higher medical education

Medical Education

The mission of the Master of Medical Sciences in Medical Education is to give those who already excel in one of the health sciences disciplines an opportunity to turn their specialized knowledge and skill towards the advancement of health professions education. Through research, skill building, and innovation, this master’s program seeks to transform health professions education in the service of advancing the health sciences and healthcare nationally and internationally. Graduates of our program will be well positioned to lead progress and make transformative change.

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Medical education, master of science in education (m.s.ed.), you are here, an innovative program for physicians and healthcare professionals who want to lead the way in medical education.

The Medical Education (Med Ed) master's program is a unique collaboration between physician educators and education experts. We provide a comprehensive, innovative curriculum designed for physicians and other healthcare professionals who want to pursue master-level training, evidence-based education, educational scholarship, and educational technologies. Our approach—brief on-site intensives paired with flexible distance learning—accommodates professionals from a broad geographic area and with a broad variety of professional roles and responsibilities.

What Sets Us Apart

About the program.

The Medical Education master’s program prepares healthcare professionals to be teachers of medical educators, educational scholars, and leaders who influence and inspire others to learn in undergraduate and graduate medical and healthcare programs. Our two-year program trains physicians and other healthcare professionals in the science of education while remaining solidly grounded in the medical environment. The executive format includes on-site classes over long weekends, independent study, and online sessions.  

1 block per semester

Culminating experience Master's capstone

• Executive-Style

Participants complete four learning blocks over four semesters: Learning and Technology, Educational Research, Leadership, and Master’s Capstone. Virtual coaching clinics are coordinated with each of the program blocks. These clinics hone students’ online teaching abilities and collaborative learning skills, and help students complete their block assignments.

Prepare to teach medical educators : Gain an understanding of how adults learn, how to develop effective and efficient educational experiences in medical education, and how to teach others to do the same. Prepare to take on the many challenges facing medical educators, including assessment, curricular design, and integrating educational technologies into all types of learning experiences.

Become a medical education researcher : Gain the skills and knowledge to meet the growing need for research and innovation in medical education. Learn how to evaluate programs and publish your research in this area.

Grow into a leadership role at your healthcare organization or medical school : Influence and inspire others to learn. Develop the leadership competencies to plan, implement, and maintain successful, sustainable programs. Acquire leadership skills and tools that are highly relevant to medical education.

Admission to the Medical Education master’s program is offered every two years. The application for the Fall 2026 cohort will be available on September 1, 2025.

Our curriculum is designed to integrate the expertise of professional educators with the perspective of clinicians. Created for adult learners, the program is active, engaging, and experiential. We provide the newest thinking and scholarship in a variety of learning formats.

Our Master of Education (M.S.Ed.) requires completion of four blocks, each composed of on-site large-group and synchronous remote small-group sessions in the following areas:

• Learning and Technology:  The Learning and Technology block introduces participants to theories of, and research on, learning, curriculum, instruction and technology in medical education. It connects the theories and research to learning and technology practices in the academic medical and healthcare contexts. In addition, participants will develop a deeper understanding of common educational challenges such as learner assessment, curricular development, and pedagogical techniques.
• Educational Research:  Inquiry and investigation are central to refining and advancing education in medicine and healthcare. Leaders in medical education must also be skilled in program evaluation, which requires research. During the course of the Educational Research block, participants will become familiar with evaluation tools and techniques, qualitative and quantitative research methodologies, and pragmatic aspects of educational scholarship such as proposal development and publishing research.
• Leadership:  The Leadership block provides an opportunity to explore concepts such as emotional intelligence, how to influence and motivate others, group and classroom dynamics, power dynamics, organizational change, and the impact of organizational culture on leading and learning in complex systems. Central to this block is the understanding that people with advanced training in education will be called upon to develop and administer programs, which requires leadership skills that few in medicine are ever taught.
• Master’s Capstone:  The Master’s Capstone allows students to design their own paper and/or project based on needs in their individual workplaces. The project/paper structure is clearly outlined by program directors and supported through synchronous and asynchronous online sessions with faculty and students.

Virtual coaching clinics are coordinated with each of the four blocks of the program, and there are three or four clinics per block. The clinics hone students’ online teaching abilities and collaborative learning skills, and help students complete their block assignments. Clinic time is an essential part of teaching and learning in medical education, and coaching supports knowledge retention and skill acquisition. By harnessing technology, the Med Ed program provides students with small group teaching and learning experiences in the virtual world, overseen by experienced and trained coaches.

For information on courses and requirements, visit the  Medical Education M.S.Ed. program in the University Catalog .

Cohort 2024-2026

Our Faculty

Affiliated Faculty

Patti Adelman Vice President, Center for Learning and Innovation & Physician Leadership Institute, Northwell Health Ed.D., University of Pennsylvania

Anthony R. Artino, Jr. Professor, The George Washington University School of Medicine and Health Sciences Ph.D., University of Connecticut

Dorene Balmer Director of Research on Pediatric Education at The Children’s Hospital Philadelphia Ph.D., Temple University

Quinn Bauriedel Co-Artistic Director, Pig Iron Theatre Company Diploma, Theatre, Ecole Jacques Lecoq

Robbin Chapman Adjunct Associate Professor Ph.D., Massachusetts Institute of Technology

Constance Filling Chief Learning Officer, Association of American Medical Colleges Ed.D., University of Pennsylvania

Pam Grossman Professor of Education Ph.D., Stanford University

Eric S. Holmboe Chief Research, Milestone Development, and Evaluation Officer, ACGME M.D., University of Rochester School of Medicine

