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Braun has recently argued in this journal that an autonomy-based approach to assisted dying avoids the expressivist objection, namely that limiting access to assisted dying to those with irremediable suffering contains the implicit judgement that this suffering makes their life less worthy of living. Contrastingly, the autonomy-based approach would remove these beneficence-based constraints and allow assisted dying to be provided to anyone who requests it. In short, this provision would be shorn of any objective judgement and instead be provided according to the patient's subjective, autonomous preferences. Against this, Donaldson has argued that Braun's apparently autonomy-based approach does not escape the expressivist objection. Instead, because a doctor may acquiesce to or decline a request, their participation necessarily implies a judgement that a particular patient's assisted death is a good (or not bad) thing. This judgement by the doctor, like beneficence-based limits on eligibility, necessarily implies that the patient's life is less worthwhile. In this paper, I argue, contra Donaldson, that the autonomy-based approach advanced by Braun can still avoid the expressivist objection. Specifically, I argue that Donaldson implicitly adopts a particular conception of autonomy's value-the catalytic approach-which considers autonomy only in terms of the goals its exercise pursues. Here, I propose a plausible alternative-the intrinsic approach-which considers autonomy as valuable as its own end. This approach contends that a doctor can provide assisted suicide based on a commitment to respecting a patient's autonomy, without endorsing their assisted death as a worthwhile end.
Women's autonomy in healthcare decision-making is a key determinant of maternal and reproductive health outcomes in Somalia. This study examined the level of women's autonomy and its associated factors using nationally representative data. A cross-sectional study was conducted using data from the 2020 Somalia Demographic and Health Survey, including 32,272 women aged 15-49 years. Data were analyzed using STATA version 17, accounting for sampling weights. Multinomial logistic regression was used, and results were reported as Relative Risk Ratios (RRRs) with 95% Confidence Intervals (CIs). Overall, 15.3% of women made healthcare decisions independently, 32.9% made decisions jointly, and 51.8% had decisions made by others. Older women aged 45-49 years were more likely to make independent decisions compared to those aged 15-19 (RRR = 1.93; 95% CI: 1.42-2.62). Urban residence was associated with higher autonomy (RRR = 1.17; 95% CI: 1.07-1.28). Women in the highest wealth quintile had a higher likelihood of independent decision-making compared to the lowest quintile (RRR = 2.68; 95% CI: 2.36-3.03). Higher maternal education was also significantly associated with increased autonomy. Women's autonomy in healthcare decision-making in Somalia remains limited and is associated with socio-demographic and economic factors. Interventions focusing on improving women's education, economic empowerment, and access to healthcare services may enhance autonomy and improve health outcomes.
Canada's Assisted Human Reproduction Act prohibits nonmedical sex selection to prevent gender discrimination and demographic imbalance. While rooted in the precautionary principle, this ban was shaped by contexts with strong cultural sex bias; however, contemporary Canada exhibits high gender equality and stable sex ratios, necessitating a re-evaluation of this blanket prohibition. This paper examines the ethical justification for Canada's prohibition on nonmedical sex selection, focusing on family balancing, and explores whether a regulated framework could align with reproductive autonomy without compromising gender equality. Demographic data confirm a balanced sex ratio in Canada, with no evidence of systemic gender preference. North American data indicate that nonmedical sex selection requests are balanced between sexes, primarily motivated by "family balancing" the desire for a child of the sex the parents do not already have. In this context, such requests reflect reproductive autonomy and psychosocial well-being rather than discriminatory intent. Ethical principles of autonomy and proportionality support reconsidering whether current legislation remains calibrated to social realities, particularly given the availability of non-invasive prenatal screening (NIPS) and the potential for harm reduction compared to existing "diagnostic termination" pathways. Furthermore, the current prohibition inadvertently fosters cross-border reproductive care and exacerbates socioeconomic inequalities. This article calls for an evidence-based policy review that offers a balanced alternative with robust guardrails, respecting individual reproductive autonomy while upholding Canada's commitment to gender equality.
