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Hand hygiene is a cornerstone of infection prevention and control and plays a critical role in preventing healthcare-associated infections. During the COVID-19 pandemic, hand hygiene awareness and adherence increased across healthcare systems, but evidence on whether these improvements were sustained as pandemic pressures subsided remains limited. Nursing students and registered nurses are key groups for understanding long-term behavioural changes, as their knowledge, perceptions, and workplace experiences influence patient safety practices. To compare nursing students' and registered nurses' knowledge and perceptions of hand hygiene at two time points: during the peak of the COVID-19 pandemic in 2020 and in the post-pandemic period in 2023. Comparative cross-sectional survey study conducted at two time points (2020 and 2023). A Swedish university and its affiliated university hospital. A total of 376 individuals: first-semester nursing students, final-semester nursing students, and registered nurses surveyed in 2020 (n = 201) and 2023 (n = 175). This study employed a two-time point, independent-sample design. Data were collected online using two validated World Health Organization instruments: the Hand Hygiene Knowledge Questionnaire for Health Care Workers and the Perception Survey for Health Care Workers. Descriptive statistics were computed for all variables. Comparisons between 2020 and 2023 were performed using the Mann-Whitney U test for ordinal variables and Fisher's exact test for categorical variables. Total knowledge scores did not differ significantly between time points. However, first-semester students had lower knowledge of transmission routes and preventive actions in 2023. Perceptions of hand hygiene differed between time points. The mean score for perceived importance of hand hygiene as a patient safety measure was significantly lower in 2023 than in 2020 for first-semester students (3.77 vs 3.30, p < 0.001), final-semester students (3.61 vs 2.89, p < 0.001), and registered nurses (3.39 vs 3.19, p = 0.041). Perceived patient expectations about hand hygiene were also lower among nursing students, and registered nurses rated perceived hand hygiene adherence among healthcare workers lower in 2023. By contrast, first-semester students reported higher ratings of educational support and tolerance of alcohol-based hand rubs in 2023. The findings indicate group-level differences in hand hygiene perceptions between the pandemic-period and post-pandemic samples, while total knowledge scores did not differ significantly within any participant group. Given the independent-sample design, these findings should not be interpreted as individual-level changes over time. Lower perceived importance of hand hygiene suggests a need for continued educational reinforcement and organisational support to maintain hand hygiene practices.

There is limited evidence on how brief, optional virtual reality (VR) experiences can be used with first-semester nursing students as experiential learning strategies to support understanding of foundational nursing concepts, outside of mandatory coursework or full-scale simulations. Additionally, little is known about students' and teachers' perceptions of VR as a low-stakes, supplemental learning strategy introduced early in nursing education. Examining these experiences can provide insight into the pedagogical value and scalability of VR-enhanced learning within the formal nursing curriculum. This study explored students' and teachers' experiences of a brief, optional, VR-enhanced workshop offered outside mandatory coursework in first-semester nursing education and described students' perceptions of cognitive, social, and teaching presence. This was a cross-sectional evaluation at a Swedish public university. A single-session workshop, co-designed by nursing teachers and the university library makerspace (implementation context), combined brief headset exposures (sympathetic arousal via a short roller coaster experience and parasympathetic engagement via a short guided meditation), peer vital-sign practice (instructional aid), small-group synthesis, and a guided debrief aligned with the community of inquiry (CoI) framework. Immediately after the session, students completed a demographics questionnaire, a 7-item workshop-specific VR-perception set, and the 34-item CoI instrument, plus 2 open-ended items; teachers provided short reflections. Analyses were descriptive for quantitative data and summative content analysis of open-ended responses. Participants included 11.9% (16/134) of the invited first-semester students (mean age 25 years, SD 5.1; 15/16, 93.8% women; 6/16, 37.5% with prior VR exposure) and 3 teachers. Most students agreed or strongly agreed that VR enhanced analysis and observation (12/16, 75%), exploration of phenomena (14/16, 87.5%), conceptual understanding and engagement (13/16, 81.3%), teacher support (13/16, 81.3%), and relevance to the session (14/16, 87.5%). CoI ratings indicated moderately positive perceptions (total mean 3.36, SD 0.44 on a 5-point scale), with cognitive presence rated the highest (mean 3.48, SD 0.41) and exploration being the top subdomain (mean 4.48, SD 0.49); design and organization and facilitation were similar (mean 3.42, SD 0.55 each), whereas direct instruction was rated lower (mean 2.88, SD 0.92). Open-ended remarks described links between theory and embodied experience and noted practical challenges. This study used an early, optional format; the results showed that brief, contrastive VR exposures paired with scaffolded inquiry and a guided debrief were perceived as pedagogically valuable for exploring foundational physiological concepts, while also highlighting feasibility and logistical considerations for routine teaching. Findings are preliminary and reflect session-level perceptions from a small, self-selected sample; nevertheless, they suggest that structured, low-stakes VR may serve as a feasible supplemental strategy in first-semester nursing education, with implications for potential scalability.