Fran Johnston Founder and CEO, Teleos Leadership Institute Ph.D., Temple University

Rachel K. Miller Associate Professor, Division of Geriatrics, Perelman School of Medicine M.D., University of Medicine and Dentistry of New Jersey; M.S.Ed., University of Pennsylvania

Jennifer Moyer Executive Coach and Leadership Development Consultant, JSMoyer Consulting M.Ed., University of Virginia

Leslie K. Nabors Olah Adjunct Associate Professor Ed.D., Harvard University

Kristi Pintar Vice President, Change Leadership and Organizational Development, Christiana Care Health System Ed.D., University of Pennsylvania

Rosemary Carol Polomano Associate Dean for Practice, Penn Nursing Ph.D., University of Maryland

Sharon M. Ravitch Professor of Practice Ph.D., University of Pennsylvania

Abby Reisman Associate Professor Ph.D., Stanford University

Matthew Riggan Co-Founder and Executive Director, The Workshop School  Ph.D., University of Pennsylvania

Gretchen Schmelzer Senior Associate, Teleos Leadership Institute Ph.D., Northeastern University

Corrie A. Stankiewicz Clinical Associate Professor of Medicine, Perelman School of Medicine M.D., University of Pennsylvania; M.S.Ed., University of Pennsylvania

Howard C. Stevenson Constance Clayton Professor of Urban Education Ph.D., Fuller Graduate School of Psychology

James K. Stoller Professor and Chairman, Education Institute, Cleveland Clinic M.D., Yale University

Greg Urban Arthur Hobson Quinn Professor of Anthropology, Penn Arts & Sciences Ph.D., University of Chicago

Michael Yudell Professor, Dornsife School of Public Health, Drexel University Ph.D./M.P.H., Columbia University

Program Directors & Staff

Kandi Wiens, M.B.A., Ed.D. Co-Director

Donald Boyer, M.D., M.S.Ed. Co-Director

Jessica Hall Administrative Coordinator [email protected]

April Coleman Administrative Assistant [email protected]

"I wanted to make myself the best teacher and clinician I could be."

Sean P. Harbison, MD

Our graduates.

The  Medical Education master's program is designed for physicians and other healthcare professionals who have, or are interested in pursuing, positions in educational leadership, such as:

• program directors
• fellowship directors
• clerkship directors
• positions with responsibilities in undergraduate or graduate medical education or faculty development

In addition, the program is tailored  to meet the needs of healthcare professionals interested in a specific facet of medical education, such as simulation, research and scholarship, program evaluation, learner assessment, or leading learning efforts in complex systems. Our program strongly emphasizes equipping graduates to serve as leaders and resources within their institutions.

Alumni Careers

• Associate Professor of Anesthesia, Harvard Medical School
• Vice Chief of Medical Oncology, Cancer Treatment Centers of America (CTCA)
• Chief Resident in Family Medicine, University of British Columbia
• Associate Professor of Clinical Medicine, Hospital of the University of Pennsylvania
• Director, Faculty Resources, Nemours/A.I. duPont Hospital for Children
• Associate Professor of Clinical Pediatrics, University of Pennsylvania
• Associate Professor of Pediatrics, Medical University of South Carolina
• Pediatric Cardiologist, A.I. DuPont Hospital for Children
• Professor of Nutrition/Associate Dean of Education, University of Pennsylvania
• Program Director of the Emergency Medicine Residency, SUNY Downstate/Kings County Hospital
• Residency Program Director, University of Pennsylvania

Admissions & Financial Aid

Please visit our Admissions and Financial Aid pages for specific information on the application requirements , as well as information on tuition, fees, financial aid, scholarships, and fellowships.

Contact us if you have any questions about the program.

Graduate School of Education University of Pennsylvania 3700 Walnut Street Philadelphia, PA 19104 (215) 898-6415 [email protected] [email protected]

[email protected]

Please view information from our Admissions and Financial Aid Office for specific information on the cost of this program.

Most students in this program fund their degree through a combination of personal resources, employer benefits, and student loans.

A Unique Synergy

The Medical Education master’s program offers a unique synergy between the educational and academic medical realms. The University of Pennsylvania Graduate School of Education, the University of Pennsylvania Perelman School of Medicine, and Children’s Hospital of Philadelphia have come together to provide program participants access to educational expertise centered in the medical context. 

The University of Pennsylvania Graduate School of Education is one of three Ivy League graduate schools of education and is a national leader in education research and the preparation of skilled education professionals.

Perelman School of Medicine

The University of Pennsylvania is the oldest and one of the finest medical schools in the United States. Penn is rich in tradition and heritage and at the same time consistently at the forefront of new developments and innovations in medical education and research. 

Children's Hospital of Philadelphia

Since its start in 1855 as the nation's first hospital devoted exclusively to caring for children, The Children's Hospital of Philadelphia has been the birthplace for many dramatic firsts in pediatric medicine. 

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World University Rankings 2022 by subject: clinical and health

The clinical and health subject ranking uses the same trusted and rigorous performance indicators as the Times Higher Education World University Rankings 2022, but the methodology has been recalibrated to suit the individual fields.

It highlights the universities that are leading across medicine, dentistry and other health subjects.

This year’s table includes 925 universities, up from 856 last year.

View the World University Rankings 202 2 by subject: clinical and health methodology

The University of Oxford leads the table for the 11th consecutive year, while Tsinghua University makes an impressive jump from 32nd to seventh to achieve China’s first ever rank in the top 10.  The University of Hong Kong features in the top 20 for the first time after moving up eight places from 28th.

