Introduction Reflective practice is central to medical education at all levels and is commonly assessed using asynchronous written reflections. The emergence of new generative artificial intelligence tools such as ChatGPT has led to concern that they may be used to generate written reflections and so to bypass the reflective process, potentially undermining the value of written reflections as a summative assessment. This scoping review asked whether written reflections remain a valid summative assessment in the age of GenAI by identifying papers which examined the ability of GenAI to write reflectively, the detection of such writing, and the use of GenAI for reflection by health professionals. Methods A scoping review was conducted in accordance with PRISMA-ScR guidelines using. Medline, CINAHL, Education Research Complete and Google Scholar. Data were charted and the descriptive content thematically analysed. Results Eighteen publications were included. We find that free GenAI chatbots such as ChatGPT can write reflections to a high academic standard, and these are difficult to detect either by humans or software. We also find that health professionals and students are using GenAI for this purpose, but also that GenAI might be used to support and enhance the reflective process through scaffolding, acting as a conversational partner and assisting in the redesigning of assessments. Discussion The findings suggest that asynchronous written reflection is vulnerable as a summative assessment in the presence of GenAI. Future research should seek to answer the question as to how the validity of reflective writing as a summative assessment can be maintained in a world where GenAI use continues to grow.

Health professions’ education (HPE) research has evolved within an academic ecosystem. This paper works to put forth that generative artificial intelligence (AI) and autonomous AI agents are exposing the underbelly of HPE. Two responses have emerged: disclosure frameworks that report AI use, and formation frameworks that assess researchers’ readiness to critically examine evolving knowledge systems being reshaped by AI. The field has emphasized the former while neglecting the latter. We argue that HPE necessitates more than disclosure policies. Training should assess researcher formation, including the ability to question evidence hierarchies, peer review, technology disruptions, and publication systems, rather than relying on research outputs alone for scholarly development.

Starting in 2024 to date, eight publications in the special series Building Excellence into Medical and Health Professional Education Programs in Medical Teacher have highlighted elements that define and evidence excellence across the domains of curriculum development, assessment, student engagement, faculty development, simulation, innovation, social accountability, and international collaboration. This commentary concludes the series by identifying critical cross-cutting features of the published articles, positioning excellence as an institutional ethos grounded in alignment of mission, cultures, and practices. Specifically, excellence is developmental, context responsive, and demonstrated through implementation, outcomes, and sustained impact. The AMEE ASPIRE-to-Excellence framework provides a constructive, globally informed roadmap for continuous quality improvement, supporting institutions in advancing equitable, socially responsive, and future ready education to meet evolving professional and societal needs.

Introduction Competency-Based Medical Education (CBME) has transformed postgraduate medical education worldwide. In 2017, Canada adopted the Competence by Design (CBD) model. While widely promoted as a successful large-scale curricular reform, emerging critiques suggest limited empirical evidence and unintended consequences. We critically examined a recent article promoting CBD’s success via citation analysis and evidence appraisal. Methods We analyzed the article’s 169 references, categorizing each by type and empirical relevance. We synthesized Canadian-situated empirical studies on Entrustable Professional Activities (EPAs) and their role in feedback within CBD systems. Additionally, we consulted the Royal College of Physicians and Surgeons of Canada’s (RCPSC) 2024 CBD Adaptations Plan to contextualize recent developments. Results Empirical studies accounted for 49.2% of the citations, and only 59.4% of those directly addressed CBME. We observed many (25.3%) self-citations, suggesting limited diversity of perspectives. Synthesized studies revealed mixed outcomes: although EPAs aimed to enhance feedback, trainees reported increased stress, administrative burden, and inconsistent feedback quality. These challenges were largely unacknowledged in the analyzed article but were recognized in the 2024 CBD Adaptations Plan’s proposed reforms. Discussion Our findings challenge the narrative of CBD’s unequivocal success in Canada. We highlight the need for context-sensitive empirical research to guide future reforms.

Context Situational judgment tests (SJTs) are increasingly considered in medical school admissions to assess non-academic competencies within holistic review. Questions remain regarding accessibility, variation in performance across applicant groups, and their relationship to admissions outcomes. This study examines the association between AAMC PREview SJT scores and admissions outcomes in a real-world applicant pool, where scores were not used in decision-making and were reviewed retrospectively. Methods We conducted a retrospective analysis of 5,993 applicants to the Icahn School of Medicine at Mount Sinai during the 2022–2023 application cycle. Of these, 4,046 (67.5%) completed the PREview SJT. Scores were not available to the admissions committee at any stage and did not influence interview or acceptance decisions. Applicants were categorized by socioeconomic status (SES) and first-generation college status. Logistic regression models evaluated associations between PREview scores, interview invitations, and post-interview committee evaluations, adjusting for demographic variables. Outcomes were compared between test takers and non-takers. Results Applicants from lower SES and first-generation backgrounds were more frequently represented among lower PREview score categories. PREview scores were not associated with post-interview committee evaluations. However, lower PREview scores were associated with a lower likelihood of interview invitation. Among interviewed applicants, neither PREview score nor demographic variables were associated with committee outcomes. Conclusions In a setting where PREview scores were not used in admissions decisions, lower scores were associated with interview invitation status but not with post-interview committee evaluations. These findings suggest limited alignment between PREview scores and the outcomes of holistic admissions review and underscore the importance of careful evaluation before incorporating SJTs into admissions processes.