Medical student academic success is dependent not only on aptitude but also on the implementation and utilization of effective learning strategies. The Learning and Study Strategies Inventory (LASSI) measures ten strategies that may impact academic performance. Since LASSI research in medical education is somewhat limited, this study examined LASSI subscale scores and multiple outcomes of academic performance. Four cohorts of medical students (N&#x2009;=&#x2009;423) completed the LASSI during orientation. Academic outcomes included first-semester GPA, pre-clerkship GPA, COMLEX-USA Level 2, and COMLEX-USA Level 3 scores. Correlational analyses, Pearson's r and Spearman's &#x3c1;, were used to explore relationships between LASSI subscales and performance measures. Partial correlation analysis was utilized to control for gender, MCAT scores, and Undergraduate Science GPA (USGPA). Across cohorts, Time Management demonstrated small but statistically significant correlations with first-semester GPA (r&#x2009;=&#x2009;0.11; p=0.028) and pre-clerkship GPA (r=0.10; p=0.036). Selecting Main Ideas correlated with COMLEX-USA Level 2 scores (r&#x2009;=&#x2009;0.16; p=0.007), and Information Processing correlated with COMLEX-USA Level 3 scores (r=0.40; p=0.014). Between cohorts, analyses yielded variability suggesting that learning strategies may differ across classes. Subscales with minimal variance, such as Attitude, Motivation, and Test Taking Strategies, did not predict outcomes, which differ from prior meta-analysis findings in other populations. Findings support the use of the LASSI as a tool for guiding academic support in medical education. Targeting interventions focused on Information Processing, Selecting Main Ideas, and Time Management may enhance performance on both internal exams and board exams. Future research should explore longitudinal patterns and the impact of learning strategy instruction on LASSI scores and academic outcomes.

This study aimed to examine whether academic background and selected psychosocial learning factors were associated with academic achievement in a foundational bioscience course among first-semester nursing students, and to critically re-evaluate the commonly assumed advantage of science-stream education. Bioscience subjects are essential yet challenging components of nursing education. Although students from science-stream backgrounds are often assumed to possess an academic advantage, emerging evidence suggests that learning outcomes may be influenced by more complex and context-dependent factors beyond prior academic preparation. A cross-sectional study design was employed. Data were collected from 108 first-semester nursing students enrolled in a Human Structure and Function course at a public nursing training institute in Malaysia. Academic achievement was measured using first-attempt institutional course scores obtained from official examination records. Psychosocial learning factors, including academic motivation, study habits, and perceived support systems, were assessed using a structured questionnaire. Independent samples t-tests, Pearson correlation, and multiple linear regression analyses were conducted. No significant differences in academic achievement were observed between students from science-stream and non-science-stream backgrounds. Furthermore, academic motivation, study habits, and perceived support systems were not significantly associated with bioscience achievement. The regression model explained only a small proportion of variance in academic achievement (R&#xb2; = .008), indicating limited explanatory power of the examined variables. These findings challenge the assumption that prior academic background and commonly cited psychosocial factors are key determinants of bioscience achievement in early nursing education. The results suggest that academic achievement may be shaped by more complex and context-dependent factors, particularly those related to instructional design and learning environments. Greater emphasis on pedagogical strategies that promote active and meaningful learning may be required to enhance student outcomes. These findings contribute to a growing body of evidence questioning the explanatory value of traditional academic and psychosocial indicators in nursing education. Science-stream background and psychosocial learning factors were not significantly associated with bioscience achievement among nursing students, highlighting the potential importance of instructional design and learning environments in shaping learning outcomes.