UK universities excel in the top 100, with 11 of the country’s 15 universities in the group maintaining or improving their previous ranking positions. The US does not enjoy as much success, as 20 of its 28 universities in the top 100 lose ground on their positions from last year.

Ninety-one universities join the clinical and health ranking for the first time in 2022. India’s JSS Academy of Higher Education and Research is the highest ranked debutant at 93rd.

Read our analysis of the clinical and health subject rankings 2022 results

View the full results of the overall World University Rankings 2022

To raise your university’s global profile with  Times Higher Education , contact  [email protected]

To unlock the data behind  THE ’s rankings and access a range of analytical and benchmarking tools,  click here

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Read more about the World University Rankings 2022 by subject: clinical and health

Student insights.

• Best universities for medicine
• What can you do with a medical degree?
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Academic Insights

• Health and science subject rankings 2022: results announced

Methodology:

Featured jobs

Featured universities.

Higher ed’s response to growing demands for medical education

No industry has been spared massive disruption from the coronavirus pandemic and resulting rapid digitalization. But for both higher education and healthcare, disruption had already been a way of life—just on a more gradual scale. The pandemic has further driven down college enrollment numbers that were already on a decade-long decline, leaving many institutions in unprecedented financial distress. Meanwhile, healthcare providers are being pushed to simultaneously deliver higher quality care at a lower cost.

For university leaders, medical education presents an ideal opportunity to address current gaps in enrollment, while also positioning the institution to meet future demands. Not only are we experiencing greater demand for healthcare workers (indeed, six of the fastest 10 growing professions in the U.S. are in healthcare), but the growth of emerging fields like advanced technology, population health, and care coordination means traditional medical schools are not adequately equipped to address current needs.

Expanding healthcare education certificate and degree programs enables universities to get more students in the door today while positioning them for long-term stability through massive transformation. But it involves rethinking the traditional approach.

Increasing demands for medical education

Since 2002, the Association of American Medical Colleges (AAMC) has reported a 31% growth in enrollment at medical schools. It’s no wonder—healthcare is where graduates will find jobs today and tomorrow. The U.S. population is growing older and sicker, with comorbidities like heart disease and diabetes on the rise. At the same time, 33% of working nurses will reach retirement age in the next 8 years. And though the nursing shortage is the most egregious, by 2030, we can expect to see a worldwide shortage of 15 million healthcare workers as the demand for jobs across health systems will likely double.

According to the U.S. Bureau of Labor Statistics, healthcare jobs are expected to grow at a faster pace than any other industry—up 14% from 2018 to 2028. These jobs appeal to a diverse population of students, too, offering a variety of entry points, educational requirements and salary expectations. A surgical technician could meet job qualifications in a shorter period of time and still expect to earn $48,000 while a nurse pursuing a RN degree will enter a labor market with a median salary of $73,000, according to the U.S. Department of Labor.

But traditional higher education is simply not equipped to handle the surge of people pursuing degrees in healthcare. Over the last ten years, the number of people applying to medical school has increased by 25% , but there are not enough openings at medical schools to accommodate them. Today’s social distancing guidelines in classrooms and residency programs add further strain.

So how can universities adapt to address this opportune gap?

Integrating traditional and digital learning in medical education

Closing the gap in high-quality medical education is not as simple as launching new degree programs. Just as there are shortages of healthcare workers and medical education spots to train applicants, there are also not enough instructors to meet the demand . And with expansive real estate footprints becoming burdensome when competing with hybrid and online campuses, universities must get creative to maximize their human and real estate capital. The key is to integrate traditional and digital learning techniques.

Digital tools like educational videos and experiential recordings can supplement an instructor’s knowledge as well as spotlight the latest advances—no matter where they occur. Additionally, as emerging fields grow in popularity, supplemental digital tools provide universities with greater flexibility to apply content to various specialties and learning paths. And considering the speed of technological advancements, relying solely on traditional in-person instruction sets students and institutions behind.

Given that not all healthcare education can be done virtually, it’s important that there be physical spaces where trainees can meet standardized patients as well as practice on simulated cases and mannequins. As traditional college buildings empty, many of these spaces can be repurposed to provide healthcare training and potentially even basic healthcare to the communities they serve.

Digital content also gives students greater control over their education, enabling them to more extensively pursue topics that interest them the most. Plus, as more people pursue their education while working, for example, a registered nurse studying to become a nurse practitioner, the demand for flexibility in content delivery will only increase.

On-demand content delivery is here to stay and the need for additional medical education will only continue to grow. Combining these two trends presents an ideal opportunity for universities seeking new ways to increase enrollment and strengthen their foundation for the future.

Shiv Gaglani is the co-founder and chief executive officer of Osmosis.org, a health education platform with an audience of current and future clinicians as well as their patients and family members. Gaglani’s primary passion is developing innovative and scalable solutions in the fields of healthcare and education. To this end he curated the Smartphone Physical, which debuted at TEDMED, and the Patient Promise, a movement to improve clinician-patient relationship through partnership in pursuing healthy lifestyle behaviors. 

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Values of academic integrity in higher medical education

Affiliation.

• 1 BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE.
• PMID: 38865638
• DOI: 10.36740/WLek202404126

Objective: Aim: The aim is to identify features of theoretical and empirical research of academic integrity as characteristics of the educational environment of medical higher education institution (hereinafter - HEI).

