Medical graduates must integrate new scientific findings into clinical practice requiring strong scientific training. In Germany, scientific education in medical curricula is often undervalued, necessitating curricular changes. This study evaluates medical students' current scientific training, perceived and objective knowledge, and their preferences for curricular organisation. A nationwide cross-sectional study was conducted using an online survey distributed to medical students across 45 German medical schools. The survey, conducted from March to May 2023, covered scientific education aspects including self-assessment of scientific skills and an optional 25-item knowledge competency test. Data were collected from 3005 students, with 1319 completing the full competency test. Only 53.8% of students were aware of their scientific curriculum, and over 60% reported no evaluation of their scientific skills at their universities. In their final year, 52.7% felt competent in literature search, and 44.1% in scientific writing. However, only 19.9% felt competent in study design, 25.7% in developing research projects, and 19.8% in applying findings to patient care. The average competency test score for final-year students was 16 out of 25, with notable deficiencies in empirics and practical applications. At least 62.2% of students expressed a desire for more scientific training, and 71.3% favoured mandatory scientific courses. German medical students are dissatisfied with their current scientific education with 75% expressing dissatisfaction. They feel unprepared to apply scientific knowledge in clinical settings. The study highlights the need for urgent curricular reforms to enhance practical scientific training and better prepare future physicians for modern medical practice and research.
Pharmacotherapy and prescribing are core skills for physicians, and all medical graduates must master the basics. From a medical education perspective, it is important to understand factors that help students attain sufficient skills for safe and effective prescribing. In this study, we evaluated autograded pharmacotherapeutic quizzes for practice and summative assessments in two undergraduate clinical courses and explored medical students' views on educational components they considered helpful in learning to treat patients with medications. Pharmacotherapeutic quizzes were implemented in two steps across two course instances for two clinical courses (Psychiatry and Neurology, seventh semester in the medical programme at the University of Gothenburg, Gothenburg, Sweden). In step I, voluntary practice quizzes and a summative assessment test were introduced. In step II, clinical contexts for the quiz questions were provided, and the summative test was expanded. The students' achieved level of knowledge post-course was investigated before and after each step, using an anonymous voluntary knowledge evaluation test including 20 case-based single best answer (SBA) questions. Based on free-text replies to a concurrent questionnaire on students' views on learning pharmacotherapy, a manifest content analysis was performed, guided by the research question "What in their education do medical students consider important in enabling them to treat patients with medications?" Meaning units were extracted, and emergent categories and themes identified. In total, 274 out of 404 course participants took the knowledge evaluation test and completed the questionnaire (response rate: 68%; 56% women; 66% ≤24 years old). Compared with pre-quiz results (median correct answers out of 20 SBA questions = 10 (lower to upper quartile 9-13)), no difference was seen after step I (11 (8-13) correct answers; P = 0.88) but a clear improvement was seen after step II (14 (12-16); P < 0.0001). In the qualitative analysis, four themes emerged: Curriculum, Clinical placement, Theoretical teaching and Student responsibility. The second theme, including the categories Preparation, Participation and Performance, was particularly prominent. Elaborated quizzes about medications, for practice and summative assessment, may increase pharmacotherapeutic knowledge in medical students. The four emergent themes regarding what students consider important can guide future course developments.
Optometric education in vocational colleges aims to cultivate technical professionals with expertise in vision assessment and ophthalmic practices. However, the sustainable development of such education in Yunnan Province faces challenges due to imbalanced resource allocation and insufficient quantitative evaluation frameworks. This study developed a hierarchical evaluation system based on the entropy method to assess the development of optometric education across seven vocational colleges in Yunnan Province. The research was conducted through comprehensive field investigations, including participation in the "survey and evaluation research on the development of optometric education in Yunnan Province", which provided firsthand insights into instructional quality, internship training, faculty allocation. Data were collected from multiple sources, including institutional reports, expert assessments, and standardized indicators. The entropy method was applied to objectively weight different evaluation indicators, ensuring a systematic and data-driven analysis of optometric education quality. The integration of empirical fieldwork and rigorous statistical analysis enhanced the reliability and validity of the findings. The study yielded three key findings. 1) Colleges D and F exhibited shortages in student-teacher ratios (exceeding 20:1), leading to insufficient individualized instruction. 2) Colleges G (Hij = 0.92) and C (Hij = 0.83) demonstrated stronger overall performance, which correlated with their longer history. 3) Entropy-based analysis identified instructional quality (ηa = 0.3128) and internship training (ηa = 0.1995) as the most significant factors for improvement. 4) Critical sub-indicators included teaching evaluation, practical exercise, textbook development, program formulation and individualized guidance, all of which were listed in descending order of importance. This study demonstrates the feasibility of constructing an entropy-weighted evaluation system for optometric education, providing a novel methodological approach to assess educational quality in this specialized field in Yunnan Province. The findings reveal critical indicators for enhancing optometric education in Yunnan Province.