Accreditation systems create and enforce the rules for medical education. When accreditors expand their scope or change their standards or protocols, every medical school they regulate must change, with lasting impacts on large numbers of graduating physicians. Because the accreditation of undergraduate medical education (UME) has become globally accepted and widespread, one may assume it is supported by strong evidence. Such is not the case. This article recounts the origins of accreditation in the U.S. over 100 years ago as an effort to distinguish allopathic physicians from their competitors. It describes how the U.S. model for UME accreditation formed the basis for approaches endorsed by global organizations, and accreditation expanded without research demonstrating that a specific combination of standards, self-studies, and site visits was optimal or necessary. Allowing assumptions about accreditation to go unchecked can create problems, such as the misalignment of accreditation systems with needs, wasted resources, and lack of trust. Accreditation science—systematic inquiry that directly interrogates and informs accreditation policies and practices—offers a way to test assumptions and generate evidence that leads to higher quality accreditation practices. We describe resources that can be used for accreditation science and examples of accreditation science so that more of the global medical education community can participate in this emerging field. We also suggest priority areas of investigation, such as how accreditation judgments are made and the economics of accreditation and international accreditor marketplaces. The scientific method has for centuries proven to be the most efficient way to generate knowledge that improves the lives of people. It is past time for accreditation to move from its longstanding basis in tradition and assumption into an era defined by scientific inquiry.

Co-creation has emerged as a transformative approach to meaningful collaboration among students, teachers, and other key stakeholders. Although co-creation aims to integrate all stakeholders’ diverse perspectives and foster engagement, motivation, and ownership among them, some practical challenges can impact its implementation. The operationalization of co-creation needs a feasible, step-by-step plan to address interpersonal, practical, and institutional challenges, which can undermine co-creation. This guide examines how Artificial Intelligence (AI) can be leveraged across all phases of the co-creation cycle—preparation, conduction, and follow-up. It offers innovative insights into the intentional deployment of AI tools to enhance collaboration while preserving the relational essence of co-creation. We describe how AI can facilitate recruitment of diverse participants, design and planning of co-creation activities, brainstorming, shared decision-making, process evaluation, dissemination of outcomes, and integration of co-created outcomes into the curricula. This guide applies the Substitution, Augmentation, Modification, Redefinition (SAMR) model and the Technology-Organization-Environment (TOE) framework to theoretically examine how AI can enhance or fundamentally reshape co-creation. It also underscores essential ethical considerations for integrating AI into co-creation. After reading this guide with comprehensive and practical guidelines, educators can effectively integrate AI into co-creation initiatives, aiming to enhance both the processes and outcomes of co-creation.

Introduction Advising is essential for student success in graduate health professions education (HPE). Advising does not happen in a vacuum, yet most research focuses narrowly on advisor-advisee relationships. To address this gap, this study examines how institutional structures, policies, and programmatic dynamics influence the effectiveness of advising in graduate HPE. Methods We conducted semi-structured interviews with 15 HPE program leaders across six WHO regions. Using framework analysis guided by Activity Theory and the concept of knotworking, we analyzed how institutional systems shape advising practices. Results Five institutional factors were identified: (1) strategic advisor recruitment, (2) supportive advising cultures, (3) bureaucratic and resource constraints, (4) advisor training and evaluation, and (5) recognition and support for advisors. Leaders described advising as an adaptive, cross-system process shaped by institutional complexity and evolving student needs. Discussion Advising in graduate HPE operates beyond dyadic relationships. It is embedded within institutional activity systems and requires ongoing negotiation across structural boundaries. Programs must adopt systemic strategies, such as faculty development, workload alignment, and policy reform, to support effective advising networks.

Health Professions Education (HPE) cannot rely on assumptions of stability. Fragile contexts – wars, disasters, political upheaval, and systemic weakness – disrupt teaching and learning, assessment, accreditation, and the well-being of learners and faculty. This AMEE Guide provides a framework for building resilient HPE that survive crises and use them as opportunities for reform. The Guide identifies three types of fragility and explores their impact on institutions, human capital, clinical training, and social accountability. To boost resilience, the guide recommended adaptive strategies that include creating crisis management committees, implementing modular and competency-based curricula, allowing credit transfers for displaced learners, and incorporating tailored training programs. For curriculum delivery innovations range from hybrid and low-tech methods to peer-assisted approaches, diaspora involvement, and community-based services. A practical model for fair and feasible assessment in disrupted environments is suggested, with a focus on outcomes, flexibility, and cross-border recognition for rethinking accreditation and quality assurance. Systems thinking underpins the Guide, highlighting how destructive cycles such as brain drain can erode capacity, while virtuous cycles – driven by technology adoption, partnerships, and community integration – can foster recovery and growth. The guide also calls on educators, institutional leaders, and policymakers to move from reactive responses to proactive preparedness.