This study examines whether hospitals with and without managerial autonomy operate under distinct production technologies and achieve different efficiency outcomes. It also analyses whether they face differing structural or technological constraints within a universally accessible, publicly funded health system. A dynamic metafrontier data envelopment analysis framework is applied to a panel of 213 general hospitals within the Spanish National Health System over seven years. The results indicate that hospitals with managerial autonomy exhibit higher technical efficiency, operate closer to the system-wide potential frontier and function under distinct production technologies compared with traditional hospitals governed by public administration. These patterns remain largely stable over the period analysed. Organisational and governance arrangements are strongly associated with differences in hospital performance. Greater managerial flexibility is related to fewer structural constraints on efficiency, even within a common regulatory and financing framework. These findings are relevant for health system managers and policymakers concerned with hospital governance and organisational design. This study contributes to the literature by analysing managerial autonomy as a source of technological heterogeneity in hospitals within a universally accessible, publicly funded health system. Applying a dynamic metafrontier data envelopment analysis framework provides new empirical evidence on the relationship between organisational and governance arrangements and efficiency, as well as on the structural conditions in which efficiency is observed, offering insights into the ongoing debate on hospital autonomy and governance.
Research has shown that robots are perceived negatively when they are less socially skilled or more autonomous than users expect them to be. However, little is known about worker expectations of robot social skills and autonomy as developments in the field have been mostly guided by technological progress without addressing future users' perspectives. Building on the literature on social skills for robots and humans, we propose a taxonomy for robot social skills and investigate the extent to which this taxonomy is reflected in employees' expectations of social robots in a qualitative interview study of 20 workers from the hospitality, manufacturing, and care industries. Our results show that workers are able to provide specific preferences when discussing future robot use in their workplace. We argue that some basic robot social skills can be broadly implemented and derive a provisional set of technical requirements. Results also suggest that a robot's degree of autonomy needs to be finely tuned to the context and its task.
In this study, we aimed to evaluate whether prior periodontal treatment experience was associated with patients' autonomy preference (AP) in clinical decision-making among individuals with stage III/IV periodontitis. This cross-sectional, questionnaire-based observational study included 146 patients with stage III/IV periodontitis who were categorised into treatment-naive and -experienced groups according to prior periodontal treatment history. Participants completed structured surveys assessing sociodemographic, medical, and oral health factors. AP was measured using a standardised scenario-based score featuring mild, moderate, and severe periodontal vignettes. Data were analysed using multivariable linear regression and propensity score weighting. In multivariable linear regression, prior periodontal treatment experience was significantly associated with a higher AP scenario score (P = .042), and this finding was supported by propensity score weighting. Higher AP in the treatment-experienced group was most evident in the mild scenarios, particularly for clinical scheduling (P = .026) and adjunctive care decisions (P = .002). However, as disease severity increased, AP diminished, with both groups universally relying on clinician-led decisions in severe cases. Prior periodontal treatment experience was independently associated with higher AP, with the association being most evident in mild periodontal scenarios. Prior periodontal treatment experience may enhance patient participation in periodontal decision-making, supporting more individualised shared decision-making in clinical practice.