Patients and methods: Materials and Methods: A complex of general scientific methods: logical-analytical, dialectical, theoretical-logical, comparative analysis, formalization and generalization, as well as quantitative sociological methods for collecting, processing and analyzing information. The object of the pilot empirical study were domestic medical students of full-time education at the Bogomolets NMU (N=472) and scientific and pedagogical staff who provide teaching of fundamental, specialized and socio-humanitarian disciplines at the university (N=153).

Results: Results: The values of academic integrity are the moral guideline that reveals the latest ethical demands of society and regulates the educational and scientific activities of all participants in the educational process. Opinions on the primary responsibility for compliance with the rules of academic integrity of a student differ between the surveyed scientific and pedagogical staff and students (p=0.000): the vast majority of the surveyed scientific and pedagogical staff tend to evenly divide the responsibility between a teacher and a student, and the majority of students-respondents noted that the student bears the primary responsibility.

Conclusion: Conclusions: Commitment to the principles of integrity motivates both students and teaching staff to act in an academic manner. Therefore, the creation of a methodology for studying the phenomenon of academic integrity in medical higher education institution through the study of attitude of the subjects of educational process to basic values is promising.

Keywords: Academic integrity; values; social research; higher medical education.

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HIGHER MEDICAL EDUCATION.

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.

The promotion of all efforts to advance and raise the standard of medical education is always a vital subject with those who have at heart the best interests of our profession. And it is with a sense of gratification that we note from year to year a visible improvement in the standard adopted and approved by the leading educators of our country.

An encouraging feature at this time is the effort that is being made to affiliate and more or less directly connect the best medical schools with established universities.

This works advantageously to all such institutions; it enables students in the academic course to so arrange their studies as to make the last two years in the latter count as the first two in their more strictly professional studies.

A young man who has pursued his studies in this manner has much the advantage of those who enter a

Rauch JH. HIGHER MEDICAL EDUCATION. JAMA. 1891;XVI(24):858–859. doi:10.1001/jama.1891.02410760030004

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• Published: 18 September 2024

Academic difficulties, education-related problems, and discrimination among Thai gender-diverse medical students: a cross-sectional study of Thai medical schools

• Awirut Oon-arom 1 ,
• Pakawat Wiwattanaworaset 2 ,
• Teeravut Wiwattarangkul 3 ,
• Papan Vadhanavikkit 4 ,
• Maytinee Srifuengfung 5 ,
• Mayteewat Chiddaycha 3 &
• Sorawit Wainipitapong 3 , 6 , 7  

BMC Medical Education volume  24 , Article number:  1025 ( 2024 ) Cite this article

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Metrics details

Medical students with sexual and gender diversity (SGD) often face challenges in educational performance and encounter more education-related problems, potentially due to discrimination in medical schools. This study aimed to compare academic difficulties, education-related issues, and experiences of discrimination among medical students with SGD versus those identifying as non-SGD.

This was a cross-sectional study. Participants included a convenient sample of medical students aged at least 18 from five Thai medical schools, all recruited during the 2021 academic year. General demographic data, academic difficulties, education-related problems, and both positive and negative aspects of medical education, encompassing physical aspects, supporting systems, and discrimination, were assessed. The descriptive data and comparison between SGD and non-SGD medical students were performed. Binary logistic regression was adopted to evaluate the association between characteristics of discrimination in each categorized type of gender diversity.

Among 1322 medical students, 412 (31.2%) described themselves as having SGD. There was no significant difference in academic performance between SGD and non-SGD students. However, SGD students reported higher dropout thoughts (39.8% vs. 23.1%, p  < 0.001) and self-perceived burnouts (84.2% vs. 74.9%, p  < 0.001). The SGD group perceived lower support from medical staff and higher inadequate financial support (30.3% vs. 22.1%, p  < 0.01; 11.2% vs. 23.1%, p  < 0.01, respectively). 64.44% of students reported witnessing at least one form of discrimination. Lesbian students were more likely to report witnessing discrimination (OR = 3.85, [1.05–14.16]). Gay students were significantly associated with experiencing sexist remarks (OR = 6.53 [3.93–10.84]) and lower selectively prohibited educational opportunities (OR = 0.36 [0.21–0.63]).

Conclusions

While academic performance did not differ between medical students with SGD and their non-SGD peers, SGD students reported more academic difficulties and perceived less support from medical staff and financial support. They also reported a higher incidence of discrimination. The need for specific interventions to address these issues should be further explored.

Peer Review reports

People with sexual and gender diversity (SGD) include people who report themselves to have diversities in gender identity, sexual identity, sexual orientation, and sexual behavior. Some might define these diversities into categories of LGBTQ + which refers to lesbian, gay, bisexual, transgender, queers/questioning, and other diversity (e.g., non-binary, asexual) [ 1 ]. Healthcare professionals with SGD reported encountering mistreatment, discrimination, and harassment from colleagues and patients [ 2 ]. This condition could lead to worse mental health outcomes such as burnout, depression, substance use, and suicidal behavior [ 3 , 4 , 5 ]. Seven out of ten medical students face moderate to high stress [ 6 ]. Concerningly, medical students with SGD might suffer higher stress than their peers due to fear of discrimination, concern over future career options, and lack of a supportive environment in medical school [ 7 ].

Medical students with SGD were also found to have more education-related problems. A large cross-sectional study of graduating medical students in the US demonstrated that bisexual, gay, and lesbian medical students perceived less favorable medical school learning environments in terms of emotional climate and faculty-student interactions [ 8 ]. The mistreatment of medical students was reported as a higher perception of being bullied and a lower perception of acceptance of SGD, especially from the department of general surgery and surgical subspecialties [ 9 ]. The previously mentioned mistreatment or inequality in medical school could lead medical students to perceive discrimination in medical school settings. The students with SGD also reported that the sources of discrimination are the faculty members and fellow medical students [ 10 ]. Furthermore, witnessing the derogatory comments from faculty members towards the patients who have SGD could lead medical students with SGD to abandon hopes of creating close relationships with the faculty member [ 11 ]. The burden of concealing essential aspects of the students’ identities and the external expectation of good academic performance creates a stressful work environment that contributes to poor mental health [ 4 ].

