Objectives:This study is aimed to assess differences in patient-centered attitudes between students using linear virtual patients focused on the patient's perspective and those participating in role-play, compare satisfaction with the methods, and explore students' perceptions. Methods:A mixed-methods study was conducted among third-year medical students attending a communication course. Students were randomly allocated to either the virtual patient or the role-play group. In total, 122 students participated. Patient-centered attitudes were assessed before and after the intervention using the Patient-Practitioner Orientation Scale. Satisfaction was measured using a 7-point questionnaire. Six students participated in semi-structured interviews. Quantitative data were analyzed using nonparametric tests and equivalence testing, while qualitative were analyzed using thematic analysis. Results:No differences were observed between the groups in patient-centered attitudes either before or after the intervention. Equivalence testing indicated that outcomes for both teaching methods fell within a predefined equivalence margin of 0.5 points on the Patient-Practitioner Orientation Scale. Students in the role-play group reported higher satisfaction (role-play: median 5.65, IQR = 5.00-6.09; virtual patients: median 5.06, IQR = 4.24-5.62; p = .001). Qualitative interviews revealed that students valued role-play for interpersonal engagement, virtual patients were appreciated for reducing stress and supporting reflective learning. Conclusions:Methods produced equivalent effects on patient-centered attitudes. Although students expressed a preference for role-play due to its realism, they recognized the reflective and low-stress advantages of virtual patients. Future research should explore hybrid approaches.
Objectives:The objective of this scoping review was to explore: (1) the nature and purposes of metacognitive regulation in clinical reasoning activities in Physical Therapy, and (2) the breadth and diversity of methods and tools used to assess metacognitive regulation in clinical reasoning activities in Physical Therapy. Methods:The nine steps of the JBI guideline and the Prisma-Scr checklist were used. The Pubmed, Google Scholar, PsycINFO, EBSCO, and ERIC databases were queried. Resources published after 2000, in English and French, were searched using a broad range of terms defining metacognitive regulation. Two researchers carried out the parallel and blinded selection and extraction of data concerning the nature of metacognitive regulation (timing, type, task characteristics) and its purposes, as well as assessment methods and tools. Results:Of the 1,025 identified articles, 36 were analyzed. An integrative model was created, synthesizing the relationships between five key characteristics: the type, timing, task, focal, interaction, and purposes of metacognitive regulation. Assessment methods showed diversity, while remaining underdeveloped overall. Conclusions:This research formalizes a conceptual framework specific to Physical Therapists metacognitive regulation during clinical reasoning. It establishes a framework and synthesizes existing tools, opening up possible avenues to clarify and develop metacognitive regulation, or engage in research in the field of education.
Objectives:This study aimed to (1) develop and validate educationally sound and feasible model session plans for patient safety learning in Japanese undergraduate medical education and (2) identify barriers to their implementation in educational settings. Methods:A convergent mixed-methods design was embedded within a modified Delphi study. Four session plans based on Merrill's First Principles of Instruction were evaluated by 45 patient safety specialists and faculty purposively sampled from Japanese national university hospitals. Participants assessed plans using a 14-item Context-Input-Process-Product checklist. Items were rated on a four-point scale; consensus was defined as a mean score ≥ 3.5 and a standard deviation < 1.0. Simultaneously, open-ended comments on implementation challenges were analyzed using directed content analysis based on Steinert's framework for educational barriers. Quantitative and qualitative data were integrated using a joint display to derive meta-inferences. Results:All four sessions met consensus criteria in the first round (n = 36; response rate = 80%). Topics covered human error, incident reporting, root cause analysis, and conflict management. Analysis identified 13 subthemes across five domains-teacher, student, knowledge, attitude, and system. Key barriers included limited faculty facilitation experience, insufficient linkage to safety practice, and institutional constraints such as lack of formal educational roles for safety specialists. Conclusions:The validated sessions demonstrated strong feasibility. However, content readiness alone does not guarantee successful adoption. Addressing identified barriers through targeted faculty development focusing on facilitation skills and organizational alignment is necessary to achieve sustainable implementation of patient safety education in undergraduate programs.