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Clinical supervision is a key component in the professional development of speech-language pathology students. However, little is known about the quality of supervision in Spanish undergraduate programs, the pedagogical strategies employed, and the extent to which clinical placements meet students' expectations for competency development. To evaluate clinical supervision during pre-professional internships in Speech-Language Pathology degrees in Spain from the perspective of graduates, analyzing the most valued aspects, areas for improvement, and the gap between lived experience and perceived importance. A total of 503 graduates completed a 20-item questionnaire assessing experience and perceived importance across five dimensions: supervisory strategies, supervisory style, autonomy, feedback, and therapeutic context. The instrument underwent content validation, internal consistency analysis, test-retest reliability, exploratory factor analysis, and comparisons between experience and importance. All importance ratings were significantly higher than experience ratings (p < 0.001). The largest discrepancies were observed in feedback and therapeutic context, followed by supervisory style and strategies; autonomy showed a smaller but still significant gap. Only 32% of participants felt professional at the end of their internships. Healthcare and social-healthcare settings were rated higher than educational settings. Results highlight a systematic mismatch between what graduates experienced and what they consider essential for high-quality training. Improving clinical placements requires strengthening structured and reflective feedback, promoting rich and interprofessional learning environments, and adjusting supervisory style and strategies to levels of student autonomy. Findings support the implementation of evidence-based supervision models to enhance clinical training in speech-language pathology. What is already known on this subject Clinical supervision is a critical component of speech-language pathology training, and high-quality supervision supports the development of clinical competence and professional identity. However, limited empirical evidence exists regarding the structure, quality, and characteristics of supervision in Spanish-speaking undergraduate programs, particularly from the perspective of graduates. What this study adds to existing knowledge This study provides large-scale evidence-based on data from 503 graduates-of a systematic and substantial mismatch between the supervision students experienced and the importance they attribute to key supervisory dimensions, using a newly developed and psychometrically validated graduate survey. It identifies the dimensions with the largest discrepancies (feedback, therapeutic context, and supervisory style) and offers clear, empirically grounded priorities for improving supervision in speech-language pathology education. What are the clinical implications of this work? Findings emphasize the need for supervision practices that provide structured and specific feedback, ensure diverse and supportive clinical environments, and adapt supervisory approaches according to students autonomy levels. These insights can guide program development, supervisor training, and quality assurance processes to improve clinical learning experiences and better prepare students for professional practice.
Shared decision-making (SDM) in mainland Chinese clinical contexts is characterized by a persistent ethical tension between Confucian familism, which prioritizes collective family interests, and the Western principle of patient autonomy, which emphasizes individual rights. This tension has led to widespread clinical challenges, including family-driven protective information concealment and ambiguous boundaries between supportive and intrusive family involvement. Current literature lacks an integrated, culturally responsive framework to reconcile these tensions. This study therefore develops a Confucian ren-based model that harmonizes patient autonomy with familial values within Chinese healthcare settings. We employed a dual methodology of theoretical reconstruction and clinical case analysis. First, we elucidated the conceptual structure, strengths, and limitations of Confucian benevolence ethics (e.g., familism, filial piety, graded love) in medical decision-making. Second, illustrative clinical cases were examined to assess the consequences of excessive family intervention on autonomy and outcomes. Finally, a cross-culturally informed model was developed through critical engagement with the Whānau Ora approach (New Zealand) and Hong Kong's "moderate familism" practice. Two illustrative clinical cases from mainland Chinese practice are analyzed to demonstrate how the proposed model addresses real-world ethical dilemmas. We propose a tiered collaborative decision‑making model centered on patient autonomy, with moderated family involvement serving as a flexible boundary. Ethical prioritization varies by context. (1) For routine treatment decisions, family‑led decision‑making, supported by structured family meeting documentation, is applied when patients delegate authority or lack capacity, thereby ensuring cultural alignment and efficiency. (2) In high‑risk interventions, mandatory tripartite shared decision‑making (clinician-patient-family) is initiated, utilizing decision aids to integrate clinical evidence, patient values, and familial concerns. (3) For end‑of‑life care, advance directives take precedence, with multidisciplinary ethics committees mediating disagreements. This framework repositions Confucian relational ethics as a resource for reinforcing patient subjectivity, establishing a "moderate familism" model that harmonizes patient, family, and clinician roles. It not only addresses institutional contradictions between legal individualism and cultural collectivism in Chinese medical practice but also offers a multicultural-sensitive paradigm for global bioethics.