Although previous reports showing the important links between SGD, academic performance, educational problems, and discrimination in medical schools in Western countries were widely reported [ 12 , 13 ], studies on the impacts of having SGD on educational problems and discrimination, specifically among medical students, especially in Asia, including Thailand, were rarely explored. The previous evidence mentioned that some medical school in Asian countries has no LGBT content in the curriculum, and some medical students developed some ideas of sexism and ridiculed LGBT from the formal medical classes and informal learning. However, some medical students were aware that they needed to prepare for LGBT patients care and acknowledged a lack of relevant professional skills in this specific population. This study aims to compare academic difficulties, education-related problems, and discrimination among medical students with SGD to the medical students who self-report themselves as non-SGD.

This study was a secondary analysis of our previous survey data [ 14 ]. Participants included a convenient sample of medical students aged at least 18 from five Thai medical schools. Sample size calculation was calculated by using the prevalence of depression from a study on mental health problems among Thai medical students with the minimum medical students of 323 (n= [z 2 *p{1- p}]/d 2 , z = 1.96, p  = 0.31, d = 0.05) [ 15 , 16 ]. All participants were recruited during the 2021 academic year (May 2021 to February 2022). Two medical schools are located in Bangkok (Chulalongkorn University and Siriraj Hospital, Mahidol University), while the other three medical schools are in different regional areas across Thailand (Chiang Mai University—Northern region; Khon Kaen University—Northeastern region, and Prince of Songkla University—Southern region). We informed the participants that our survey would include information about mental health, academic difficulties, behaviors, and SGD among medical students. Medical students who were studying in the first through the sixth academic year of medical school had fluency in reading and answering the questionnaire in the Thai language and agreed to participate in the study after the information was informed and discussed. We excluded the medical student who was on academic leave. Only eligible students were invited to complete the online self-administered informed consent and all questionnaires. The survey was completely anonymous, and no personal data that could be tracked was collected.

General demographic and SGD data

General demographic data (such as age, academic year of study, and current underlying health issues) were collected. We assessed SGD by using self-reported sex assigned at birth, gender identity (personal sense of own gender), and sexual orientation (gender they are sexually attracted to). The definition and explanation of each factor were provided in the questionnaire and all responses were reported as non-SGD and SGD, including lesbian, gay, bisexual/pansexual male or female, transgender (with any sexual identity and orientation), non-binary, asexuality, and questioning.

Academic difficulties and education-related problems

Academic difficulties and education-related problems were assessed using questionnaires with binary responses. They also had the option to choose ‘prefer not to answer’ for any items they felt uncomfortable addressing. Participants indicated whether they perceived these obstacles in their medical education. Regarding academic difficulties, the items assessed were: (1) failing any exams, (2) repeating academic years, (3) dropout thoughts, (4) loss of motivation in academics, and (5) feeling burnout. As for education-related problems, we addressed (1) having adequate time for learning, (2) the need to study uninterested topics, (3) feeling overwhelmed by academic workloads, (4) exhaustion from studying, (5) dissatisfaction with academic results, (6) encountering rigid academic staff, (7) falling behind in school, and (8) having financial problems. Participants were instructed to select only one response per question. We cannot provide internal consistency for academic difficulties since we separately interpreted each item in our analysis.

Positive and negative aspects of medical education

The positive and negative aspects of medical education were assessed in three aspects: physical activities aspects (e.g., hours of sleep, exercises), supporting system (e.g., from friends, adequate financial support), and discrimination. The Association of American Medical College (AAMC) Graduation Questionnaires (GQ) were adopted to assess discrimination and mistreatment in medical school. This questionnaire covered five characteristics of discrimination, including public humiliation, sexist remarks, the requirement to perform personal services, denied opportunities for training or rewards based on gender and witnessing gender/sexual discrimination. Each discrimination characteristic was identified in 4 Likert scales as never, sometimes, frequently, and always [ 17 , 18 ]. The reliability estimates of the measurements used in measuring supporting systems and discrimination were reported in the emotional climate and faculty-student interaction subscales in the learning environment scale in AMCC GQ, which showed Cronbach’s alpha at 0.9 and 0.8, respectively. The reliability of measurement for the physical aspect was selected items from The Health Promoting Lifestyle Profile II (HPLPII). The overall measurements reported strong internal reliability (α = 0.90), test-retest reliability (rtt = 0.81–0.91), and convergent validity with other health measures. Internal reliability in each aspect of the current investigation in the Thai context was questionable or acceptable (supporting system α = 0.65; discrimination α = 0.75). We cannot provide internal consistency for physical activities since we separately interpreted each item in our analysis.

This multicenter study was completed following the Declaration of Helsinki as revised in 2013. The Institutional Review Board granted ethical approval for this study from all study locations.