Healthcare practitioners' beliefs and attitudes towards low back pain (LBP) influence patients' beliefs, pain experience, and treatment outcomes. This study examined beliefs, attitudes, and conceptual understanding of LBP among practicing physiotherapists (PTs) in Austria and compared them with first-semester healthcare students. This cross-sectional online survey was conducted between May and November 2025. Beliefs about LBP were assessed using the Back Beliefs Questionnaire (BBQ; range 14-70, higher scores indicate more positive beliefs) and the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS; range 15-105, higher scores indicate stronger pain-disability beliefs). Participants included practicing Austrian PTs and first-semester students enrolled in healthcare-related programs at two universities. In total, 517 participants completed the survey (391 PTs, 99 students; 27 others excluded). PTs demonstrated significantly more positive beliefs than students, with higher BBQ scores (34.5&#xa0;&#xb1;&#xa0;5.9 vs. 28.7&#xa0;&#xb1;&#xa0;5.4; p&#xa0;<&#xa0;0.001) and lower HC-PAIRS scores (54.9&#xa0;&#xb1;&#xa0;12.9 vs. 65.5&#xa0;&#xb1;&#xa0;10.8; p&#xa0;<&#xa0;0.001). These differences remained significant after adjustment for age, education, and professional experience. Despite this, both groups predominantly held negative, pain-implies-disability-oriented beliefs about LBP. Notably, greater professional experience among PTs was associated with more negative, disability-oriented and biomedical pain beliefs. Although PTs held more positive beliefs about LBP than students, increasing professional experience was paradoxically linked to more negative pain-disability beliefs. These findings underscore the need for improved, longitudinal educational strategies that reinforce contemporary, evidence-based perspectives on LBP throughout clinical careers. We registered our study at https://osf.io/kr7ag.

Mental health of college students in the United States is a major public health crisis requiring innovative solutions. The Art and Science of Human Flourishing (ASHF) course is a credit-bearing academic course that has been found to improve well-being and mental health outcomes. Using a qualitative approach, the present study examined first-year, first-semester student experiences with the course as well as perceived mechanisms of change. Purposive sampling was utilized to recruit a racially diverse sample (N = 15), with over half the sample identifying as a racial or ethnic minority (n = 8). Thematic analysis was used to analyze semi-structured interviews conducted with the participants. Five themes were identified in the results: 1) applying learnings from the class, 2) cultivating connections with other students, 3) dual focus challenges, 4) positive experiences with meditation, and 5) generating insights and reflections. While most students reported a positive and impactful experience in the class, there was variability across some themes based on students' racial identities and neurodiversity. The findings provide insights into student experiences and perceived mechanisms of the course, which may be beneficial for the implementation and assessment of ASHF and other similar interventions.

Evidence-based approaches for measuring competency in clinical and simulation settings are lacking. Without standardized evaluation, programs risk missing opportunities to identify learning needs and provide timely support of students. This study examined methods to evaluate first-semester nursing students' competency using standardized grading rubrics and student self-evaluation to identify patterns of growth, refine instructional strategies, and advance evidence-informed approaches to early competency development. A prospective study was conducted with all students (N&#xa0;=&#xa0;113) enrolled in a first-semester course. Standardized performance assessments were conducted in weeks 5 and 15, using validated instruments and student reflections. Analyses showed measurable increases in student self-efficacy, engagement, and perceptions of simulation performance. Embedding early, standardized competency measurement in clinical and simulation education ensures that nursing students progress with the competency and professional readiness needed for safe, effective practice.

