Satoshi Kondo

Background: Physician shortage is a crucial global issue. Some countries have introduced task shifting to expand paramedics’ roles. This expansion requires citizens’ social trust in paramedics in general. During medical emergencies, citizens must allow treatment by paramedics, with whom they often have no prior relationship. Although social trust is vital in medical emergencies, its level among hospital paramedics is unclear. This study aimed to evaluate citizens’ social trust in hospital paramedics and their acceptance of the paramedics’ medical practices, as well as the impact of educational outreach regarding hospital paramedics. Methods: In this within-participant pre–post assessment, citizens completed a web-based questionnaire distributed online to assess social trust in hospital paramedics before and after receiving information about hospital paramedics. Social trust was assessed using a validated questionnaire, and acceptance of paramedic medical practices was evaluated using a five-point Likert scale. Descriptive analyses were performed to assess social trust and acceptance of paramedic medical practices. The impact of educational outreach was evaluated using mean differences and corresponding confidence intervals. Results: A total of 630 participants were included. Citizens’ social trust in hospital paramedics and their acceptance of paramedic medical practices were high. After educational outreach regarding hospital paramedics, acceptance of their practices showed a statistically significant but modest improvement, whereas social trust did not show a statistically significant change. Conclusions: Society may already accept hospital paramedics’ activities because social trust in ordinary paramedics has already been established. Task shifting to allied healthcare professionals to address physician shortages may require credible certification and education systems to gain high social trust and acceptance of hospital paramedics.

Longitudinal integrated clerkships (LIC) represent an innovative model in medical education, wherein students engage in comprehensive care of patients over extended periods [1]. This approach foste...

Virtual patients have been increasingly utilized in medical education to develop empathy in a structured and scalable manner. Compared with traditional methods such as clinical practice and standardized patients, virtual patients can offer reproducible, resource-efficient learning experiences. This scoping review maps the research on virtual patient-based interventions designed to foster empathy in medical students. It seeks to identify existing research gaps, including conceptual definitions of empathy, scenario design, instructional strategies, assessment methods, and outcome measures. The Joanna Briggs Institute's scoping review methodology was followed, and the PRISMA-ScR guidelines for reporting were used. A comprehensive search was conducted in PubMed, CINAHL, ERIC, Web of Science, Scopus, and the Cochrane Library. Two independent reviewers screened all titles, abstracts, and full texts; a third reviewer resolved any discrepancies. Findings were presented narratively and in tabular form to highlight key insights and research gaps. Eighteen studies involving 1,920 medical students were included. The most common study design was single-arm pre-post pilot studies (n = 4, 21.1%), followed by randomized controlled trials (n = 2, 10.5%) and mixed-methods designs (n = 2, 10.5%). Five research gaps were identified: 1) lack of explicit definitions of empathy, 2) limited diversity in clinical scenarios, 3) absence of repeated virtual patient interventions, 4) limitations in assessment methods, and 5) insufficient evidence on the sustained outcomes of empathy. These findings offer important insights into the current state of medical education, where standardized curricula for empathy training remain underdeveloped. Future efforts should address these challenges by integrating virtual patients into instructional designs that effectively foster empathy in medical students. This review provides a foundation for developing and implementing educational programs that meet the needs of students seeking to enhance their empathic abilities and contribute to improved patient outcomes and prevent clinician burnout.

Introduction: To address the shortage of healthcare professionals in rural regions of Japan, Longitudinal Integrated Clerkship (LIC) programs were introduced with the objective of training community‐oriented generalists. LIC provides students with a longitudinal approach to clinical education, fostering a commitment to primary care careers. Studies have shown that LIC graduates are more likely to work in rural settings, with a significant proportion pursuing primary care. The LIC model has recently garnered increased interest, leading several institutions in Japan to adopt this educational framework to enhance regional healthcare delivery.Methods: This study employed semi‐structured interviews with three sixth‐year medical students who completed the LIC program between 2014 and 2020. Interview transcripts were subjected to thematic analysis to identify factors influencing career choices.Results: The analysis revealed six key themes that influenced the career decisions of the LIC participants. The students' interactions with mentors and their involvement in long‐term patient care emerged as pivotal experiences, reinforcing their dedication to community healthcare and primary care. The participants reported an enhancement of their clinical competencies and a growing confidence in their roles as generalists.Discussion: Despite the limited number of LIC participants, the findings indicate that the program effectively promotes interest in general practice careers. The study identified potential areas for program enhancement and elucidated the mechanisms by which LIC influences career decision‐making. Additionally, the results highlight the importance of educational strategies based on established learning theories, which foster students' professional growth, adaptation to community healthcare, and reinforce their commitment to primary care.