Objectives:The objective is to identify what is needed in Cultural Competence Curricula in medical schools and suggest a framework for evidence-based curricula that can be flexibly applied. Methods:We conducted a scoping literature review of Cultural Competence Curricula in United States medical schools. After reviewing 160 articles, 77 met inclusion criteria for analysis. We collected qualitative data on curricula described in each article to analyze elements of curriculum structure, evaluation, and study design. Results:Our results illustrate a high prevalence of structure styles conducive for quality learning, including longitudinality, integration, incorporation into clinical training, and experiential learning. The most common method for evaluating student learning was student self-evaluation with few programs performing reevaluations or utilizing patients as evaluators. Of knowledge, attitudes and skills, skills were least evaluated. Curricula with higher self-reported efficacy used a greater proportion of self-evaluations, while ones with lower self-reported efficacy used more external evaluations. Quasi-experimental study designs were more common in curricula with high self-reported efficacy. Conclusions:Curriculum developers across the world can improve implementation of Cultural Competency Curricula by maximizing the quantity of structural components, having higher quality of evaluation, and connecting with the local community surrounding their medical school. To develop a robust curriculum, we encourage longitudinal multi-component learning in integrated courses evaluated via experimental and quasi-experimental study designs.
Objectives:To develop and content-validate a consensus-based, Self-Determination Theory (SDT)-informed single-session coaching framework for the transition from medical school to residency (TTR). Methods:We conducted a modified Delphi study with 13 medical educators from 11 U.S. medical schools, purposively sampled for diversity of geography, institutional type, and coaching infrastructure. Eligibility required experience coaching in medical education. Using a nominal group technique, panelists generated 125 prompts and 12 skills across the coaching arc (opening, exploring, planning, closing). Duplicates were consolidated by consensus rules. In Round 1, panelists rated items on a 1-10 scale; consensus was >80% rating 9-10. In Rounds 2-3, binary yes/no voting determined inclusion or exclusion. Quantitative analysis included medians, interquartile ranges, and Kendall's coefficient of concordance (W) for Round 1. Qualitative comments were analyzed with rapid content analysis to guide revisions. Results:All panelists completed each round (100% retention). In Round 1, 17 questions and 2 skills met consensus (median = 9, IQR 0-1; W = 0.78). Round 2 retained 2 questions and 1 skill, and excluded 62 items. Round 3 added 6 questions and 1 skill, yielding a final framework of 25 prompts and 4 skills. Prompts were distributed across phases (opening 5, exploring 9, planning 7, closing 4) and mapped to SDT needs (autonomy 9, competence 8, relatedness 8). Panelists affirmed clarity, feasibility, and acceptability for non-coach faculty. Conclusions:This consensus-derived framework provides a pragmatic, SDT-grounded tool for coaching at the TTR. Future studies should evaluate feasibility, fidelity, and learner outcomes.
Objectives:To examine stressors and coping skills as reflected in the student population at a southeastern United States medical school, including identifying key stressors over time and coping mechanisms used. Methods:Repeated cross-sectional cohort, mixed-methods study conducted between 2016 and 2022 at a four-year medical school program. Participants were students from seven classes, with two classes providing data during each of their four years of medical school. A census sampling approach was used, with survey data collected annually from each class across four years. Two surveys were used: the Perceived Stress Scale (PSS) and a modified Coping Orientation to Problems Experienced (COPE) Inventory. Open-text questions captured qualitative responses. Statistical analysis included Welch's t-tests, Pearson correlations, and Cronbach's alpha reliability testing. Qualitative data were examined through inductive thematic analysis. Results:Students reported moderate levels of perceived stress across all four years with fluctuations identified by year of study. There were no statistically significant differences in perceived stress based on student gender; however, qualitative findings identified gender differences related to coping strategies. Thematic analysis of qualitative data revealed three recurring categories of stressors: academic workload, residency application and match pressures, and personal life challenges. Stressors shifted from academic in the pre-clinical years to career concerns during the clinical years. Conclusions:This study highlights the presence of stress throughout medical school and underscores the importance of adaptive coping strategies and the need for phase-specific interventions to support student well-being. Future research should evaluate the effectiveness of interventions in reducing stress across training stages.