Enhancing nursing expertise contributes to the advancement of healthcare as a whole. Therefore, it is crucial that nurses be able to perform specialized tasks. However, the factors related to nursing profession self-efficacy are insufficiently understood. This study aimed to theoretically and comprehensively examine the factors associated with nursing profession self-efficacy. This cross-sectional study involved 325 nurses from seven facilities in the Chubu region of Japan. Based on prior research, factors influencing nursing profession self-efficacy were established as professional autonomy, communication skills with patients, work motivation, self‑education, perceived stress, and basic attributes. Data were analyzed using descriptive statistics, nonparametric tests, and multiple regression analysis. Nursing profession self-efficacy was positively associated with work motivation (β = 0.384), self‑education (β = 0.246), professional autonomy (β = 0.236), and communication skills with patients (β = 0.157) (all p <.001). In contrast, perceived stress and basic attributes were not statistically significant in the final model. Model fit indices (R =.756, R2 = 0.571, adjusted R2 = 0.557; Durbin-Watson = 1.988) indicated no issues with residual independence or autocorrelation. This study identified work motivation, self‑education, professional autonomy, and communication skills with patients as factors associated with nursing profession self-efficacy. These findings suggest that workplace environments that support professional meaning in daily work and promote continuous learning may help strengthen nursing profession self-efficacy among nurses. Organizational cultures that encourage autonomous decision-making and educational programs that incorporate practical communication training may also be useful for supporting nursing profession self-efficacy. Not applicable. Not applicable.
Diagnosis-related groups (DRGs) are among the most widely adopted case-mix-based hospital payment systems, introduced to improve efficiency, enhance cost transparency and contain rising healthcare expenditure. Although a substantial body of literature evaluates the economic and system-level effects of DRGs, comparatively less attention has been paid to the perspectives of healthcare providers who work within these reimbursement structures and directly experience their consequences in daily clinical practice. This systematic review synthesises evidence on physicians' and hospital administrators' perspectives of DRG-based payment systems in high-income countries, with particular attention to perceived effects on clinical decision-making, quality of care, administrative workload and professional autonomy. Nursing and allied health perspectives are identified as warranting a separate dedicated review and are not the focus of the present work. The review was conducted in accordance with PRISMA 2020 guidelines and registered with PROSPERO (CRD42024575025). Six electronic databases (PubMed, Scopus, Web of Science, CINAHL, Embase and ProQuest) were searched for English-language studies published between 1994 and 2024. Qualitative, quantitative and mixed-methods studies reporting provider or hospital-level perspectives on DRG implementation were included. Methodological quality was assessed using the Joanna Briggs Institute (JBI) appraisal tools and risk of bias was assessed using the ROBINS-I tool. The Mixed Methods Appraisal Tool (MMAT) was available for mixed-methods studies, though none were ultimately included. Findings were synthesised narratively using thematic aggregation. Twelve studies from approximately 25 high-income countries met the inclusion criteria. Healthcare providers acknowledged several benefits of DRG systems, including improved cost transparency, more standardised care pathways and incentives for efficiency. However, concerns were consistently raised regarding increased administrative workload, reduced clinical autonomy, financial pressure to shorten length of stay and potential risks to care quality, particularly for complex or severely ill patients. Provider acceptance of DRGs varied substantially across settings and was strongly influenced by local system design, training, coding infrastructure and alignment with professional values. From the perspective of physicians and hospital administrators, DRG-based payment systems represent a trade-off between economic rationalisation and clinical discretion. Although DRGs can support efficiency and accountability, their success depends critically on thoughtful system design, adequate training, robust data infrastructure and ongoing engagement with providers to safeguard care quality and professional autonomy. Nursing and allied health perspectives, which the available evidence base did not allow this review to address adequately, represent an important and underexplored dimension of provider experience with DRG systems and warrant focused future research.
