Chinese Journal of Medical Education

AI-empowered smart curriculum construction and practice of oral and maxillofacial surgery

Ding Zhangfan, Li Chunjie, Zhu Guiquan, Li Zhixuan, Ye Li, Lian Haosen

2026, 46 (9): 641-646. DOI: 10.3760/cma.j.cn115259-20251010-01265

Abstract ( 53 )

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Artificial intelligence (AI) technology presents a significant opportunity for the reform of modern teaching models. To enhance the teaching efficiency of oral and maxillofacial surgery, West China Hospital of Stomatology constructed an AI-empowered smart curriculum. An AI portal and specialized course platform were established based on the university database and DeepSeek, by which we built the knowledge atlas of oral and maxillofacial surgery. An intelligent agent was used to aid lesson preparation before class; AI and virtual reality technologies were employed to realize a digital class guide and intelligent interaction during class; man-machine conversation enabled round-the-clock tutoring after class. In this study, we successfully developed an AI-empowered smart curriculum for oral and maxillofacial surgery, and 483 five-year and eight-year undergraduate students enrolled in 2019 and 2020 were recruited to undergo this new teaching mode, and then a questionnaire survey was conducted. The results showed that compared with traditional classroom teaching, the degree of students′ satisfaction after the implementation of the AI-empowered smart courses has improved from 34.4% (166/483) to 52.2% (252/483), and the students with high interest have significantly increased [73.1% (353/483) vs. 90.5% (437/483)], which demonstrates that the AI-empowered smart courses in oral and maxillofacial surgery have boosted students′ professional interest, enlivened the classroom atmosphere, and effectively improved learning efficiency and teaching outcomes.

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A comparative analysis of the awareness and acceptance of narrative medicine between medical interns and standardized residency training trainees

Hu Zhengyan, Cheng Meng, Gan Wenmei, Gu Qiong, Qin Lang, Li Bo

2026, 46 (9): 647-651. DOI: 10.3760/cma.j.cn115259-20250917-01153

Abstract ( 31 )

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Objective To compare and analyze the awareness and acceptance of narrative medicine (including parallel charts) among undergraduate medical interns and residents undergoing standardized residency training. Methods A successive sampling method was adopted to recruit eligible participants in the Department of Obstetrics and Gynecology at West China Second University Hospital, Sichuan University, from January 2024 to July 2025. A total of 62 undergraduate interns and 118 residents undergoing standardized training were surveyed regarding their awareness of narrative medicine. Following a theoretical lecture on narrative medicine (including parallel charts), a subsequent survey was administered to assess their acceptance of narrative medicine. Data were analyzed using the chi-square test and the independent samples ttest. Results Sixty-two valid questionnaires from the intern group and 118 from the resident group were collected. Among all respondents, the proportion who reported having ″never known about″ narrative medicine was significantly higher in the resident group [50.8% (60/118) vs. 24.2% (15/62), P<0.001]. After the theoretical lecture, 45 valid questionnaires from the undergraduate intern group and 98 from the resident group were collected. The resident group demonstrated significantly higher acceptance scores regarding the positive role of narrative medicine in stimulating work enthusiasm and improving professional competence [(2.47±0.71) vs. (2.20±0.73), P=0.038; (2.48±0.69) vs. (2.22±0.67), P=0.039]. A significantly larger proportion of the resident group expressed willingness to recommend narrative medicine to others [89.8% (88/98) vs. 73.3% (33/45), P=0.011]. Conclusions The interns demonstrated a better awareness of the concepts of narrative medicine (including parallel charts) than residents, whereas residents showed higher acceptance of narrative medicine (including parallel charts).

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The role of parallel charting in writing and sharing in the cultivation of patient-doctor communication skills among general practice supervising physicians

Zhao Tiefu, Deng Liqun, Ma Hanying

2026, 46 (9): 652-657. DOI: 10.3760/cma.j.cn115259-20251210-01598

Abstract ( 15 )