Objectives:This study aimed to identify and compare the perceptions of senior, middle, and frontline managers regarding the core competencies required for effective healthcare middle managers in Bahrain and Saudi Arabia. It also explored how these competencies can inform competency-based leadership development programs globally. Methods:A qualitative descriptive design was adopted. Twenty-seven participants from healthcare and medical education institutions in Bahrain and Saudi Arabia were purposively selected across three hierarchical levels: senior (n = 6, 22%), middle (n = 10, 37%), and frontline (n = 11, 41%). Semi-structured interviews were conducted virtually, audio-recorded, transcribed verbatim, and analyzed thematically using Braun and Clarke's six-step framework. Credibility was strengthened through member checking, peer debriefing, and an audit trail. Results:Five overarching competency domains emerged in the study. They include personality, managerial skills, work ethics, mental ability and interaction. Personality, integrity, and organizational ability were the most frequently cited traits (93%). Managerial and social competencies such as time management (90%), teamwork (83%), communication (70%), and decision-making (60%) were emphasized across all managerial levels. Senior managers prioritized strategic agility and ethics, whereas frontline managers stressed interaction and communication. These patterns reflect the dual operational and relational demands of middle management in healthcare. Conclusions:Successful healthcare middle managers require a balanced integration of technical proficiency, ethical integrity, interpersonal competence, and adaptability. Embedding these domains into competency-based leadership training could enhance organizational performance and strengthen healthcare governance across the region.
Objectives:To explore the effectiveness of overall faculty development (FD) programs in terms of three indicators of successful careers of clinical teachers (CTs): positive feedback (on personality traits or teaching skills) from students, teaching awards, and scholarly publications. Methods:Data on student feedback, number of teaching awards, number of scholarly publications, and sum of FD participation hours in a teaching hospital with 23 clinical departments and 623 clinical faculty members (2019-2021) were collected and analyzed using Spearman's rank-order correlation coefficient (rs) and independent-samples t-tests (with Welch's correction where appropriate). Results:The sum of FD hours was significantly associated with positive feedback from students (rs = 0.15, p = .001) but not with teaching awards or publications. Furthermore, faculty members with more FD hours on research skills received better positive feedback from students regarding personal traits or teaching skills (Cohen's d = 0.60, 95% CI [0.34, 0.86], p < .001) and more teaching awards (Cohen's d = 0.34, 95 % CI [0.13, 0.55], p = .010) but did not have a greater number of publications (Cohen's d = 0.15, 95% CI [-0.07, 0.36], p = .780) than those with lower research FD hours. In addition, the number of teaching awards was significantly associated with positive feedback from students regarding personal traits (rs = 0.92, p < .001) or teaching skills (rs = 0.93, p < .001), and publication quantity (rs = 0.13, p < .001) was markedly correlated with the number of teaching awards. Conclusions:FD activities may provide positive impacts on CTs in terms of feedback from students and teaching awards but do not directly impact scholarly publications. However, faculty members who received teaching awards and positive feedback from students may have better scholarly publication performance.