Ensuring high-quality care in assisted living (AL) is a growing priority, yet little is known about factors shaping resident-reported quality of life (QoL). In the United States, Minnesota recently implemented statewide measurement and public reporting of AL resident-reported QoL. Leveraging these unique data, we evaluated resident- and facility-level factors associated with 7 validated QoL domain scores: staff, environment, food, engagement, autonomy, culture, and security. Cross-sectional survey. Eleven thousand six hundred eighty-four AL residents in facilities with more than 5 beds, who participated in the 2024 statewide QoL survey (90% aged ≥65 years, 66% female, and 84% White). We identified resident- and facility-level correlates of AL resident-reported QoL in 7 domains, using multivariable linear mixed regression with facility-level random intercept to account for facility-level clustering. Mean domain-specific QoL scores ranged from 1.6 to 1.9 out of 2, with food and engagement rated lowest and environment highest. Older residents reported significantly higher scores across most QoL domains (β = 0.02-0.08; P < .05). Females rated food and security significantly lower (β = -0.04 and -0.02; P < .05), whereas American Indian/Alaskan Native residents reported significantly lower scores in culture, security, staff, and environment (β = -0.05 to -0.10; P < .05). Smaller facilities (<25 beds) had significantly higher scores in food, staff, and autonomy (β = 0.02-0.07; P < .05). Facilities with dementia care unit licensure had significantly higher food scores but significantly lower autonomy, staff, and security scores (β = - 0.02 to -0.03; P < .05). Our findings indicate sociodemographic differences in AL residents' QoL, with lower QoL among vulnerable subgroups. Patterns in resident-level and facility-level correlates of residents' QoL scores differ by QoL domain, underscoring the need for targeted interventions and policy efforts to enhance resident well-being in AL.
While puzzle-based examinations are increasingly used to promote engagement in anatomy education, the mechanisms underlying their effects on learning and emotional responses remain insufficiently understood. This clarification study aimed to examine how puzzle-based examinations are associated with students' motivation, cognitive processing, and stress regulation, interpreted through the lenses of Self-Determination Theory (SDT), Cognitive Load Theory (CLT), and the Control-Value Theory of Achievement Emotions (CVT). A mixed-methods design was employed with 71 third-year dental students who undertook a puzzle-based anatomy examination. Quantitative data were collected using validated scales assessing intrinsic motivation, cognitive load, and test anxiety in relation to the examination experience. Qualitative data were obtained via open-ended questionnaires and thematically analysed. Codes and themes were deductively mapped to SDT, CLT, and CVT frameworks. Students demonstrated increased intrinsic motivation (mean change +18%, p < 0.01), reduced test anxiety (-15%, p < 0.05), and moderate intrinsic cognitive load. Qualitative analysis yielded three mechanism-related themes: (1) Autonomy and competence support (SDT) - the playful, self-paced problem-solving fostered engagement; (2) Optimised cognitive load (CLT) - visual cues and hints reduced extraneous load, enabling deeper processing; (3) Positive achievement emotions (CVT) - novelty and challenge generated enjoyment and reduced anxiety for most students, though time pressure occasionally triggered negative emotions. These findings suggest that puzzle-based exams are associated with students' learning experiences through mechanisms related to autonomy, competence, cognitive load management, and achievement emotions. These findings offer a theoretical explanation for the associations observed in relation to puzzle-based examinations, supporting their broader application in medical education. Future research should test these mechanisms experimentally and across diverse educational contexts.
Bereaved parents and family members are increasingly engaged as educators in simulation-based communication training, particularly in pediatric palliative care. Their lived experience can deepen learners' understanding of serious illness conversations while raising important ethical questions regarding participant well-being, autonomy, and institutional responsibility. To examine the ethical considerations surrounding bereaved family member participation in pediatric simulation through the perspective of a bereaved spouse serving as a parent-actor and medical educator. This ethical analysis draws upon personal experience within an established pediatric palliative care simulation program and applies the principles of beneficence, non-maleficence, autonomy, and justice to evaluate the opportunities and challenges of incorporating lived experience into communication training. Bereaved family members provide an authenticity that enhances resident learning and encourages more compassionate, family-centered communication. However, meaningful participation requires careful attention to emotional safety, ongoing consent, equitable recognition, and institutional safeguards. Ethical program design includes trauma-informed recruitment, structured preparation and debriefing, appropriate compensation, access to psychological support, and deliberate efforts to broaden participation among diverse family perspectives. The educational value of bereaved family educators depends not simply on their presence but on ethically grounded partnerships that recognize lived experience as expertise. Integrating bereaved family members into simulation programs can strengthen communication training while honoring participant well-being when programs intentionally balance educational benefit with respect, protection, and justice.