While scholarly activities are considered essential for medical advancement and improved patient outcomes, the educational value and potential impact on postgraduate medical trainees' well-being has not been well studied. We examined whether clinical research experience and scholarly activity requirements during early postgraduate medical training affect trainees' competency and well-being. We conducted a cross-sectional study of Japanese early postgraduate medical trainees (postgraduate year [PGY]1-2) recruited from hospitals participating in the General Medicine In-Training Examination (GM-ITE) in January 2024 and from teaching hospitals with scholarly activity requirements that did not participate in GM-ITE. Participants were classified into three groups based on scholarly activity experience: no scholarly activity, scholarly activity without clinical research, and scholarly activity with clinical research. The primary outcome was evidence-based medicine (EBM) competency assessed using the Japanese version of the Assessing Competency in EBM (ACE) tool. Secondary outcomes included GM-ITE scores, future scholarly activity intentions, depression symptoms, and well-being measures. Associations between scholarly activity experience and outcomes were examined using multiple regression analysis for continuous outcomes and logistic regression analysis for binary outcomes, adjusting for potential confounders; missing data were addressed using multiple imputation. Among 1,152 participants (1,150 from GM-ITE-participating hospitals and 2 from non-participating hospitals), 656 (57.0%) reported engaging in scholarly activities during early postgraduate medical training, with 60 (9.1%) conducting clinical research. After adjusting for potential confounders, compared to trainees without scholarly activity, the difference in ACE tool scores was 0.22 points (95% confidence interval [CI]: 0.02 to 0.41) for those who engaged in scholarly activities without clinical research and 0.40 points (95% CI: -0.02 to 0.83) for those who conducted clinical research. Stratification by program requirements revealed differences of 0.34 points (95% CI: 0.09 to 0.58) for voluntary scholarly activities and 0.09 points (95% CI: -0.19 to 0.37) for required activities. Trainees who conducted clinical research or engaged in required scholarly activities showed higher odds of future academic interest (adjusted odds ratio [OR]: 2.68 [95% CI: 1.33-5.37] and 1.52 [1.02-2.25], respectively), while those who engaged in scholarly activities without clinical research or without requirements showed similar odds to the reference group (adjusted OR: 1.27 [0.97-1.68] and 1.24 [0.88-1.74], respectively) Well-being measures showed minimal differences across groups. Scholarly activities during early postgraduate medical training, whether required by programs or not, had little impact on trainees' competency and well-being. However, trainees who engaged in clinical research showed increased interest in future academic activities, suggesting the importance of establishing supportive environments for interested trainees.
Burnout and clinical depression are often experienced by medical students in the United States, which impacts individual wellbeing as well as professionalism, empathy, and patient care. This study aimed to evaluate stress and wellbeing among first-year medical students at one accredited M.D. institution by administering the Medical Student Stress Scale (MSSS), a context-specific measure designed to capture multidimensional sources of medical student stress. The MSSS, a 22-item questionnaire, was administered to first-year medical students during the 2024-2025 academic calendar, in the fall and spring, alongside a Brief Resilience Scale (BRS) and demographic questionnaire. According to the MSSS, stress was measured by calculating a summative score, ranging from 0 to 88, with higher scores indicative of greater levels of stress. The BRS measures resilience with a total score determined as a summation of the six item responses, categorized as low (1-2.99), normal (3-4.3), or high (4.31-5). The overall response rate was 61% (107/175) in the fall and 47% (87/175) in the spring. Average student stress scores in the fall and spring were 34.3 and 38.8, respectively. The resilience score in the fall and spring was 3.6 and 3.5, respectively. Multivariable linear regression showed that student stress decreased by 10 and 13 points with every 1-point increase on the BRS in the fall and spring, respectively (p < 0.001). This correlates with a 11-15% reduction in stress. Additionally, at both time points, males displayed a significantly lower estimated stress score than females (p = 0.044 and p = 0.016). In the spring, compared to students of Christian faith, Jewish students displayed an estimated 10-point increase in stress (p = 0.024), and Muslim students displayed an estimated 17-point increase in stress (p = 0.005). Additionally, students that reported they were low-income displayed an estimated 8-point increase in stress compared to non-low-income students (p = 0.009). To identify trends in both stress and resilience, the MSSS and BRS are feasible surveys to implement in medical schools. Understanding how stress and resilience are affecting medical students provides an opportunity to create tangible interventions to better support student wellness and create resilient physicians.