Statistical analysis

Descriptive statistics were used to describe the demographic data. Categorical variables were presented as counts and percentages, while the mean and standard deviation or the median and interquartile range were used to present continuous variables depending on data distribution. The participants with missing data were excluded before the analysis. Chi-square, Fisher’s exact test, and t-test or Mann-Whitney test were used as appropriate to determine the difference between the two groups. Binary logistic regression was adopted to assess the association between characteristics of discrimination in each categorized type of gender diversity. Each discrimination characteristic was interpreted into binary data by scoring any frequency as presence and scoring ‘never’ as absence. SGD were categorized into seven groups (Lesbian, Gay, Bisexual, Transgender, Non-binary, Asexuality, and Questioning). All statistical tests were two-tailed comparisons, and a p-value of ≤ 0.05 was considered statistically significant. The SPSS version 29.0 (IBM) was utilized to analyze this study.

The response rate in this survey was 16.5%, based on the total number of 8031 medical students in Thailand when we launched the survey. A total of 1,322 medical students completed the questionnaires, and 412 (31.2%) described themselves as SGD. The mean age of SGD medical students was 21.06 years, which did not differ significantly from the overall participants. A substantially higher proportion of SGD medical students was found in the regional medical schools and regional hometowns. No statistically significant differences were observed in academic years, parental status, or financial support. Regarding gender identity, approximately half (50.4%) reported female as their assigned sex at birth. Bisexuality was reported to be the highest prevalence (16.8%), comprising 11.5% bisexual females and 5.3% bisexual males, followed by gay men (7.6%). Meanwhile, non-binary and questioning people were less frequent than 1%, and 0.6% chose not to report their sexual orientation. The demographic data were previously addressed in our study on sexual behaviors [ 14 ] and are provided in Supplementary Table 1 . The breakdown of specified gender diversity profiles for all participants can be found in Supplementary Table 2 .

Academic difficulties and education-related problems among SGD medical students

Regarding academic performance, there were no significant differences in the semester Grade Point Average (GPA) and the accumulated GPA (GPAX) between SGD and non-SGD students. However, the SGD group reported higher rates of dropout thoughts and self-perceived burnout compared to the non-SGD group (39.8% vs. 23.1%, p  < 0.001, and 84.2% vs. 74.9%, p  < 0.001, respectively). Factors such as failing examinations, repeating academic years, and losing motivation did not show statistically significant differences between the groups. Regarding education-related problems, 40.2% of SGD students and 42.7% of non-SGD students reported at least one education-related problem (see Table  1 ). SGD students reported significantly greater difficulties related to inadequate time for studying, falling behind in school, and financial issues. Meanwhile, other problems examined showed no significant differences between the groups as presented in Table  2 .

Preventive and risk factors related to medical education among medical students with SGD

Table  3 displays the positive and negative aspects of medical education. Among medical students with SGD, the perceived support from medical staff and inadequate financial support were addressed significantly lower than the non-SGD groups (Perceived good support from staff; non-SDG 30.3% vs. SGD 22.1%, p  < 0.01; inadequate financial support non-SDG 11.2% vs. SDG 23.1%, p  < 0.01, respectively), while perceived support from peers was not significantly different. Students with SGD also had a higher number of SGD friends (non-SDG 2.00 vs. SDG 3.00, p  < 0.01). Regarding academic-related health risk factors, SGD reported a greater impact of night shifts during the daytime (non-SGD 94.9% vs. SGD 99.4%, p  = 0.01). At the same time, they had no difference in hours of sleep at night, daytime sleepiness, and number of exercises per week.

• Discrimination

Most medical students (64.4%) reported witnessing at least one form of discrimination, with no significant difference between SGD and non-SGD groups. Public humiliation was the highest discrimination experienced by all medical students (40.1%), followed by selectively prohibited educational opportunities (34.1%), being requested to do personal services other than education (22.9%), sexist remark (17.5%), and verbal or physical abuse (7.3%). Medical students with SGD reported witnessing higher discrimination and had significantly higher experiences of sexist remarks (non-SGD 62.3% vs. SGD 69.2%, p  = 0.02 and non-SGD 11.5% vs. SGD 30.6%, p  < 0.001, respectively) (See Table  3 ).

From Bivariate logistic regression (Table  4 ), Students self-identifying as lesbian were associated with witnessing any discrimination (OR = 3.85, [1.05–14.16]). Meanwhile, being gay was associated with higher experiences of sexist remarks (OR = 6.53 [3.93–10.84]) and lower selectively prohibited educational opportunities (OR = 0.36 [0.21–0.63]). Additionally, being transgender was associated with experiencing sexist remarks (OR = 7.49 [2.99–18.72]), while students with questioning identity were associated with experiencing verbal or physical abuse (OR 8.98 [1.28–62.87]).

This study is one of a few studies that explore medical students with SGD regarding their education-related problems and discrimination in Thailand and Asia. Most previous studies in Asian countries mainly described attitudes, perceptions, and knowledge toward individuals with SGD and SGD healthcare. According to a few pieces of studies in Asia that described the discrimination and inadequate skills from the curriculum, the findings emphasized the integrating issues of gender into medical education, such as gender sensitivity language use, and broadening the experiences of those LGBT who have been discriminated would be helpful in understanding the diversity of human in the medical education setting [ 19 , 20 , 21 , 22 ]. In this study, although no differences in academic performance between SGD and non-SGD were found, medical students with SGD encountered more educational-related problems, including inadequate time for studying, being left behind by others, and financial issues. In addition, they perceived lower support from medical staff and financial support. More than half of medical students had witnessed discrimination in medical school, while SGD students reported significantly higher witnesses and experiences of sexist remarks.

