Entrustable professional activities (EPAs) have become a critical bridge connecting ″competency″ with ″actual clinical practice″ in medical education. However, various challenges arise during their implementation at the micro, meso, and macro levels. On August 24, 2025, an international symposium titled ″Entrustable Professional Activities: Issues in Global Implementation″ was organized in Barcelona by Olle ten Cate and Marije P. Hennus from the University Medical Center Utrecht in the Netherlands, along with Roberta I. Ladenheim from the University Institute of the Italian Hospital of Buenos Aires in Argentina. The symposium brought together medical education experts from around the world to engage in in-depth discussions on the challenges and strategies of implementing EPAs across different cultural, policy, and healthcare systems. This article systematically reviews the common challenges encountered in the implementation of EPAs and the practical experiences from various regions, aiming to inform and inspire medical educators.

Objective To analyze the current status and challenges of medical students′ participation in the innovation and entrepreneurship training program (IETP) and propose optimization strategies. Methods From October 2024 to June 2025, 117 medical students and 4 supervisors from Chongqing Medical University were selected using cluster sampling and stratified purposeful sampling. Data regarding participation motivation, project implementation, research skill enhancement, and difficulties were collected via self-developed questionnaires and semi-structured interviews. Results The primary motivations were enhancing competitiveness for further education [107 (91.5%)] and achieving research outputs [84 (71.8%)]. In total, 98 (83.8%) projects were finalized by students through literature reviews based on research frameworks provided by supervisors. All 117 (100.0%) students spent at least one hour daily on their projects, mastering various experimental skills and improving comprehensive research capabilities. The main obstacles were insufficient research time [98 (83.8%)] and technical learning difficulties [84 (71.8%)]. Conclusions While the IETP helps stimulate students′ initiative and cultivate their comprehensive research capacity, however, several problems remain, including insufficient research time, difficulties in mastering experimental techniques, an imperfect assessment system, and strong utilitarian motivations among students. Future improvements should be made in reasonably optimizing curriculum schedules, providing research skills training, establishing a tripartite assessment mechanism involving universities, supervisors, and students, and offering dedicated political and virtuous awareness courses for innovation and entrepreneurship.

Virtual standardized patient (VSP), which result from the advanced integration of artificial intelligence with simulation-based medical education, are catalyzing a shift in medical education towards a data-driven paradigm. This paper provides a systematic analysis of the technological advancements in VSP, highlighting their fundamental distinctions from traditional standardized patients. It further examines the divergent developmental trajectories in technical architecture and functional orientation between China and other countries. Domestically, there is an emphasis on intelligent scoring systems for assessment and evaluation, whereas internationally, the focus is on process-oriented multimodal immersive interaction. VSP presents notable benefits in terms of cost-effectiveness, uniformity in instruction, and adaptability in various scenarios. However, they also encounter practical challenges, such as limitations in replicating non-verbal communication, potential for content distortion, and the lack of standardized evaluation criteria. Future advancements in VSP development should focus on technological integration, progressing from multimodal interactions to physiological closed-loop systems. Additionally, there is a need for standardization to move from disparate practices to a cohesive assessment framework, and for security governance to transition from passive protection measures to proactive management strategies. This study seeks to serve as a foundational reference for the localized development and implementation of VSP, as well as for the advancement of intelligent methodologies in medical education.