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Objective To explore the effect of parallel medical record writing and sharing on improving general practice physicians′ communication skills and patient satisfaction. Methods From June 2024 to June 2025, 47 clinicians qualified for general practice resident standardized training and teaching from Beijing Anzhen Hospital, Capital Medical University were selected as subjects. After organizing guidance physicians to learn narrative medicine methods, complete parallel medical record writing and exchange, we evaluated their outpatient doctor-patient communication SEGUE scale scores and patient satisfaction before and after the intervention, and compared the scores with t-test. Fifteen doctors were enrolled in the study using purposive sampling. The one-on-one semi-structured in-depth interview method was adopted in this study. The interview data was processed through audio recording and text transcription, analysis unit construction, content coding, and theme extraction. Descriptive phenomenological analysis was finally applied to conduct logical analysis on the interview materials, so as to clarify doctors′ perceptions and opinions regarding narrative medicine training and parallel chart writing, as well as summarize the core themes derived from the interviews. Results After intervention, scores for the preparation stage (4.79±0.55 vs. 3.15±0.36), information collection (7.74±1.13 vs. 4.26±2.24), information provision (3.72±0.45 vs. 2.66±0.76), patient understanding (3.72±0.50 vs. 1.64±0.87), final inquiry (1.36±0.49 vs. 1.09±0.50), total SEGUE score (21.34±2.09 vs. 12.79±3.36), and patient satisfaction (8.17±0.64 vs. 7.64±0.71) were all higher than pre-intervention (all P<0.01). General practitioners scored higher than specialists in information provision (3.92±0.29 vs. 3.66±0.48), patient understanding (3.92±0.29 vs. 3.66±0.54), and patient satisfaction (8.58±0.79 vs. 8.03±0.51), all P<0.05. Doctors′ understanding and perspectives on narrative medicine training and parallel chart writing can be summarized into two main themes and four sub-themes: pre-training resistance (perceived as an additional burden, lack of perceived benefits) and narrative empowerment (deepened empathy, reaffirmation of initial medical motivations). Conclusions Doctors have gone through a process of moving from resistance to acceptance, and finally to active participation in narrative medicine training for parallel chart writing. Narrative medicine parallel medical record writing and sharing can improve general practice teachers′ communication skills and patient satisfaction, and the improvement effect for general practitioners is better than that for specialist physicians.

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Analysis of the current status and influencing factors of medical ethics cognition and privacy protection attitudes among medical imaging undergraduates

Du Jun, Chen Jiayi, Hao Ziyan, Lin Liyun, Liu Jiahui, Jiang Kunlong, Li Kun

2026, 46 (9): 658-664. DOI: 10.3760/cma.j.cn115259-20251110-01438

Abstract ( 21 )

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Objective To analyze the current status and influencing factors of medical ethics cognition and privacy protection attitudes among undergraduate students majoring in medical imaging, and to provide evidence for the staged optimization of ethics education content and scenario-based teaching of imaging data privacy protection. Methods In November 2023, a total of 269 undergraduate students majoring in medical imaging were selected from seven geographical regions in China using a multistage stratified sampling method. A self-designed questionnaire was used to collect data on general information, medical ethics cognition, privacy protection attitudes, and education and training experiences. According to the type of data, the chi-square test was used for intergroup comparisons, and multiple linear regression analysis was performed to identify related influencing factors. Results Among the 269 undergraduates, 183 students (68.0%) were in the high-score group for medical ethics cognition, and 213 students (79.2%) were in the high-score group for privacy protection attitudes. A total of 229 students (85.1%) had studied medical ethics courses or received ethics-related training, among them, 72 students (31.4%) were able to list practical scenarios related to medical imaging ethics; and 192 students (71.4%) had received medical ethics education or privacy protection training. Regarding support for privacy protection measures, 220 students (81.8%) supported strict restriction of data access, 236 students (87.7%) supported strengthening data encryption, and 224 students (83.3%) supported privacy protection education. The distribution of medical ethics cognition score levels differed significantly by grade and by whether students had received medical ethics education or privacy protection training (all P<0.001). The distribution of privacy protection attitude levels differed significantly only by whether students had received medical ethics education or privacy protection training (P=0.039). Multiple linear regression analysis showed that grade, medical ethics education or privacy protection training score, and ethics importance recognition score were positive influencing factors for the total medical ethics cognition score (β=0.417, 0.398, and 1.153, all P<0.001). Training helpfulness for professional development score, privacy protection importance recognition score, and data processing priority score were positive influencing factors for the total privacy protection attitude score (β=0.250, 1.313, and 1.094, all P<0.05). Conclusions Undergraduate students majoring in medical imaging generally showed good medical ethics cognition and privacy protection attitudes, but a gap remained between medical ethics education or privacy protection training and its translation into practice. Medical colleges and universities should provide staged medical ethics education according to students′ learning stages and carry out scenario-based practical teaching focused on restricting data access, strengthening data encryption, and privacy protection education, so as to improve students′ medical ethics cognition and practical ability in privacy protection.