The objective of this study is to evaluate the ethical dimensions of reflex and reflective testing (RRT) within the framework of value-based laboratory medicine and in alignment with ISO 15189:2022. The study aims to highlight the challenges in guiding and standardizing these practices in an era of value-based medicine. The ISO 15189:2022 requirements for quality and competence were examined alongside the IFCC Code of Ethics and relevant literature. The ethical evaluation was structured around the four core principles of bioethics: beneficence, non-maleficence, autonomy, and justice. Specific ethical issues related to RRT were identified through expert discussion and compared with the ISO standard. The thorough examination reveals that although ISO 15189:2022 does not use the RRT terminology directly, its requirements provide a robust framework for these interventions. Based on beneficence, non-maleficence, autonomy, and justice, RRT interventions align with ISO 15189:2022 and promote value-based laboratory medicine. Laboratory specialists/professionals must balance the four ethical principles to ensure that the "total testing process" serves the patient's best interest in conformity with ISO 15189:2022. By adopting a strong ethical culture, the profession can successfully transition from being a producer of test results to a key partner in personalized and value-based medicine.
The rapid adoption of conversational AI among adolescents has sparked growing debate about its implications for development and well-being. This article applies a Self-Determination Theory lens to explore how and under which conditions adolescents' conversational AI usage supports or frustrates their basic psychological needs for competence, relatedness, and autonomy. Conversational AI may enhance competence through learning assistance, relatedness through emotional and relational support, and autonomy through increased independence. At the same time, it may also promote the risk of superficial competence, displace human relationships, and constrain authentic autonomy. Overall, the role conversational AI plays in adolescents' development is unlikely to be universally positive or negative for all adolescents, but instead depends on how, why, and in which context these technologies are used, highlighting the need for nuanced research and developmentally sensitive design.
Unwanted or mistimed pregnancies are pregnancies that occur in women who do not intend to become pregnant or did not desire another child at the time of conception. Ensuring access to contraception is important for both preventing unwanted pregnancy among active duty service women (ADSW) and preserving their right to reproductive autonomy. Women's Health Clinics (WHCs), available on some installations, bases, or duty stations owned and operated by the United States military, are intended to improve contraceptive access. This study aims to determine the association between availability of WHCs and unwanted pregnancy among ADSW. Using data from the 2020 Women's Reproductive Health Survey of ADSW we examined unwanted pregnancy in 2,939 ADSW who reported pregnancy in the last 12 months. Bivariate analyses and weighted binary and multivariable logistic regressions were used to assess the relationship between women reporting an unwanted pregnancy and having a WHC at their installation. We identified 354 unwanted pregnancies. Having a WHC at their current installation was significantly associated with a 39% decreased odds of unwanted pregnancy (aOR = 0.61; 95% CI: 0.42-0.88). Having a WHC at an ADSW's installation is associated with significantly decreased odds of unwanted pregnancy. This suggests that access to specialty women's health care at duty stations may promote reproductive autonomy among ADSW, contributing to the prevention of unwanted or mistimed pregnancies, ultimately enhancing mission readiness.