This study explored student experiences with team-based learning (TBL), a highly structured teaching-learning method. Participants were first-semester students enrolled in a prelicensure nursing course in the entry-level master's program at a private university. Student engagement, accountability, preference for lecture or TBL, and satisfaction with TBL were measured. Results showed that students were highly engaged with TBL, and their perceptions toward this method were favorable. TBL is an effective learning method that allows for more active learning.

"Crucial" conversations occur commonly in the veterinary profession and students require exposure to, and training in, these difficult communication dynamics. To introduce the concept of how people respond during perceived crucial, intense, or difficult communication dynamics, we asked first-semester veterinary students to complete a "Style Under Stress&#x2122;" self-assessment offered by the Crucial Conversations&#xa9; (Crucial Learning) educational platform. This tool is used in the training of the Crucial Conversations&#xa9; model and provides important insight into how people may respond during crucial conversations. First-year veterinary students in the initial (fall) semester of their curriculum completed this assessment beginning in 2016 (Class of 2020) continuing annually through fall of 2024 (Class of 2028). Responses were compared between classes (years) to determine student style consistency between years. Most students were assigned a "Silence" style (examples including "withdrawing," "masking," or "avoiding") and this was preserved throughout the different years. The feedback provided through the assessment is used as a component of medical communication training in developing competency during crucial communication encounters. Students learn about their individual defaults as well as how others may respond in similar crucial conversation situations.

Biochemistry is fundamental to medical education; however, traditional teaching may limit clinical integration and long-term retention. Although clinical simulation has emerged as a strategy to promote active and contextualized learning, its effectiveness in biochemistry teaching remains limited. This study evaluated the impact of clinical simulation on cognitive knowledge, technical skills, and communication among first-semester medical students compared with traditional practical instruction. A mixed-methods, quasi-experimental design was used with 404 students from the Central University of Ecuador, allocated to a simulation group (n = 205) or control group (n = 199). Both groups received identical theoretical instruction. Outcomes were assessed at baseline and post-intervention in four domains: theoretical knowledge, clinical interpretation, technical skills, and communication. Student satisfaction and perceptions were evaluated using surveys and qualitative analysis. Both groups improved after sessions; however, the simulation group demonstrated significantly greater gains across all domains (theoretical knowledge, clinical interpretation, technical skills, and communication). Students in the simulation-based group also achieved higher success rates in blood-sampling procedures, completed tasks in less time, and reported more positive emotions, reduced anxiety, increased confidence, and greater satisfaction. Simulation-based education appears to be an effective and feasible approach to enhance&#xa0;knowledge, technical, communication skills, and student motivation in medical biochemistry teaching.

Among Hispanic undergraduate students, the association between research-related coursework and research interest remains largely underexplored. This exploratory study examined differences in research interest among undergraduate nursing students according to their exposure to research-related coursework, drawing on Social Cognitive Career Theory. A cross-sectional study was conducted with 106 nursing students from a Peruvian university. Participants completed the Interest in Research Questionnaire (IRQ), which demonstrated excellent internal consistency (&#x3b1;&#x2009;=&#x2009;0.98). Research interest was compared across four academic-semester groupings reflecting proximal and distal exposure to research-related coursework using rank-based nonparametric methods. Significant differences in research interest were observed across groups (Anderson-Darling test&#x2009;=&#x2009;9.41, p&#x2009;=&#x2009;0.001), indicating a curvilinear pattern. Students currently or recently exposed to research-related coursework (levels 2 and 4) reported significantly higher research interest than those with more distal exposure (level 3; p&#x2009;<&#x2009;0.05; medium effect sizes). First-semester students showed research interest levels comparable to those of the proximally exposed groups. Research interest may decline in the absence of sustained engagement in research activities, underscoring the importance of early and continuous integration of research experiences throughout undergraduate nursing curricula. The findings also provide initial evidence supporting the use of the IRQ in Spanish-speaking undergraduate contexts.

