{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:59:13Z","timestamp":1790845153160,"version":"4.1.0"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":44,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Educ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Healthcare e-learning operates under pressures that are difficult to satisfy simultaneously: it must be evidence-based, regulator-acceptable, clinically credible, and delivered on time. Established instructional design models, including ADDIE, the Successive Approximation Model, Dick and Carey, and Kemp, were not developed with these combined demands in mind and predate the routine use of artificial intelligence (AI) in content production. The field lacks a methodology that combines the structured governance required for regulated healthcare training, particularly in postgraduate medical education and continuing professional development (CPD), with the responsiveness needed to keep pace with evolving clinical evidence and AI-enabled production.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This article develops and presents INSPIRE, a healthcare-specialized instructional design methodology, as a conceptual contribution. The methodology was developed through a structured synthesis of the strengths and limitations of established instructional design models, integration of recent evidence on artificial intelligence in medical education, and iterative practical refinement in a national health professions education setting. The framework is described in relation to its theoretical foundations, systematically mapped against four established alternatives on six dimensions relevant to healthcare, and illustrated through phase-level integration of AI-supported tasks paired with explicit human checkpoints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>INSPIRE is a seven-phase agile-phased hybrid framework comprising Intake, Needs Analysis, Structure, Production, Implementation, Review, and End Closure. It treats early technical integration, continuous quality assurance, and human-in-the-loop use of artificial intelligence as core design commitments rather than optional additions. The framework addresses three combined gaps that no single existing model resolves: it integrates and organizes agility and governance into a single workflow suited to compliance-bound healthcare education; it formalizes the role of artificial intelligence across the lifecycle while retaining clinical and pedagogical accountability with human experts; and it makes quality review a continuous rather than terminal function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>INSPIRE integrates phase-based governance, iterative production, continuous quality assurance, and human-in-the-loop AI use in one workflow built for healthcare e-learning. The contribution is conceptual; empirical validation against time-to-delivery, learner outcomes, and accreditation-quality measures is the next step. National regulators, postgraduate training boards, and CPD providers are the intended adopters.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12909-026-10173-2","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T10:24:32Z","timestamp":1787048672000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["INSPIRE: a healthcare-specialized instructional design methodology for high-stakes e-learning in the era of artificial intelligence"],"prefix":"10.1186","volume":"26","author":[{"given":"Hilalah","family":"Alturkistani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahad","family":"Almalki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"issue":"1","key":"10173_CR1","doi-asserted-by":"publisher","first-page":"2378617","DOI":"10.1080\/28338073.2024.2378617","volume":"13","author":"GT McMahon","year":"2024","unstructured":"McMahon GT, Alnasser M, Alzouman H, Aldakhil L, Alotaibi F, Albabtain A, Alsulami S, Alshamrani M, Alenizi F, Alotaibi M, Alshamsan A. Transforming continuing professional development for healthcare professionals to meet national goals in Saudi Arabia. J CME. 2024;13(1):2378617. https:\/\/doi.org\/10.1080\/28338073.2024.2378617.","journal-title":"J CME"},{"key":"10173_CR2","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1186\/s12909-023-04698-z","volume":"23","author":"SA Alowais","year":"2023","unstructured":"Alowais SA, Alghamdi SS, Alsuhebany N, Alqahtani T, Alshaya AI, Almohareb SN, Aldairem A, Alrashed M, Bin Saleh K, Badreldin HA, Al Yami MS, Al Harbi S, Albekairy AM. Revolutionizing healthcare: the role of artificial intelligence in clinical practice. BMC Med Educ. 2023;23:689. https:\/\/doi.org\/10.1186\/s12909-023-04698-z.","journal-title":"BMC Med Educ"},{"issue":"4","key":"10173_CR3","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1080\/0142159X.2024.2314198","volume":"46","author":"M Gordon","year":"2024","unstructured":"Gordon M, Daniel M, Ajiboye A, Uraiby H, Xu NY, Bartlett R, Hanson J, Haas M, Spadafore M, Grafton-Clarke C, Gasiea RY, Michie C, Corral J, Kwan B, Dolmans D, Thammasitboon S. A scoping review of artificial intelligence in medical education: BEME Guide 84. Med Teach. 