Young adults with cerebral palsy (CP) experience challenges navigating adult healthcare systems due to limited access to age-appropriate, CP-specific information. Health literacy is a key enabler of autonomy and participation, yet few customised resources have been co-designed with this population. To co-design and pilot an online health literacy education module 'Your health' with young adults with CP, their parents/carers, and healthcare professionals, and assess initial usability. A three-stage sequential mixed methods design within an integrated knowledge translation framework was used. Stage 1 involved focus groups and interviews with young adults with CP (n = 8) and healthcare professionals (n = 14) to explore health information needs. Stage 2 involved iterative module co-design across 13 Working Group meetings with young adults with CP, parents/carers, and clinicians. Stage 3 involved usability testing with young adults with CP (n = 11) using a modified System Usability Scale (SUS) and optional qualitative feedback. Interview and feedback data were thematically analysed to identify key insights and usability considerations. Stage 1 findings highlighted unmet needs for credible, accessible, and individualised health information. The co-designed module addressed these needs via lived experience content, accessible design features, and user-driven navigation. Usability testing yielded a mean SUS score of 80.2 (range 57.5-100), indicating strong usability. Participants found the module engaging, clear, and relevant, with minor suggestions for improvement. This study demonstrates the feasibility and value of embedding co-design in health literacy resource development, providing a scalable model to support autonomy and healthcare participation among young adults with CP.
To assess attitudes regarding conducting research and perceived learning experiences during residency of physicians specializing in "elderly" care medicine. Multimethod longitudinal study (December 2019-March 2024). Residents of a 3-year program specializing in long-term care for older adults in the Netherlands, conducting a mandatory training research study as part of their curriculum. Attitudes were assessed at the beginning, midway, and end of the study using validated scales for intrinsic and extrinsic motivation, self-efficacy, and perceptions of conducting research. Explorative analyses across study phases were conducted using random-effects models. Independent of the quantitative analyses, residents' reflection reports were analyzed inductively and then thematically using a Self-Determination Theory framework. The findings were compared for an integrated synthesis. Of 78 invited residents, 41 (53%) participated. Residents in groups that started before the pandemic, nonnative Dutch residents, and those with more research experience had more favorable attitudes toward conducting research. Changes-in particular, decreased intrinsic motivation when conducting analyses-were noted in the initial phases, including when developing a research question, whereas in the later phases, attitudes mostly returned to initial levels. In the reflection reports, most participants stated that they found the training study educational in some way. The residents supported each other, using their previously acquired skills to contribute to the assignment and learn from one another. Factors that stimulated intrinsic motivation to conduct research comprised a coherent mix of autonomy, competence, and relatedness. The findings suggest that attitudes toward conducting research are largely shaped already before residency, in turn affecting learning experiences. The cohort effect indicates that the COVID pandemic affected attitudes. A sufficient sense of autonomy, competence, and relatedness, particularly regarding the choice of research subject, course planning, and supervision, is needed to foster positive attitudes toward research and successful joint learning.
This study examined how dimensions of self-compassion are associated with psychological well-being among collegiate athletes and whether these associations operate through resilience, contingent on levels of self-efficacy. A total of 342 Korean collegiate athletes completed validated measures of self-compassion, resilience, self-efficacy, and Ryff's multidimensional psychological well-being domains (autonomy, environmental mastery, personal growth, purpose in life, and positive relations with others). Conditional process analyses were conducted using PROCESS Macro Model 14. The results indicated that resilience significantly mediated the relationships between multiple self-compassion dimensions and psychological well-being outcomes. Moreover, self-efficacy moderated several of these indirect pathways, such that the magnitude and direction of the mediated effects varied across well-being domains. Specifically, moderated mediation was supported for autonomy, environmental mastery, purpose in life, and positive relations with others. In contrast, no significant conditional indirect effects were observed for personal growth, although certain self-compassion dimensions exerted significant direct effects on this outcome. Taken together, these findings elucidate the multidimensional psychological mechanisms through which self-compassion contributes to athletes' well-being and highlight the critical roles of resilience and self-efficacy in shaping mental health outcomes. The results underscore the value of interventions that simultaneously strengthen resilience and enhance self-efficacy to promote psychological well-being among collegiate athletes..