Contrary to prior studies indicating reduced academic performance among SGD medical students and associated mental health challenges [ 23 , 24 ], our findings diverged. We hypothesized that medical students with SGD in our settings, despite reporting more educational-related problems, might benefit from positive factors that prevent them from having lower academic results. Strategies promoting inclusive environments, such as fostering a safe and supportive climate, educator intervention, and SGD-related curricula, can be instrumental [ 25 ]. Notably, one Thai study on medical students highlighted that a significant portion of medical students exhibit neutral to positive attitudes toward people with SGD, with positive attitudes often correlated with personal connections to SGD individuals like family members and friends [ 22 ]. In addition to supportive resources, positive attitudes can mitigate stigma, a key factor influencing academic difficulties like dropout [ 26 ].

A previous study highlighted that mistreatment intensity among medical students with SGD increased the odds of burnout in a dose-response manner. A greater proportion of humiliation and mistreatment, either specific or non-specific to gender and sexual orientation, were found in medical students with SGD [ 4 ]. In our study, the types of mistreatment were expansively identified, and the most reported discrimination was humiliation, which was relevant to the previous studies. Our finding also found that another interesting mistreatment experience was selectively prohibited educational education towards medical students with SGD. This finding underlined the existence of authority abuse in medical school [ 27 , 28 ]. The problematic issues in authority abuse in medical school included hierarchy and a culture of self-sacrifice, resilience, and deference. Medical students perceived that these factors created barriers to reporting mistreatment as it would lead to being labeled a ‘troublemaker’ and affecting career progression. These abusive environments could lead to a lower sense of belonging, which was associated with higher levels of depression and anxiety afterward [ 13 ]. However, medical students in the study might have compensated for a sense of belonging derived from the medical staff by having peer support from non-SGD and SGD friends, which could be observed by higher numbers of SGD friends among SGD medical students. This is relevant to previous studies, which demonstrated that the sense of belonging tends to effectively develop among the people who belong to SGD [ 29 , 30 ]. The intervention strengthening the sense of belonging could be an effective method to rescue medical students with SGD who experienced education-related problems, mistreatment, and discrimination [ 31 ].

Some limitations should be considered when interpreting the results. First, this is a secondary analysis of an observational cross-sectional study. We could only discern associations, not causations. Additionally, the voluntary recruitment method used in the study introduced selection bias, capturing only those willing to participate, especially the participants with SGD tend to be more interested in response to the SGD issue. Accordingly, the absence of international standardized questionnaires measuring academic difficulties, education-related problems, and discrimination in the Thai language caused limitations, potentially affecting the study’s interpretation and generalizability when contrasted with research using different tools.

Our study employed several strengths. It was conducted in an Eastern context, shedding new aspects on SGD and its association with academic performance within medical education. We gathered data from a large number of participants across the country, ensuring the representation of varied identities. We delved into a wide range of positive and negative factors within medical education. Crucially, the survey maintained complete anonymity, ensuring responses were unaffected by concerns, authority, or potential stigma.

Further studies should focus on the specific needs of medical students concerning education-related problems, mistreatment forms, and discrimination experiences, paving the way for targeted intervention. The study underscored the significant impacts of staff within medical schools. Rather than solely focusing on students, early interventions should encompass enhancing the knowledge, attitudes, and behaviors of staff toward students, patients, and SGD issues in a social context. Qualitative studies are necessary to discern these needs across different contexts and develop tailored interventions.

Data availability

The quantitative data used in and analyzed during the current study cannot be publicly available for confidentiality reasons. Still, they can be available on request from the corresponding author.

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Acknowledgements

We thank all participants for their time in responding to our survey. Also, we are grateful for the collaboration and support from all organizations to help complete this national study. This study is partially supported by the Faculty of Medicine, Chiang Mai University, regarding resource utilization.

This study was financially supported by the Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn University, grant no. RA65/040.

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Awirut Oon-arom

Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

Pakawat Wiwattanaworaset

Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Teeravut Wiwattarangkul, Mayteewat Chiddaycha & Sorawit Wainipitapong

Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Papan Vadhanavikkit

Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Maytinee Srifuengfung

Center of Excellence in Transgender Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

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Awirut Oon-arom: Validation, Visualization, Writing – Original Draft, Visualization; Pakawat Wiwattanaworaset: Validation, Investigation, Resources, Writing – Review & Editing; Teeravut Wiwattarangkul: Conceptualization, Methodology, Investigation, Resources; Papan Vadhanavikkit: Validation, Investigation, Resources, Writing – Review & Editing; Maytinee Srifuengfung: Validation, Investigation, Resources, Writing – Review & Editing; Mayteewat Chiddaycha: Conceptualization, Methodology, Formal analysis, Data curation, Writing – Review & Editing; Sorawit Wainipitapong: Conceptualization, Methodology, Formal analysis, Writing – Original Draft, Project administration, Funding acquisition.

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The present study was approved by the Institutional Review Board (IRB) of all medical schools participating in the study, including Chulalongkorn University (0006/2022), Siriraj Hospital, Mahidol University (167/2022), Chiang Mai University (PSY-2565-08832), Khon Kaen University (HE651083), and Prince of Songkla University (65-085-3-1). All participants completed the online self-administered informed consent.