2024;46(4):446\u201370. https:\/\/doi.org\/10.1080\/0142159X.2024.2314198.","journal-title":"Med Teach"},{"issue":"4","key":"10173_CR4","doi-asserted-by":"publisher","first-page":"715","DOI":"10.3390\/ejihpe13040054","volume":"13","author":"H Abuhassna","year":"2023","unstructured":"Abuhassna H, Alnawajha S. Instructional design made easy! Instructional design models, categories, frameworks, educational context, and recommendations for future work. Eur J Investig Health Psychol Educ. 2023;13(4):715\u201335. https:\/\/doi.org\/10.3390\/ejihpe13040054.","journal-title":"Eur J Investig Health Psychol Educ"},{"issue":"4","key":"10173_CR5","doi-asserted-by":"publisher","first-page":"852","DOI":"10.30918\/AERJ.94.21.125","volume":"9","author":"CA Ali","year":"2021","unstructured":"Ali CA, Acquah S, Esia-Donkoh K. A comparative study of SAM and ADDIE models in simulating STEM instruction. Afr Educ Res J. 2021;9(4):852\u20139. https:\/\/doi.org\/10.30918\/AERJ.94.21.125.","journal-title":"Afr Educ Res J"},{"key":"10173_CR6","volume-title":"Leaving ADDIE for SAM: An agile model for developing the best learning experiences","author":"MW Allen","year":"2012","unstructured":"Allen MW, Sites R. Leaving ADDIE for SAM: An agile model for developing the best learning experiences. Alexandria (VA): ASTD; 2012."},{"issue":"1","key":"10173_CR7","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s41077-025-00357-z","volume":"10","author":"FL Barra","year":"2025","unstructured":"Barra FL, Rodella G, Costa A, Scalogna A, Carenzo L, Monzani A, Della Corte F. From prompt to platform: an agentic AI workflow for healthcare simulation scenario design. Adv Simul. 2025;10(1):29. https:\/\/doi.org\/10.1186\/s41077-025-00357-z.","journal-title":"Adv Simul"},{"issue":"8","key":"10173_CR8","doi-asserted-by":"publisher","first-page":"638","DOI":"10.3109\/0142159X.2010.501190","volume":"32","author":"JR Frank","year":"2010","unstructured":"Frank JR, Snell LS, Ten Cate O, Holmboe ES, Carraccio C, Swing SR, Harris P, Glasgow NJ, Campbell C, Dath D, Harden RM, Iobst W, Long DM, Mungroo R, Richardson DL, Sherbino J, Silver I, Taber S, Talbot M, Harris KA. Competency-based medical education: theory to practice. Med Teach. 2010;32(8):638\u201345. https:\/\/doi.org\/10.3109\/0142159X.2010.501190.","journal-title":"Med Teach"},{"issue":"8","key":"10173_CR9","doi-asserted-by":"publisher","first-page":"651","DOI":"10.3109\/0142159X.2010.500709","volume":"32","author":"WF Iobst","year":"2010","unstructured":"Iobst WF, Sherbino J, Ten Cate O, Richardson DL, Dath D, Swing SR, Harris P, Mungroo R, Holmboe ES, Frank JR. Competency-based medical education in postgraduate medical education. Med Teach. 2010;32(8):651\u20136. https:\/\/doi.org\/10.3109\/0142159X.2010.500709.","journal-title":"Med Teach"},{"key":"10173_CR10","unstructured":"Quality Matters. Specific review standards from the QM higher education rubric. 7th ed. Annapolis (MD): Quality Matters. 2023. Available from: https:\/\/www.qualitymatters.org\/qa-resources\/rubric-standards."},{"key":"10173_CR11","unstructured":"Fang B, Broussard K. Augmented course design: using AI to boost efficiency and expand capacity. EDUCAUSE Review. 2024. Available from: https:\/\/er.educause.edu\/articles\/2024\/8\/augmented-course-design-using-ai-to-boost-efficiency-and-expand-capacity."}],"container-title":["BMC Medical Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12909-026-10173-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-026-10173-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-026-10173-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:28:24Z","timestamp":1790843304000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12909-026-10173-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["10173"],"URL":"https:\/\/doi.org\/10.1186\/s12909-026-10173-2","relation":{},"ISSN":["1472-6920"],"issn-type":[{"value":"1472-6920","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"assertion":[{"value":"20 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable. This article is a conceptual, methodological contribution and did not involve human participants, their data or biological material, or animal subjects.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. This study did not include any individual person\u2019s data in any form.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare the following competing interest: INSPIRE is a methodology developed by the authors at the Saudi Commission for Health Specialties, and the authors hold a commercial interest in the methodology and may seek to commercialize it in the future. The authors declare no other competing interests related to this work.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1559"}}