Soft skills correspond to intrapersonal and interpersonal abilities related to how individuals interact, make decisions, and manage their activities. In the context of undergraduate nursing education, their development is fundamental to the preparation of professionals capable of acting in an ethical, critical, and relational manner, making it relevant to understand how these competencies are incorporated into the teaching and learning process. In this context, the objective of this study is to understand how faculty members in undergraduate nursing programs incorporate soft skills into their pedagogical approaches and practices, identifying the competencies considered essential and the challenges to their implementation. A qualitative study was conducted with 26 nursing faculty members from four federal public universities in southern Brazil. Data were collected between June and September 2025 through semi-structured interviews, following the criteria of the Consolidated Criteria for Reporting Qualitative Research checklist. The interviews were processed using IRaMuTeQ software and analyzed in light of Discursive Textual Analysis. Three analytical categories emerged: faculty understanding of soft skills in nursing education; pedagogical approaches and strategies for the development of these competencies; and perceived difficulties in their promotion within teaching. The faculty members recognize the relevance of soft skills and report the use of active methodologies and reflective strategies for their development. However, most had not received specific training, and the teaching of these competencies occurs predominantly in an implicit manner. The findings demonstrate that, although soft skills are widely valued in nursing education, their promotion still lacks pedagogical systematization and institutional support. Challenges such as the subjectivity of these competencies, the prioritization of technical skills by students, and distractions associated with the use of technologies limit their intentional development. These results contribute to the international literature in nursing education by highlighting the need for structured institutional strategies for faculty development and for the explicit integration of soft skills into nursing curricula.
In addition to pharmacological treatments, self-care education is crucial for managing chronic conditions such as rheumatoid arthritis. Concept mapping, a visual and learner-centered educational strategy, has shown potential in improving self-care engagement. However, evidence for its effectiveness in rheumatoid arthritis populations remains limited. Therefore, this study aimed to evaluate the effect of concept map-based self-care education on quality of life in patients with rheumatoid arthritis. Following the intervention, participants in the experimental group showed significantly better outcomes compared to the control group in overall quality of life (P < 0.001) and most domain-specific measures, including Activities, Movement, and Energy (P = 0.007); Mood/Emotions (P < 0.001); and Physical Contact (P = 0.015), with moderate to large effect sizes. However, no significant difference was observed in the Self-Care domain (P = 0.300). Within-group analyses revealed significant improvements in quality of life across all domains in the intervention group (all P < 0.05), whereas no changes were observed in the control group (all P > 0.05). Therefore, concept mapping, as a structured and visual educational strategy, may enhance patients' understanding of complex self-care information and improve quality of life among individuals with rheumatoid arthritis. The protocol of this clinical trial has been registered in the Iranian Clinical Trial Registration Center (registration code: IRCT20230405057828N1). Registered 23 June 2023- registered while recruiting, https://www.irct.ir/.
Disasters disrupt social systems, threaten physical safety, and generate substantial psychological distress among affected populations. Disaster psychiatry has often focused on psychiatric symptoms and service delivery, with less attention paid to the experiences of patients' families' experiences of suffering, caregiving, and recovery within disrupted social environments. This qualitative interpretive study analyzed second-order reflective narratives written by sixteen medical students who participated in supervised psychiatric and mental health care during flood disaster responses in Southern Thailand. Inductive thematic analysis was conducted, following the six-phase framework of Braun and Clarke, to explore students' observations of patient experiences, family caregiving, and the social conditions influencing mental health during the disaster. Five interconnected themes emerged. First, participants observed that basic survival needs, including food, shelter, and access to medication, were essential foundations for psychological recovery. Second, narratives described lived experiences of suffering, uncertainty caused by displacement, illness, and disruption of daily life. Third, students observed varied forms of resilience and meaning-making as individuals sought hope and purpose amid adversity. Fourth, family caregiving emerged as a central source of relational dignity and continuity of care. Finally, reflections highlighted structural vulnerability and the limits of medicine, as poverty disrupted access to resources, and social inequalities shaped patient experiences, requiring broader social support. The findings suggest the importance of social and relational dimensions of disaster mental health experiences. Suffering, resilience, and recovery were closely intertwined with family relationships, community networks, and structural conditions. Recognizing these factors may support more holistic approaches to disaster mental health care, disaster response planning, and medical education.