Objective To compare the effectiveness of computer-based simulation and full-scale mannequin-based scenario simulation in advanced cardiac life support (ACLS) training for newly enrolled anesthesia trainees at Tianjin Medical University General Hospital. Methods From October 2020 to December 2021, a prospective randomized controlled design was used to randomly divide 62 newly admitted residents and interns into computer software simulation group (group C), full-scale simulator scenario simulation group (group M) and computer simulation group (SM group). The baseline test was performed before training (T0), and the immediate test was conducted after training (T1). The technical and non-technical competency scores of the participants before and after training were compared, and a questionnaire survey was used to evaluate their satisfaction with the training model at T1. Descriptive statistics, t-tests, analysis of variance, and χ² tests were used for data analysis. Results In terms of technical competency, the technical competency scores of Groups C, M and SM at T1 were significantly higher than those at T0 [(21.05±3.39) vs. (14.24±4.31), (21.33±2.93) vs. (15.14±3.66), and (20.33±3.62) vs. (15.06±3.63), respectively; all P<0.05], with no significant differences among groups at the same time point (P>0.05). For non-technical competency, the scores of the three groups at T1 were (10.67±2.33), (12.38±2.16) and (12.20±2.14) respectively, with the scores of Group M and Group SM higher than that of Group C (P<0.05). In the survey, the satisfaction of Groups M and SM with the statement ″this training mode can stimulate my interest″ was significantly higher than that of Group C (P<0.05). Conclusions Computer simulation and full-scale simulator scenario simulation can effectively improve the ACLS technical and non-technical abilities of the trainees, while scenario simulation has more advantages in non-technical ability improvement. Therefore, computer simulation can be used as an effective complementary tool for scenario simulation in ACLS training.

Objective To explore the limitations in clinical experience caused by regional and inter-hospital disparities in China′s standardized residency training for general practitioners, and to analyze the necessity and feasible pathways for inter-institutional collaborative training. Methods A qualitative research approach was adopted. In December 2024, purposive sampling was used to select 30 participants, including general practice residents, mentors, and training administrators from two public hospitals located in the southeastern coastal and northwestern inland regions of China. Focus group interviews were conducted, centered on training disparities and collaborative pathways. Thematic analysis was employed to extract core themes. Results Five key themes were identified: (1)Objective disparities exist between different regions/hospitals regarding disease spectrum, typical case resources, patient healthcare-seeking behaviors, and disciplinary development priorities. (2)Although training administrators are aware of these disparities, their potential impact on training homogenization has not been systematically addressed due to factors such as the current training guidelines emphasizing quantitative case coverage, the predominant trend of residents seeking local employment, and a primary focus on enhancing teaching and learning capabilities in current quality assessments. (3)Implementing multi-hospital collaborative training is necessary for promoting teaching homogenization, broadening residents′ clinical thinking, and improving mentors′ instructional skills. (4)Offline collaborative training faces low feasibility due to practical constraints including policy support, cost, geographical distance, and safety concerns. (5)Online collaborative training (e.g., remote case discussions, online teaching clinics, shared AI case databases, and virtual collaborative lesson preparation among mentors) is considered a viable and effective alternative at present. Conclusions Objective regional and inter-hospital resource disparities exist in China′s general practitioner training, posing a challenge to training homogenization. It is recommended to actively explore and promote a multi-center collaborative training model, starting with online collaborative training as an entry point. This approach can compensate for the limitations of single-institution training resources and systematically enhance the overall quality of general practitioner training.

Objective To investigate the educational work preferences of faculty involved in the standardized residency training of TCM, and to provide a reference for formulating targeted faculty incentive strategies. Methods From September to November 2024, attributes and levels of educational work preferences for TCM residency training faculty were determined by referring to authoritative guidelines, conducting a literature review, and applying the Delphi method. A DCE was designed and combined with a questionnaire survey. Using stratified sampling, 230 faculty members from six national TCM residency training bases in Zhejiang Province were selected for the investigation. A mixed logit model was employed to analyze the faculty′s teaching work preferences and willingness to pay (WTP). Results A total of 217 valid questionnaires were collected. Six attributes—monthly teaching income, teaching workload intensity, teaching atmosphere, teaching venue, credit for professional title promotion, and honors/training opportunities—significantly influenced the teaching preferences of the faculty (all P<0.05). ″Harmonious teaching atmosphere″ demonstrated the highest utility (β=0.806) and the highest WTP (1 409.17 CNY). Under baseline conditions, improving the level of a single incentive resulted in the greatest increases in probability for teaching atmosphere (19.6%), monthly teaching income (13.9%), and teaching workload intensity (13.6%). The attribute levels ″moderate credit for professional title promotion″ (β=0.162) and ″availability of honors and learning opportunities″ (β=0.161) showed relatively lower utility. Preferences varied among faculty of different genders and professional titles. Conclusions Both economic and non-economic factors collectively influence the educational work preferences of TCM residency training faculty. A ″harmonious teaching atmosphere″ is the core driving factor, while appropriate teaching income and reasonable workload intensity form the foundation for sustaining teaching motivation. The relative attractiveness of incentive methods within the current system, such as credits for professional title promotion, needs enhancement. It is recommended to prioritize fostering a harmonious teaching atmosphere, simultaneously ensure reasonable economic compensation and manageable workload, and construct differentiated incentive mechanisms and measures to comprehensively enhance the teaching motivation of TCM residency training faculty.

