculty instruction. The absence of formal oversight introduces potential variability in content quality and accuracy [16]. To mitigate this, future iterations of SI should incorporate standardized content templates, and emphasize collaborative faculty support to promote and enhance the SI program.

  Informal Near-Peer Teaching Effects on Medical Student Pre-Clinical Learning · 2026 · DOI

• To further optimize near-peer education, institutions may consider standardized peer teaching, implementing dedi- cated tutoring office hours, and expanding SI to include board-style review sessions. Prospective, mixed-methods evaluations could assess not only performance outcomes but also student confidence, sense of belonging, and perceived preparedness for clerkships. Additionally, longitudinal fol- low-up would help determine whether early participation in NPT influences later clinical performance or teaching competence.

  Informal Near-Peer Teaching Effects on Medical Student Pre-Clinical Learning · 2026 · DOI

• The fact that skill application was the strongest predictor supports the competence pyramid of Miller and underlines that effective CME should not be limited by the knowledge only but be provided with the possibilities to practise empirically in a clinical environment.

  Impact of Continuous Medical Education on Clinical Performance and Career Development of Paramedical Professionals · 2026 · DOI

• This study was conducted at a single, large tertiary hospital in China, which may have limited generalizability to other TCM orthopedic training programs with different institutional resources, faculty-student ratios, cultural contexts, or levels of technological support.

  Impact of a combined case-based and evidence-based medicine teaching approach in traditional Chinese orthopedic residency training: a single-center, retrospective educational study · 2026 · DOI

• A minimum core dataset for MSPE-equivalent documents should be articulated, including a transparent academic history summary with explanation of grading schemas and clearly defined metrics, but implementation details require further development.

  The Medical Student Performance Evaluation in global medical education: addressing a missing Middle Eastern perspective · 2026 · DOI

• Future efforts must require strict adherence to AAMC guidelines, eliminate appendices, and standardize visual presentation of comparative data across all medical schools.

  The Medical Student Performance Evaluation in global medical education: addressing a missing Middle Eastern perspective · 2026 · DOI

• Full compliance and standardization of MSPE remain elusive, with challenges including inconsistent graphical data presentation, use of appendices contrary to guidelines (37.2% still use them), and no consensus on defining and reporting professionalism and remediation.

  The Medical Student Performance Evaluation in global medical education: addressing a missing Middle Eastern perspective · 2026 · DOI

Most-cited papers in Innovations in Medical Education

• Medical Student Education in the Time of COVID-19 · JAMA · 2020 · 1,185 citations
• A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8 · Medical Teacher · 2006 · 994 citations
• The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23 · Medical Teacher · 2012 · 928 citations
• Peer teaching in medical education: twelve reasons to move from theory to practice · Medical Teacher · 2007 · 498 citations
• AMEE Guide No 20: The good teacher is more than a lecturer - the twelve roles of the teacher · Medical Teacher · 2000 · 446 citations
• Student teaching: views of student near-peer teachers and learners · Medical Teacher · 2007 · 340 citations
• Implementation of competency‐based medical education: are we addressing the concerns and challenges? · Medical Education · 2015 · 328 citations
• Faculty development initiatives designed to promote leadership in medical education. A BEME systematic review: BEME Guide No. 19 · Medical Teacher · 2012 · 314 citations
• Microlearning in Health Professions Education: Scoping Review · JMIR Medical Education · 2019 · 251 citations
• Portfolios in medical education: why do they meet with mixed success? A systematic review · Medical Education · 2007 · 235 citations

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