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Oon-arom, A., Wiwattanaworaset, P., Wiwattarangkul, T. et al. Academic difficulties, education-related problems, and discrimination among Thai gender-diverse medical students: a cross-sectional study of Thai medical schools. BMC Med Educ 24 , 1025 (2024). https://doi.org/10.1186/s12909-024-06018-5

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Internationalization of higher medical education in the post-COVID-19 era

Norbert skokauskas.

a Regional Centre for Children and Youth Mental Health and Child Welfare, Central Norway, IPH, Norwegian University of Science and Technology, Trondheim, Norway

b Child and Adolescent Psychiatry Section, World Psychiatric Association, Geneva, Switzerland

Branko Aleksic

c Department of International Medical Education, Nagoya University Graduate School of Medicine, Nagoya, Japan

Madeleine Moe

d Norwegian Embassy in Ottawa, Ottawa, Canada

e Department of Political Science, University of Oslo, Oslo, Norway

Divya Rayamajhi

f Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway

Anthony Guerrero

g Department of Psychiatry, University of Hawaii School of Medicine, Honolulu, HI, USA

COVID-19 pandemic has caused disruption in higher medical education and healthcare worldwide. To thrive in times of uncertainty, medical higher education institutions have to adapt to the post-COVID-19 era and innovate its international activities. To make a difference in societies locally, nationally and internationally, they will have to enhance their global presence. Internationalization is the best way to the exchanging of knowledge, enhancement of the medical curriculum, and mobilization of talent and resources for research and teaching. To remain competitive, universities will need to expand their international activities. This paper highlights several suggestions to enhance internationalization of medical higher education institutions in the post-COVID-19 era.

Internationalization is the best way to the exchanging of knowledge, enhancement of the medical curriculum, and mobilization of talent and resources for research and teaching. To remain competitive, universities will need to expand their international activities. To thrive in times of uncertainty, they have to adapt to the post-COVID-19 era and innovate its international activities. To make a difference in societies locally, nationally and internationally, they will have to enhance their global presence.

Below we highlight several suggestions to enhance internationalization of medical Higher Education Institutions (HEI) in the post-COVID-19 era:

• Universities will be able to recruit more outstanding and diverse international students by strengthening existing partnerships, working closely with their alumni, targeting carefully selected new geographic regions, and taking advantage of emerging big data analytics. Challenges : Physical recruitment activities suffered due to COVID-19, and some economies, hit hard by the virus, may witness a decline in numbers of outbound students. While China will remain the largest student recruitment market in the near future, its overall weak growth was evident even before pandemic [ 1 ]. Opportunities : There is a need and an opportunity for diversification of recruitment portfolios going beyond high-value regions and countries (i.e., China, Malaysia), with a focus on ‘potential growth regions’ such as Sub-Saharan Africa, Central Asia, and others. Decision support systems go beyond clinical practice [ 2 ] and new digital recruitment platforms are bringing big data analytics into the recruitment system [ 3 ].
• Universities will have to provide students with diverse mobility opportunities rendering benefits for individuals and communities at a local, regional and global level. Challenges : Ecological problems exemplified by climate change will affect international travel. There will be a need to make digital interaction simple and natural. Opportunities : A positive consequence of digitisation of classes during the pandemic has been the flexibility that it has given students. This can be an opportunity to cater to the needs of students who are working, commuting or traveling.
• Universities will have to empower staff members to be facilitators and advocates for comprehensive internationalization and create an environment and a culture to nurture creativity and achievement, with a focus on quality and excellence. There is a need to identify and invest in opportunities that promote global mobility for staff so that they become more internationally knowledgeable and interculturally skilled. Challenges : Some faculty members, especially in countries where the English language is not commonly spoken, may be resistant to change and comprehensive internationalization (partly because of language barrier). However, the survey by the International Association of Universities suggests just the opposite: internationalization gives a unique opportunity for professional, personal growth and modernization of the education process [ 4 ].
• The internationalized curriculum will ensure that all our students are exposed to international and intercultural perspectives. Having international partnerships as part of a degree shall give more legitimacy to the program and shall make the students adapt to the globalized world. Online learning innovation may be important driving force for an internationalized curriculum; however, the curriculum should be engaging, and communication should be interactive to provide results that are similar to an in-class experience. Challenges : Internationalization of the curriculum (IoC) has been emphasized in many universities for a period of time, and might receive less attention from the staff in the post-COVID −19 era. However, IoC has been defined as an ongoing process and opportunity for the incorporation of international, intercultural and global dimensions into the content of the curriculum, as well as learning outcomes, assessment tasks, teaching methods and support services of the study programme [ 5 ].
• The future research collaborations have to tackle important global problems outlined in UN Sustainable Development Goals (SDGs) [ 6 ]. Although climate change has been identified as one of the greatest threats to health, medical school curricula have very little coverage of its health consequences [ 7 ]. Most students are concerned about the future and wish to make environmentally conscious decisions. Challenges : There are limited funding opportunities for global health and related topics. Opportunities : Universities have to invest in young researchers to develop international excellence and to support career development that spans the postgraduate, early career, and international leadership stages. The internationalized curriculum shall cover SDGs.
• In post COVID −19 era partnerships and networks have to bring diverse viewpoints, inspiring discussions, additional resources, and rewarding activities to address global issues. Alumni around the world has to play an important role in establishing new partnerships and networks. Challenges : There is growing competition among HEIs for a place in the best partnerships and networks. Partnerships will allow to embrace opportunities not otherwise available.
• Universities will have to have an inclusive system for monitoring, reflecting upon, evaluating and reviewing internationalization progress. Challenges : There is a need to be sensitive to understandings and attitudes towards internationalization, and miscommunication between stakeholders. Financial restrictions may also pose difficulties. Opportunities : Such a review process will help to strengthen competence, confidence, and credibility.

Practical solutions for internationalization have to be tailored to individual HEI needs and recourses and be flexible and adaptable.

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The author(s) reported there is no funding associated with the work featured in this article.

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Study in Russia. Higher education: bachelor, master, engineer, PhD, Oil and Gas Engineering.