Objective To explore the effectiveness of applying whole slide imaging (WSI) combined with case-based learning (CBL) in the standardized residency training of clinical pathology. Methods This study adopted a controlled experimental design. Eighty pathology trainees who participated in the standardized residency training at the Cancer Hospital of Dalian University of Technology from September 2020 to August 2023 were selected as research subjects and randomly divided into experimental group and control group using a random number table. The experimental group received WSI combined with CBL teaching, while the control group received traditional microscope teaching. The teaching effects were evaluated through theoretical knowledge assessment, practical examination, learning initiative, and teaching satisfaction questionnaire. Data were analyzed using independent samples t-test. Results The experimental group showed higher scores in theoretical knowledge assessment [(85.63±2.51) points], practical examination [(85.05±2.39) points], learning initiative [(88.75±16.94) points], and teaching satisfaction [(96.00±4.12) points] compared with the control group [(73.90±3.35) points, (74.97±3.11) points, (65.63±14.64) points, and (84.00±2.54) points, respectively, all P<0.05]. Conclusions WSI combined with CBL teaching helps improve the clinical pathology learning outcomes of resident physicians, enhances their pathological diagnostic capabilities and autonomous learning efficacy, and provides practical evidence for digital pathology teaching reform.

The self-directed learning model represents a form of continuing education that aligns with both physicians′ individual learning needs and the developmental demands of the healthcare sector. It demonstrates significant potential in enhancing the relevance and effectiveness of continuing medical education (CME) in China, reducing unnecessary burdens on frontline practitioners, fostering lifelong learning competencies among health professionals, and promoting innovation in continuing education.This study employs a documentary analysis approach to examine and synthesize practices related to self-directed learning models in CME from Australia, the United Kingdom, and Canada. By identifying transferable elements, this research aims to provide insights for the further development and standardization of a ″planned self-directed learning″ model within China′s CME context.

Objective To assess satisfaction with the psychiatric scope-of-practice transfer training program among participating physicians in Sichuan Province, in order to inform improvements in training content and quality. Methods In January 2025, a self-designed questionnaire based on the reaction level of the Kirkpatrick four-level evaluation model was administered to 454 trainees from cohorts 9 to 11 of the psychiatric scope-of-practice transfer training program in Sichuan Province. The questionnaire collected information of trainees′ basic characteristics, sending institutions, motivation for participation, and satisfaction with theoretical and practical training. Descriptive analysis was performed on the data, and non-parametric tests were used to compare satisfaction scores among different categories of trainees. Results The overall satisfaction score was 4.65 (4.00, 5.00). Satisfaction with theoretical training 4.73 (4.00, 5.00) was higher than that with practical training 4.61 (4.00, 5.00). Among all dimensions, satisfaction scores for theoretical training content and practical training conditions were relatively low: 4.67 (4.00, 5.00) and 4.60 (4.00, 5.00), respectively. Among the 77 trainees who responded to the open-ended question regarding training suggestions, 39 (50.6%) proposed that training opportunities and duration should be increased. Of the 79 trainees who reported difficulties in engaging in mental health work, 30 (38.0%) identified insufficient institutional resources as the primary difficulty. Trainees who participated with personal initiative reported higher satisfaction 4.82 (4.00, 5.00) than those who participated due to institutional requirements 4.27 (4.00, 4.73). Similarly, trainees whose institutions valued mental health work reported higher satisfaction 4.73 (4.00, 5.00) than those whose institutions did not 4.36 (4.00, 5.00), and both differences were statistically significant (all P<0.05). Conclusions The psychiatric scope-of-practice transfer training program in Sichuan Province was generally well received by trainees. However, gaps remained in theoretical training content and practical training conditions. Insufficient institutional resources hindered their engagement in mental health work to some extent. While personal initiative in participation and institutional emphasis on mental health work were associated with higher satisfaction. Future efforts should focus on motivating trainees, securing institutional support, optimizing theoretical content, and increasing practical training opportunities, so as to strengthen the psychiatric workforce.