Human cognition is reflected in gaze behavior, which involves eye movements to fixate or shift focus between areas. In natural interactions, gaze behavior serves two functions: signal transmission and information gathering. While expert gaze as a tool for gathering information has been studied, its underlying cognitive processes remain insufficiently explored. This study investigated differences in gaze behavior and cognition between expert physicians and novice medical students during a simulated medical interview with a simulated patient, drawing implications for medical education. This study employed an exploratory sequential mixed methods design. During the simulated medical interview, participants’ gaze behavior was measured across five areas: the patient’s eyes, face, body trunk, medical chart, and medical questionnaire. A hierarchical Bayesian model analyzed differences in gaze behavior between expert physicians and novice medical students. Then, a semi-structured interview was conducted with participants to discern their perceptions during their gaze behavior; their recorded gaze behavior was presented to them, and analyzed using a qualitative descriptive approach. Model analyses indicated that experts looked at the simulated patient’s eyes less frequently compared to novices during the simulated medical interview. Expert physicians stated that because of the potential for discomfort, looking at the patient’s eyes was less frequent, despite its importance for obtaining diagnostic findings. Conversely, novice medical students did not provide narratives for obtaining such findings, but increased the number of times they did so to improve patient satisfaction. This association between different perceptions of gaze behavior may lead to new approaches in medical education. This study highlights the importance of understanding gaze behavior in the context of medical education and suggests that different motivations underlie the gaze behavior of expert physicians and novice medical students. Incorporating training in effective gaze behavior may improve the quality of patient care and medical students’ learning outcomes.

Background: Social trust in medical students is trust in the cluster of medical students and not individual medical students. Social trust in medical students seems critical in clinical practice since citizens often face unknown medical students for the first time. However, most previous research has focused on interpersonal trust in particular medical professions, and social trust in medical students has not been addressed sufficiently. In social science, the Salient Value Similarity model has demonstrated that the value similarity between professionals and citizens is associated with social trust. This research aimed to explore the relationship between social trust in medical students and the perception of value similarity. This study also aimed to determine whether the information of medical students strengthens social trust in them. Methods: We conducted a cross-sectional study to investigate how the perception of value similarity affects social trust. The participants answered the social trust questionnaires before and after reading a brief summary of the medical education curriculum and certification via the internet in Japan. The model structure of social trust in medical students, including the perception of value similarity, was investigated using SEM. A paired t-test was used to examine the effect of informing citizens about the knowledge, skills, and professionalism requirements of students attending medical school on social trust by reading the brief summary. Results: The study included 658 participants, who all answered a web questionnaire. Social trust in medical students was associated with the perception of ability and value similarity. Social trust in medical students, the perception of ability, and value similarity were improved by information about medical students. Conclusions: The perception of ability and value similarity seem to affect social trust in medical students. Information on medical education regarding the knowledge, skills, and professionalism of medical students may improve social trust in these students. Further research is required to sophisticate the model of social trust in medical students by exploring social trust in the medical students’ supervisors in clinical settings.

Introduction: An understanding of social determinants of health (SDH) and patients' social circumstances is recommended to deliver contextualised care. However, the processes of patient care related to SDH in clinical settings have not been described in detail. Observable practice activities (OPAs) are a collection of learning objectives and activities that must be observed in daily practice and can be used to describe the precise processes for professionals to follow in specific situations (process OPA.) Methods: We used a modified Delphi technique to generate expert consensus about the process OPA for patient care related to SDH in primary care settings. To reflect the opinions of various stakeholders, the expert panel comprised clinical professionals (physicians, nurses, public health nurses, social workers, pharmacists and medical clerks), residents, medical students, researchers (medical education, health care, sociology of marginalised people), support members for marginalised people and patients. The Delphi rounds were conducted online. In Round 1, a list of potentially important steps in the processes of care was distributed to panellists. The list was modified, and one new step was added. In Round 2, all steps were acknowledged with few modifications. Results: Of 63 experts recruited, 61 participated, and all participants completed the Delphi rounds. A total of 14 observable steps were identified, which were divided into four components: communication, practice, maintenance and advocacy. The importance of ongoing patient–physician relationships and collaboration with professionals and stakeholders was emphasised for the whole process of care. Discussion: This study presents the consensus of a variety of experts on the process OPA for patient care related to SDHs. Further research is warranted to investigate how this Communication–Practice–Maintenance–Advocacy framework could affect medical education, quality of patient care, and patient outcomes.