Objectives:This study explores the application of the current curriculum, launched in 2016, for interprofessional learning (IPL) at the Faculty of Medicine and Health Sciences at Linköping University, Sweden. Methods:Perceptions from students, teachers and key persons (n=19) were investigated with focus groups and individual interviews. The interviews explored perceptions of curriculum design, implementation, and interprofessional learning activities. A four-dimensional framework for curriculum development and evaluation constituted the theoretical lens for the analysis. Specifically, a qualitative directed content analysis was used. Results:Four overarching categories were identified. 1) "Aiming towards high quality healthcare professionals working together naturally", included the arguments for IPL within healthcare and why the curriculum revision was conducted. 2) "Comprehending how to work in a group, a team, and an interprofessional team", related to the desired learning outcomes and competencies. 3) "All on board? - The search for meaningful learning activities for students and teachers that the programs embrace", reflected on how learning activities were designed and experienced. 4) "Enhancing legitimacy and the provision of organizational prerequisites for the curriculum", described the organisational structures for enhancing the legitimacy of the IPL curriculum, as well as the role of teachers. Conclusions:This study emphasizes balancing pedagogical innovation with pragmatic considerations for successful curriculum application. The findings highlight the need for experienced teachers, organisational support, and meaningful learning activities that align with both program-specific and interprofessional outcomes. Despite challenges, the current curriculum at Linköping University shows potential as a model for integrating interprofessional learning into health professions education.
Objectives:This study aimed to elucidate, through qualitative analysis, the cognitive processes by which experienced oncology nurses regulate their emotions when facing anxiety and emotional conflict in communication with patients. Methods:We employed a qualitative exploratory design using semi-structured individual interviews with six certified oncology nurses in Japan. Participants were recruited via snowball sampling and provided written informed consent. Interviews were conducted in Japanese using a pre-tested interview guide; audio data were transcribed verbatim. Data were analyzed with the Steps for Coding and Theorization (SCAT) method. Metacognitive theory-distinguishing metacognitive knowledge and metacognitive regulation-guided interpretation of the findings. Results:Analysis of 38 theoretical descriptions yielded two overarching themes: (1) anxiety and conflict in communication with cancer patients, and (2) metacognitive emotion-regulation strategies. The latter comprised two subthemes: (a) patient-oriented cognitive strategies (e.g., linguistic adjustments, trust-building, facilitating patients' self-regulation), and (b) self-oriented cognitive restructuring (e.g., reframing dilemmas, monitoring and modulating one's own emotional responses). These processes reflected deliberate monitoring and regulation of thinking and feelings to sustain constructive engagement with patients. Conclusions:Experienced oncology nurses use metacognition to recognize, interpret, and flexibly regulate emotions in challenging interpersonal situations. Educational implications include integrating structured metacognitive reflection alongside empathy and mindfulness training to cultivate durable, transferable coping skills. Future studies should examine this approach in diverse clinical contexts, include larger and cross-cultural samples, and evaluate longer-term outcomes in nurses' emotional resilience and clinical practice.
Objectives:This study aims to explore the preparedness of faculty in health professions education at three Malaysian universities by assessing their perceptions of basic concepts in microlearning as well as factors affecting effective content construction and digital format preferences. Methods:An explanatory sequential mixed-method approach was used to systematically analyse faculty perceptions by integrating quantitative and qualitative findings. A total of 121 faculty members voluntarily completed the online survey. A qualitative exploratory study was conducted with 20 selected staff members, followed by a thematic analysis. Descriptive and analytical statistics, including Pearson's chi-square test, were used to analyse the data. Results:The survey revealed that 95.9% (n=116) of faculty members agreed that microlearning is ideal for the acquisition of microcontent with single learning outcomes. The optimal duration should be between 3 and 5 minutes. Strong associations [χ2(16, N=121) =33.17, p=0.007] between time duration and content size and content size and form of knowledge [χ2(16, N=121) =28.79, p=0.025] were observed in chi-square goodness-of-fit test. Microcontent of a single learning outcome, chunking of content, cognitive load, and degree to which topic connects with the media used emerged as primary sub-themes. Challenges in adapting skills to construct engaging microlearning content were highlighted. Conclusions:The study provides a microlearning framework for health professional educators to consider the complexity of content, its format, and integration with suitable digital tools. Future research should explore how combinations of microlearning and other instructional formats optimise learning outcomes.