Research in health professions education emphasizes the importance of self-regulated learning strategies in academic success. The Learning and Study Strategies Inventory (LASSI) is a validated measure of self-regulated learning and is linked to academic outcomes in health professions. However, its application in Doctor of Physical Therapy education remains underexplored. This gap is vital, as first-semester academic performance is a critical predictor of student retention. With increasing workforce demands and notable student attrition due to academic failure, withdrawal, or dismissal, identifying students who may benefit from academic support is critical. This study examined the relationship between LASSI scores and first-semester academic performance among first-year Doctor of Physical Therapy (DPT) students. The sample included first-year physical therapy students, who voluntarily completed the LASSI during orientation in Fall 2024. A retrospective correlational design was used, employing Spearman correlations, point biserial correlations, and regression analysis to explore associations between LASSI subscales and academic outcomes. Concentration, time management, and motivation subscales showed moderate positive correlations with course grades (&#x3c1; = 0.39 to 0.61, P < .01), with concentration emerging as the most consistent predictor across courses. Lower scores in anxiety, concentration, motivation, selecting main ideas, and overall LASSI averages were significantly correlated with academic failures and being placed on academic warning. Regression analysis revealed that LASSI subscales moderately predicted academic failures (R = 0.571, R 2 = 0.326), although the result was not statistically significant ( P = .198). In contrast, LASSI subscales significantly predicted placement on academic warning ( P = .007), explaining 71.6% of the variance (R 2 = 0.716). Findings support using the LASSI to identify learning strengths and weaknesses among DPT students. Early assessment may help programs provide targeted academic support, enhancing student success and retention in rigorous DPT curricula.

Pharmacy curricula often assume that early mastery of foundational skills predicts durable competence later in training. That assumption warrants closer examination. This commentary argues that progression through a Doctor of Pharmacy curriculum should not be mistaken for retention of essential knowledge and skills. Using a hypothetical example of later-semester students struggling with first-semester calculations content, it examines the issue through the lenses of retrieval science, competency-based education, just culture, and professionalism. Just culture should not be interpreted as absolution from learner responsibility; rather, it requires fair accountability for both curricular design and student behavior. Pharmacy programs should treat safety-relevant foundational skills as longitudinal competencies, embed cumulative retrieval and reassessment throughout the curriculum, and articulate more clearly when remediable incompetence becomes a professionalism concern.

Mental health problems among college students have increased significantly and barriers to care contribute to a substantial treatment gap. Digital mental health interventions (DMHIs) show promise for overcoming barriers, but engagement with DMHIs is challenging, underscoring the need for low-burden strategies. This pilot trial evaluated the feasibility and acceptability of a six-week, low-burden, preventative DMHI that delivered supportive text messages and personalized feedback (PF) to first-semester college students. Students (N&#xa0;=&#xa0;120, 64% women, 55% non-Hispanic White) who had mild-to-moderate depressive symptoms (PHQ-9 scores between 5 and 14) and were not engaged in formal mental health care were randomized to intervention (n&#xa0;=&#xa0;90) or assessment-only (n&#xa0;=&#xa0;30) conditions. Those in the intervention condition received a weekly PF report and/or supportive text messages at random intervals as part of an embedded micro-randomized trial (MRT). Primary outcomes were feasibility and acceptability of the intervention components. Exploratory analyses examined 1) clinical outcomes after six weeks for the intervention and assessment-only conditions, and 2) weekly clinical outcomes within the intervention group based on the MRT. The trial demonstrated high feasibility (95% enrollment; 87% retention) and strong intervention acceptability, especially for PF and assessment components. Exploratory analyses did not reveal consistent patterns in between- and within-group comparisons. Low-burden strategies for assessment and intervention are feasible and acceptable to first-year college students at risk for depression. There is significant potential for integrating these lower-intensity strategies into a full-scale trial that adaptively delivers higher-intensity DMHIs and/or integrate human-delivered components in response to needs over time.