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A review of theoretical models and measurement tools for intercultural competency of healthcare professionals

Mi Ke, Yin Hui

2026, 46 (9): 665-671. DOI: 10.3760/cma.j.cn115259-20251107-01428

Abstract ( 33 )

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With the acceleration of globalization and the increasing frequency of China′s international medical exchanges, enhancing the cross-cultural competence of medical and health personnel has become an important issue in medical education and practice. However, there is still a lack of localized measurement tools for the cultivation and evaluation of cross-cultural competence in the current medical education system in China. Therefore, exploring the theoretical model and international mainstream measurement tools of cross-cultural competence of medical and health personnel is of great significance for developing a localized evaluation system that fits the multi-ethnic and foreign-related diagnosis and treatment scenarios in China. This study reviewed six databases, including CNKI, Wanfang Data Knowledge Service Platform, and Embase, from 2000 to 2024, incorporating 15 studies. With an analytic focus on five international classic scales, namely the Behavior Assessment Scale for Intercultural Competence (BASIC), the Intercultural Sensitivity Scale (ISS), Intercultural Competence Questionnaire (ICQ), the Intercultural Development Inventory (IDI), and the Inventory for Assessing the Process of Cultural Competence (IAPCC) for healthcare personnel, this study found that the theory of cross-cultural competence in healthcare has evolved into a multidimensional integrated system encompassing cognitive, affective, and behavioral dimensions. Internationally, mainstream measurement tools such as the Behavioral Assessment Scale for Intercultural Competence (BASIC), the Intercultural Sensitivity Scale (ISS), and the Intercultural Competence Questionnaire (ICQ) have been developed primarily within Western cultural contexts, resulting in limited applicability for healthcare professionals in developing countries. This paper proposes constructing a localized comprehensive evaluation framework tailored to China′s medical context by leveraging the strengths of international scales. while establishing multi-context comparative analyses to advance medical education and improve healthcare service quality.

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Bibliometric analysis of the application of self-directed learning in medical education

Liu Huiting, Huang Xiaoming, Fan Hongwei, Jiao Yang

2026, 46 (9): 672-677. DOI: 10.3760/cma.j.cn115259-20251013-01276

Abstract ( 19 )

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Objective To analyze the current status and emerging frontiers of selfdirected learning applications in the medical field. Methods A bibliometric approach was adopted. The publications on the application of selfdirected learning in medicine from January 1, 2015 to December 31, 2024 in the Web of Science Core Collection, China National Knowledge Infrastructure, Wanfang Data, and Chinese Medical Journals databases was retrieved. VOSviewer 1.6.18 was used for keyword clustering analysis, and CiteSpace 6.3.R1 was used for burst keyword detection. Results A total of 2 523 Chinese-language and 932 English-language publications were included. The overall annual publication volume of Chinese articles was higher than that of English articles; however, from 2020, the annual number of English publications increased markedly. Highfrequency keywords from Chinese and English literatures formed six and four clusters, respectively. Prominent burst keywords included ″selfassessment″, ″artificial intelligence″, ″clinical thinking″ and ″teaching evaluation.″ Conclusions Research on self-directed learning in medical education has continued to gain momentum. While Chinese-language publications dominate in total volume, English-language research has exhibited a sharper growth trajectory in recent years. The research hotspots center on the application of emerging technologies, the establishment of teaching evaluation systems, and the cultivation of clinical thinking, all of which have implications for future research directions.

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A study on the impact of peer learning in the medical integration course on medical students′ learning experiences and ability development

Wu Jingnan, Chen Litong, Huang Zhengwen, Liu Ruikai, Xin Gang

2026, 46 (9): 678-683. DOI: 10.3760/cma.j.cn115259-20250722-00817

Abstract ( 20 )