Objective To address the practical needs of full-time personnel in medical simulation centers, a competency evaluation index system suitable for full-time personnel of domestic medical simulation centers has been established to inform the capacity building of these personnel. Methods From February to June 2025, through analysis of domestic and international literature, preliminary competency evaluation indicators for full-time personnel in domestic medical simulation centers were established. A total of 19 experienced experts in the field of medical education were selected to conduct two rounds of structured consultations using the Delphi method to establish the indicator system and the analytic hierarchy process was used to determine the weights of indicators at all levels. Results The effective response rates for both rounds of expert consultation were 100.0%. The expert authority coefficients were 0.85 for both rounds, and the Kendall′s coefficient of concordance were 0.244 and 0.232, respectively (all P<0.05). The constructed evaluation index system comprises 3 primary indicators, 12 secondary indicators, and 54 tertiary indicators. Conclusions The constructed competency evaluation index system for full-time personnel in medical simulation centers is comprehensive and demonstrates a high level of expert consensus. A valuable reference for enhancing the capacity building of full-time personnel in medical simulation centers can be provided.

Singapore′s medical education, having evolved over a century, possesses distinct characteristics. This study systematically analyzes the training models for medical students at the three existing medical schools in Singapore—Yong Loo Lin School of Medicine, National University of Singapore, Lee Kong Chian School of Medicine, Nanyang Technological University, and Duke-NUS Medical School. The analysis is conducted through a combination of field research and textual analysis. The models are characterized by the parallel implementation of a five-year program and a ″4+4″ program, with an emphasis on the integration of basic and clinical sciences, early clinical exposure, comprehensive quality development, research skills training, and the broadening of international perspectives. Collaborative active learning methods are adopted, and formative and summative assessments are effectively integrated. Insights derived from Singapore′s experience can be drawn upon by China to advance the high-quality development of its medical education through initiatives such as optimizing talent cultivation pathways, deepening curriculum integration reforms, innovating teaching methodologies, and refining assessment mechanisms.

China has become one of the world′s major destinations for international students. In recent years, Sri Lanka has emerged as a significant source country of international medical students studying in China. This paper aims to analyze the reforms in medical education and the medical licensing examination in Sri Lanka. Drawing on publicly available information and the author′s years of practical experience in international medical education, it begins with an overview of the current state of medical education in Sri Lanka, systematically reviews the institutional structure and recent policy reforms of its Examination for Registration to Practice Medicine (ERPM), and employs an international comparative perspective to explore the driving forces behind these reforms. The study finds that the medical education system in Sri Lanka emphasizes the integration of theoretical knowledge and clinical practice, and its licensing examination is progressively transitioning toward internationally recognized evaluation methods in both content and format. This transformation reflects not only the country′s internal needs for healthcare talent development but also the influence of global trends toward standardization in medical education.

A comparative analysis of nursing education accreditation systems was conducted between China and the United States, and recommendations are proposed for enhancing China′s nursing education and accreditation framework. The US employs a parallel accreditation model through Commission on Collegiate Nursing Education and Accreditation Commission for Education in Nursing, which comprehensively covers multi-level nursing programs and emphasizes dynamic standard adjustment and industry alignment. In contrast, China primarily focuses on undergraduate nursing accreditation and prioritizes standardization, while demonstrating limitations in scope and international compatibility. This study proposes that China can draw on international experiences to refine tiered accreditation standards and establish a dynamic mechanism for nursing education. Additionally, the need for progressive training in clinical competencies and the promotion of interdisciplinary learning is emphasized. By linking accreditation outcomes with educational policies, this approach aims to align nursing education with healthcare demands, thereby contributing to the cultivation of high-quality nursing talent for the Healthy China 2030 initiative.