BACKGROUND AND OBJECTIVE: Physiology is a foundational course in the medical sciences, including nursing. More active learning strategies, such as the flipped classroom, can enhance educational effectiveness and support practical medical applications. Therefore, this study aimed to investigate the effect of the flipped classroom on learning in the physiology lab course. METHODS: This quasi-experimental study compared lecture-based learning with a flipped classroom approach, using convenience sampling and randomized block allocation. The study population included all first-semester nursing students at Shahid Beheshti University of Medical Sciences during the academic year 2024&#x2013;2025. Both groups received eight two-hour lecture sessions for the theoretical component of the course. The control group&#x2019;s practical course consisted of lectures followed by hands-on practice, whereas the intervention group&#x2019;s practical course employed a flipped classroom model, where students reviewed instructional videos before engaging in exercises and discussions during eight two-hour in-person sessions. One week after completing the training for theoretical and practical courses, satisfaction and learning were evaluated and compared in both groups. RESULTS: The study included 87 students (51 females (58.62%), 36 males (41.38%); mean age&#x2009;=&#x2009;19.80 years, SD&#x2009;=&#x2009;1.31). Chi-square tests revealed no significant gender differences between groups (&#x3c7;2 (1, N&#x2009;=&#x2009;87)&#x2009;=&#x2009;0.25, p&#x2009;=&#x2009;0.62). Similarly, an independent samples t-test showed no significant age differences between groups (t (85)&#x2009;=&#x2009;0.88, p&#x2009;=&#x2009;0.38). Independent samples t-tests revealed no significant differences between intervention and control groups in theoretical exam scores, both before (t (85)&#x2009;=&#x2009;0.30, p&#x2009;=&#x2009;0.77) and after (t (85)&#x2009;=&#x2009;0.32, p&#x2009;=&#x2009;0.75) the theoretical course. However, significant differences emerged after the practical course, with the intervention group scoring higher on both the practical course mark, with large effect sizes (t (85)&#x2009;=&#x2009;5.61, p < 0.001, d&#x2009;=&#x2009;1.21, &#x3b7;&#xb2; = 0.27), and satisfaction scores, with large effect sizes (t (85)&#x2009;=&#x2009;4.61, p&#x2009;<&#x2009;0.001, d&#x2009;=&#x2009;0.88, &#x3b7;&#xb2; = 0.16). Paired t-tests showed significant improvements in nursing students&#x2019; knowledge scores after the theoretical course (t (86) = -54.72, p&#x2009;<&#x2009;0.001), with a considerable effect size, dppc2 = 7.90, &#x3b7;&#xb2; = 0.97. In addition, satisfaction scores after the practical course (t (86)&#x2009;=&#x2009;8.42, p&#x2009;<&#x2009;0.001) demonstrated a large effect size, dppc2 = 1.17, &#x3b7;&#xb2; = 0.45. CONCLUSION: The flipped classroom (FC) significantly improved nursing students&#x2019; practical physiology learning and satisfaction compared to traditional lectures. While theoretical knowledge gains were similar, FC enhanced practical skills, engagement, and motivation. By combining pre-class preparation with interactive in-class activities, FC supports active, student-centered learning and better prepares students for clinical practice. These findings highlight FC as an effective strategy for enhancing educational outcomes in laboratory-based nursing courses. CLINICAL TRIAL REGISTRATION: This study was registered on the Iranian registry of clinical trial (http://irct.behdasht.gov.ir) on 23.3.2025 with IRCT ID: IRCT20210131050189N13.