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Objective To explore the multi-dimensional impacts of peer-assisted learning (PAL) in the context of medical integration courses on students′ learning experiences and ability development, and to provide a reference for universities to optimize the systematic integrated teaching methods. Methods A mixed-method research approach was adopted. Based on the systematic integrated teaching model of Shantou University Medical College, from May 2023 to May 2024, 86 undergraduate students from the clinical medicine program of Shantou University Medical College (2021-2023 intakes) were selected as the research subjects. Questionnaire surveys were conducted on students′ reaction, learning, behavior, and outcome dimensions. Statistical analysis was performed using the Wilcoxon signed-rank test. Based on the questionnaire survey results, 10 students were selected for semi-structured focus group interviews regarding the impact of PAL on their ability development within the systematic integrated course. The interview data were coded using NVivo and analyzed using thematic framework analysis. Results In the reaction dimension, 84 (97.7%) students were satisfied or very satisfied with PAL. In the other three dimensions, post-PAL scores were higher than those in the retrospective self-assessments before PAL, with scores for learning 4.32 (3.97, 4.93) vs. 3.18 (2.64, 3.75), for behavior 4.75 (4.00, 5.00) vs. 3.50 (3.00, 4.00), for outcome 4.80 (4.20, 5.00) vs. 3.80 (3.00, 4.40), all P<0.001. Four themes were extracted from the interviews: PAL promotes understanding and adaptation of the systematic integrated model, promotes multi-dimensional development, promotes positive changes in learning behaviors, and offers multiple advantages. Conclusions PAL helps improve medical students′ learning experiences and promotes their abilities. It has prominent advantages in cultivating students′ thinking ability and enhancing their enthusiasm for autonomous learning, and can serve as an important supplement to systematic integrated teaching.

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Application of generative artificial intelligence combined with scenario-based simulation teaching in standardized residency training in critical care medicine

He Jianzhuo, Wu Tiesheng, Gu Huiwen, Zhang Minzhou, Guo Liheng

2026, 46 (9): 684-689. DOI: 10.3760/cma.j.cn115259-20251207-01585

Abstract ( 28 )

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Objective To investigate the application effect of combining Generative Artificial Intelligence (GenAI) with scenario-based simulation teaching for standardized residency training in the intensive care unit (ICU). Methods This controlled experimental study included 128 resident physicians who underwent standardized residency training in the Department of ICU at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine) from January to December 2024. Participants were grouped according to their rotation period: residents rotating from January to June 2024 were assigned to the control group (n = 63) and received traditional teaching, while those rotating from July to December 2024 were assigned to the experimental group (n = 65) and received GenAI with scenario-based simulation teaching. After the teaching intervention, training efficacy were evaluated by comparing end-of-rotation assessment scores, Mini-clinical evaluation exercise (Mini-CEX) scale scores, and teaching satisfaction questionnaire results between the two groups. Data were analyzed using the independent-samples t test, Chi-square tests, or Fisher′s exact test. Results The end-of-rotation assessment score of the experimental group (85.74±1.69) was higher than that of the control group (80.94±0.78), with a statistically significant difference (P<0.001). The Mini-CEX assessment showed that the scores of the experimental group in history taking (7.28±1.13), physical examination (7.54±0.87), clinical judgment (6.92±0.96), and overall clinical performance (7.65±0.82) were significantly higher than those of the control group (6.87±0.98, 7.10±1.13, 6.46±1.44, and 7.21±1.12), with all differences reaching statistical significance (all P<0.05). The teaching satisfaction survey showed that the scores of the experimental group in improving learning interest and efficiency (4.38±0.60), enhancing clinical work competence (4.43±0.61), and improving doctor-patient communication skills (4.32±0.73) were significantly higher than those of the control group (4.14±0.74, 4.14±0.74, and 4.03±0.82), with all differences statistically significant (all P<0.05). Conclusions GenAI-integrated scenario-based simulation teaching can effectively improve the training outcomes of standardized residency trainees in critical care medicine, and provide a reference for optimizing the teaching model of critical care residency training.

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Application of a combined teaching method using digital cephalometry and traditional manual measurements in orthodontic laboratory teaching

Hong Xiaomei, Lai Yingzhen

2026, 46 (9): 690-696. DOI: 10.3760/cma.j.cn115259-20250730-00858

Abstract ( 13 )