Objectives:To address the problem of medical school applicants' lying about their reasons for becoming physicians in the admissions process, this study aims to explore the grounds for their reasons by distinguishing between their beliefs and statements. Methods:The participants, recruited by convenience sampling, were 15 medical students and physicians who had entered graduate-entry programs of medical schools in Japan. We conducted individual semi-structured online interviews in 2020 and performed a reflexive thematic analysis. Results:We generated five themes regarding the grounds for applicants' reasons in their beliefs: consistency with past interests, experience of being underprivileged, experience of family disease, parental influence, and no grounds; four themes regarding the grounds for applicants' true reasons in their statements: consistency with actual past interests, actual experience of being underprivileged, actual experience of family disease, and actual experience of being powerless for patients; and four themes regarding the grounds for applicants' untrue reasons in their statements: consistency with actual or fictional past interests, actual experience of family disease, fictional parental influence, and convenient origin. Conclusions:This study is the first to distinguish between applicants' beliefs and statements and analyze the grounds for their reasons for becoming physicians. The findings propose a reconstruction of the concept of reasons for becoming physicians and suggest that admissions committees may be able to verify applicants' reasons in their statements by asking them to present the grounds for them.
Objectives:This study aimed to develop a reliable and valid scale to assess nurses' information ethics behavior, facilitating self-reflection and supporting the application of ethical principles in clinical settings involving digital information management. Methods:A scale development study with exploratory factor analysis was conducted in 2023, targeting 1,464 hospital-based and home-visit nurses across Japan. Participants completed a preliminary version of the Information Ethics Behavior Evaluation Scale for Nurses along with demographic questions. Item analysis and exploratory factor analysis (EFA) using the alpha factor extraction method and promax rotation were performed. Criterion-related validity was assessed via Spearman's rank-order correlation with the Self-Evaluation Scale for Ethical Behavior as a Nurse. Results:Valid responses were obtained from 427 participants. Item analysis led to the exclusion of 14 items due to low factor loadings or double loading. EFA identified a three-factor structure comprising 21 items: (1) conscious behavior in handling information, (2) appropriate information management, and (3) response to information leakage risk. The scale demonstrated strong internal consistency (Cronbach's α = .86). Criterion-related validity was supported by a significant correlation with the external measure (rs = .74, p < .001). Conclusions:The Information Ethics Behavior Evaluation Scale for Nurses is a brief, reliable, and valid tool for assessing ethical conduct related to information handling in nursing practice. It provides a framework for ethical self-assessment and may contribute to the prevention of information breaches and the promotion of ethical decision-making. Further research should investigate the integration of digital literacy and internet-specific ethical competencies.
Objectives:This study investigated the perspectives of residents on training in error managing. The research question was: how do residents perceive and experience their training in handling errors in clinical practice? Methods:The study used a qualitative exploratory design to gain insight into the residents' experiences. The data consisted in seven virtual focus groups with 22 Danish residents from 11 specialties at various educational levels, i.e. from first to fourth year of their training. The data were transcribed and analyzed using reflexive thematic analysis. Results:The analysis showed three themes: 1) formal education, 2) culture and clinical context, and 3) the need for more training. The residents reported learning primarily about the legal aspects of errors, complaints, and the adverse events reporting system. They emphasized the need for practical training in error disclosure and managing emotional reactions to errors. Training in error managing was described as sporadic in specialist training, often contingent on departmental culture and individual supervisors. Conclusion:The study revealed that residents perceive their training in error handling as inadequate, particularly in terms of disclosure, emotional reactions, and victim support, and identified the need for greater emphasis on these aspects in both undergraduate education and postgraduate training. The Danish framework for physician roles and specialist training curricula should be revised and a more open culture regarding medical errors fostered. Furthermore, supervisor training is crucial as training in error management should be integrated into the clinical setting where errors occur.