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Objective To explore the application effect of a combined teaching method of digital cephalometric analysis and traditional manual measurement in orthodontics laboratory teaching. Methods A non-randomized controlled trial design with grade-based grouping was adopted. From 2022 to 2024, 199 fourth-year undergraduate students majoring in oral medicine (five-year program) from Xiamen Medical College (classes of 2018-2020) were enrolled as research subjects. The 2018 cohort (65 students) received traditional manual measurement instruction, the 2019 cohort (65 students) received digital cephalometric measurement instruction, and the 2020 cohort (69 students) received combined teaching incorporating both digital cephalometric analysis and traditional manual measurement. After course completion, theoretical and practical examination scores of the three groups were compared, and student evaluations of teaching effectiveness were collected via questionnaire. One-way analysis of variance (ANOVA), LSD post-hoc test (with FDR correction), and chi-square test were used for data analysis. Results The ranking of students′ theoretical examination scores was combined teaching group [(82.93±2.80) points] > traditional manual measurement group [(80.23±4.38) points] > digital measurement group [(77.35±5.31) points]. The ranking of practical examination scores was combined teaching group [(88.59±5.37) points] > digital measurement group [(86.42±6.02) points] > traditional manual measurement group [(83.77±6.25) points], all P<0.05. Questionnaire results showed that in the four dimensions of teaching effectiveness evaluation—knowledge acquisition, skill application, learning attitude, and learning outcomes—most specific items in the combined teaching group scored higher than the other two groups, with statistically significant inter-group differences after FDR correction (all q<0.05). A total of 185 students (93.0%) were willing to choose the combined approach of digital cephalometric analysis and traditional manual measurement. Conclusions The combined approach helps enhance students′ theoretical knowledge and practical operational skills and is highly accepted by students. It is recommended to adopt the combined teaching approach in orthodontics cephalometric laboratory instruction.

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Investigation and analysis of the implementation status of the tutor guidance model for medical postgraduates in a university

Zhu Xiaoyan, Li Yusheng, Shen Minxue, Zhou Fei, Wang Aimin, Zhang Le

2026, 46 (9): 697-703. DOI: 10.3760/cma.j.cn115259-20251119-01483

Abstract ( 16 )

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Objective To understand the current implementation status of the mentoring model for medical graduate students at a certain university, identify its key characteristics and existing problems, and provide empirical evidence for optimizing the mentoring model and improving the quality of training. Methods In July 2023, a questionnaire survey was conducted on all 2023 graduating students (referred to as graduates) at an affiliated hospital of a university in Hunan Province using purposive sampling. The content focused on the fulfillment of the seven responsibilities of mentors in promoting moral education and their professional ethics and conduct. The K-means clustering algorithm was used to classify the mentors, and the chi-square test was employed to compare the differences in the dimensions of professional ethics and conduct among different categories. Results A total of 627 valid questionnaires were recovered (360 for professional degree and 267 for academic degree). The graduates′ satisfaction with the fulfillment of all responsibilities of mentors in promoting moral education was all > 90.0%; the overall recognition of professional ethics and conduct was 96.3% (604/627). Based on the three-dimensional evaluation of ″humanistic care and academic support, academic ethics and research integrity, and integrity and respect for personality″, K-means clustering was used to divide the mentors into three groups: benchmark type, development type, and improvement type. Through the chi-square test, the differences in the frequency of scores in each dimension among the three groups were statistically significant (all P < 0.001). In terms of classified training, 86.5% (231/267) of academic degree graduates highly recognized academic training, while 93.6% (337/360) of professional degree graduates highly agreed with clinical practice guidance. In addition, 72.7% (456/627) of graduates suggested that ″professional ethics evaluation″ be the primary standard for mentor selection and assessment. Conclusions The mentoring model is generally recognized in terms of responsibility fulfillment and classified training, but there are cluster differences in professional ethics performance, and most graduates advocate strengthening the weight of professional ethics evaluation in mentor management. The research results provide empirical evidence for universities to build differentiated assessment systems based on the characteristics of mentor clusters and suggest the need to further pay attention to the improvement of the regular management and supervision mechanism of professional ethics.

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Nursing postgraduate students′ mentoring relationship and the related factors impact on its quality

Xu Yanxue, Niu Yanping, Wang Kebing, Sun Yuanyuan, Liang Minyu

2026, 46 (9): 704-710. DOI: 10.3760/cma.j.cn115259-20250507-00513

Abstract ( 11 )

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Objective To understand the current status of the mentoring relationship and the factors influencing its quality among nursing graduate students in China. Methods A cross-sectional online survey was conducted among 437 nursing graduate students from 46 universities across China from May to July 2025, utilizing validated scales: graduate nursing student mentoring relationship expectations scale, positive mentoring experiences scale, negative mentoring experiences scale, mental health continuum scale short form, innovative behavior scale, and quality of mentoring relationships scale. Descriptive statistics, independent t-tests, one-way ANOVA and multiple linear regression were performed on data from 437 valid responses. Results The mean item score of the quality of mentoring relationship scale was 3.68±0.86. The mean item score of the positive mentoring experiences scale was 3.73±0.84, and the mean item score of the negative mentoring experiences scale was 2.24±0.70. The mean item score of the mental health continuum scale was 2.43±1.01, the mean item score of the innovative behavior scale was 3.54±0.73. And the mean item score of the graduate nursing student mentoring relationship expectations scale was 4.44±0.55. Negative mentoring experiences negatively influenced mentorship quality (β=-0.304, P<0.05), positive mentoring experiences, innovation behavior, psychological resilience and communication initiative positively influenced mentorship quality (β=0.090~0.430, all P<0.05). Mentors′ positive and negative mentoring experiences, students′ positive psychology and innovative behavior, and proactive communication between both parties significantly influenced the quality of the mentoring relationship, explaining 70.5% of the variance in the dependent variable. Conclusions The quality of the mentoring relationship among nursing graduate students in China is at an above-average level. Mentors′ guidance experiences, students′ innovative behavior, students′ positive psychology, and proactive communication between both parties are external and individual factors influencing the quality of the mentoring relationship. Improving the mentoring relationship to promote high-level talent cultivation requires attention to the interactive experiences within the relationship and leveraging the positive guidance of mentors. Simultaneously, emphasis should be placed on cultivating students′ positive psychology and fully stimulating their proactive communication to ensure efficient collaboration between mentors and students, thereby advancing the high-quality development of the nursing discipline.

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Survey on health technicians′ satisfaction with online training in Chinese infectious disease hospitals

Wang Ying, Wang Yu, Qiang Tianyao, Hao Yiwei, Yang Zhiyun, Wei Ping

2026, 46 (9): 711-715. DOI: 10.3760/cma.j.cn115259-20250729-00849

Abstract ( 10 )

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Objective To investigate the satisfaction with online training among different health technician groups in infectious disease hospitals to inform effective online training. Methods A survey was conducted among 4 675 health technicians in 29 infectious disease hospitals nationwide between November 2023 and February 2024 with a self-designed questionnaire. The results were analyzed using non-parametric tests. Results The overall satisfaction score of online training was 4.00 (3.94, 5.00). In terms of gender, females had higher satisfaction, with a score of 4.06 (3.94, 5.00). The highest rating for working years was those with 6-10 years of working experience, with scores of 4.18 (4.00, 5.00). As for age, those between 21 and 30 years old reported the highest score of 4.18 (4.00, 5.00). Regarding majors, nursing obtained the highest score of 4.18 (4.00, 5.00). The highest rating for positions was also nursing, with a score of 4.12 (4.00, 5.00), while contract-based staff ranked the highest with regard to employment methods, with a score of 4.06 (4.00, 5.00). As to training frequency, the participants who had attended more than 7 training sessions after the pandemic reported the highest satisfaction score of 4.47 (4.00, 5.00). Statistically significant differences were observed across different genders, working years, age, majors, positions, employment methods, and training frequency (all P<0.05). Conclusions The satisfaction with online training of health technicians in infectious disease hospitals was at a moderately high level. The differences were observed in the satisfaction with online training among different groups of participants. Stratified and categorized training should be implemented by focusing on differentiated needs among various groups.

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Research on the reasons for the bias in student evaluations of teaching in medical colleges

Jiao Mingli, Sun Chao, Li Yuanheng, Wang Yazhou, Chi Haoyu, Tang Hanye, Zhang Qi, Guo Jinfeng

2026, 46 (9): 716-720. DOI: 10.3760/cma.j.cn115259-20250801-00870

Abstract ( 18 )

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Objective This paper explores the reasons for the bias in student evaluation of teaching (SET) during medical education. Methods This paper uses qualitative research methods. A total of 22 medical students participated in the semi-structured interviews on their evaluation behaviors. Following the coding framework of grounded theory, the interview data were coded using NVivo 12 software. The reasons for bias in SET were summarized and categorized. Results The results showed that 16 primary codes were obtained: teacher personality, teacher misconduct, classroom management, teacher engagement, defensive psychology, revenge psychology, stereotyping, leniency bias, peer influence, career orientation, indicator homogeneity, excessive number of teachers to evaluate, insufficient time, lack of confidentiality, mandatory evaluation, and lack of feedback. These codes were further grouped into 7 secondary codes: teacher-student relationship, classroom atmosphere, students' subjective psychology, students' social psychology, evaluation content issues, unreasonable evaluation timing, and evaluation system issues. Finally, three third-level codes were identified: students′ psychology, flaws in evaluation system design, and quality of teacher-student interaction. Conclusions The bias in SET is the result of multiple interacting factors. Among these, leniency psychology was identified as a unique characteristic specific to medical students′ evaluations. It is suggested that medical universities take multiple measures to rectify bias in SET.

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