Objectives:This quasi-experimental study evaluated the impact of simulation-based emergency training on novice critical care nurses' knowledge, skills, and confidence compared to traditional clinical teaching, aiming to enhance their preparedness for high-pressure emergency scenarios. Methods:A pretest-posttest non-equivalent control group design was conducted in a Taiwan medical center's critical care unit from October 2023 to January 2024. Sixty-seven nurses with less than two years of experience were recruited via convenience sampling and assigned to an experimental group (n=32, simulation-based training) or a control group (n=35, traditional teaching). The experimental group underwent an OSCE-based intervention with three stations. Data were collected using the Nursing Competency Questionnaire, OSCE scoring rubric, and Learning Satisfaction Scale. Paired and independent t-tests with effect sizes (Cohen's d) were used for analysis. Results:The simulation group showed significant improvements in skills (t(31) = 1.92, p = .016, d = .34) and confidence (t(31) = 2.92, p = .004, d = .40); the traditional group improved in confidence only (t(34) = 2.24, p = .027, d = .33). No significant between-group differences were found (e.g., skills: t(65) = 1.29, p = .201, d = .33). Conclusions:Simulation-based training effectively enhances skills and confidence in novice critical care nurses, complementing traditional methods. Integrating both approaches can optimize training outcomes, improving patient safety and nurse retention in medical education. These findings advocate for incorporating simulation into nursing curricula to better prepare novice nurses for emergency care. Future research should explore multi-center studies with objective measures.
Objectives:To explore how clinical instructors in emergency medicine perceive and integrate Entrustable Professional Activities (EPAs) into their teaching practices, identify challenges they face, and explore the support required for effective implementation. Methods:This study utilized grounded theory methodology to explore the pedagogical experiences of clinical instructors within emergency medicine. A qualitative approach was adopted, involving semi-structured interviews with participants recruited through purposive and snowball sampling techniques. A total of 18 emergency physicians, each with over five years of clinical teaching experience in a teaching hospital, were included in the study. Results:The study revealed several critical insights: (a) Emergency medicine clinical instructors are integral in supervising, training, and providing feedback to residents, facilitating their development. (b) The implementation of EPAs is hindered by limited resources, time constraints, and the challenges of delivering real-time feedback. Instructors often experience a lack of confidence in their teaching efficacy, observe diminished motivation among residents, and encounter difficulties in assessing residents' soft skills. (c) The effective implementation of EPAs necessitates a supportive educational environment, a robust reward system, and objective feedback mechanisms. (d) Instructors derive a significant sense of fulfillment from witnessing the progression of residents into competent and autonomous practitioners, underscoring the importance of empowering educators through enhanced training and institutional support. Conclusions:The findings offer valuable insights for developing of emergency medical education programs and underscore the need for targeted strategies to enhance the quality of clinical instruction in emergency settings.
Objectives:This study aims to enhance our understanding of how educational supervision operates from the perspective of medical residents, and how they engage with it within the context of implementing competency-based medical education. Methods:We conducted a qualitative research study following the principles of grounded theory methodology. Participants were recruited from national residency training courses. Data was collected using an electronically distributed questionnaire with open-ended questions, which invited respondents to share their experiences with educational supervision. 96 written narrative responses were applicable for analysis. Results:We identified three categories indicative of residents' experiences with educational supervision: I) Access to educational supervision, II) Links between quality of educational supervision and organisational facilitation, and III) Pushbacks to educational supervision and how residents cope with pushbacks. Residents' experiences varied significantly. When educational supervision was well-organised and available, residents managed to express how educational supervision enhanced their education. However, many residents struggled to access educational supervision (ES). Conclusion: When educational supervision is integrated into clinical practice, residents perceive its benefit to their education. Conversely, inadequate organisation of educational supervision forces residents to expend significant effort to ensure meetings occur. Amidst the implementation of competency-based medical education, residents risk being left with the individual responsibility to initiate and sustain educational supervision, which in turn places an undue burden on trainees to navigate repeated pushbacks, and workplace cultures that devalues educational support. Further research is needed to explore the affordances relevant for different medical specialties, and observational studies are much needed as a complement to self-reported data.