Multiple Choice Questions (MCQs) remain the most widely used written assessment format in health professions education due to their efficiency and reliability; however, their susceptibility to cueing raises concerns regarding their authenticity in assessing true knowledge. Very Short Answer Questions (VSAQs) have emerged as a promising alternative that reduces cueing effects and requires learners to generate responses with greater cognitive engagement, while retaining the logistical advantages of computer-marked assessments. This systematic review and meta-analysis evaluates the comparative performance, discrimination, reliability, and practice effects of VSAQs versus MCQs. Following PRISMA guidelines (31), a systematic search identified studies comparing VSAQs and MCQs in undergraduate and postgraduate health professions education. Data extraction and risk of bias assessment were conducted independently by two reviewers, with disagreements resolved through consensus. Mean scores, standard deviations, discrimination indices, and reliability coefficients were extracted. Standardized Mean Differences (SMD) were pooled using a random-effects model. Psychometric indices were transformed using Fisher's z-scores. Heterogeneity was quantified using the I² statistic, and sensitivity and subgroup analyses were performed to explore the impact of outliers. Six cohorts (n = 1,191) derived from three included studies contributed data for score comparisons. The initial pooled analysis showed no significant difference between VSAQs and MCQs (SMD = - 0.52; 95% CI - 1.34 to 0.30), with extreme heterogeneity (I² = 98%). Sensitivity analysis identified Dhok et al. (2023) as an outlier. Excluding this dataset yielded a significant effect favoring MCQs (SMD = - 0.86; 95% CI - 1.01 to - 0.70; p < 0.00001) with markedly reduced heterogeneity (I² = 4%). Meta-analysis of psychometric properties demonstrated strong discrimination (pooled Fisher's z = 1.45) and acceptable reliability (pooled Fisher's z = 0.43) for VSAQs. Evidence on practice effects was mixed, with no consistent advantage for either format. VSAQs exhibit strong psychometric integrity and are designed to reduce the cueing effect observed in MCQs. Although associated with lower student scores, VSAQs likely provide a more accurate reflection of independent knowledge and clinical reasoning ability. Their integration into medical assessment systems may enhance the authenticity and validity of written examinations.
Bystander intervention at the scene of illness or injury can significantly impact the outcomes of emergencies. This scoping review aims to identify the determinants of bystander behavior in such scenarios. A comprehensive search was conducted across PubMed, Cochrane, Google Scholar, CINAHL, and grey literature, resulting in 3957 studies. After removing duplicates, 2499 studies were screened for titles and abstracts by two independent reviewers, with conflicts resolved by a third reviewer. A total of 257 articles were then subjected to full-text screening, leading to the inclusion of 42 studies for data extraction. Data were collected on various factors, including the type of emergency, region, area of study, setting, age group, gender, prior training, presence of bystander intervention, and determinants of behavior. In studies presenting age‑stratified analyses, bystander intervention was reported in 75% of studies involving individuals aged ≤ 18 years and in 69% of studies focused on adults. Where training status was reported, 18% of adult‑oriented studies indicated prior training, with no such reporting among studies involving individuals ≤ 18 years. Cardiac arrest was the most common type of emergency (95%). Most studies were conducted in community settings (76%), with the remainder in institutional settings (24%). Negative determinants included lack of knowledge, skills, and self-efficacy, with variations between community and institutional settings. Motivators for intervention, though less frequently reported, included young age, education/training, and a supportive environment. The review highlights key barriers and motivators for bystander intervention, emphasizing the need for targeted education and training programs, as well as supportive environments to enhance bystander response in emergencies. These findings provide a foundation for developing multifaceted strategies to improve bystander behavior and emergency outcomes.
Strengthening professional identity is crucial to mitigate nursing students' attrition and ensure a sustainable workforce. While the hidden curriculum and learning engagement are believed to influence this identity, their interrelationships remain unclear. This study aims to explore the relationship between hidden curriculum and professional identity and examine whether learning engagement mediates the relationship between hidden curriculum and professional identity. A cross-sectional study was conducted among 623 undergraduate nursing students from two medical colleges in China. The general information questionnaire, Hidden Curriculum Evaluation Scale in Nursing Education, Utrecht Work Engagement Scale-Student, and Professional Identity Scale for Nursing Students were used for data collection, and IBM SPSS 26.0 and PROCESS macro (Model 4) were used for statistical analysis. Hidden curriculum, learning engagement, and professional identity were significantly positively correlated. Learning engagement partially mediated the relationship between hidden curriculum and professional identity, accounting for 44.13% of the total effect. Nursing educators should proactively develop the hidden curriculum and implement strategies to boost learning engagement, thereby fostering students' professional identity and reducing future workforce attrition.
In Ethiopia, a substantial proportion of women experience physical, psychological, or sexual violence perpetrated by their husbands or intimate partners. There is limited evidence on interventions aiming to improve awareness, alter attitudes, and control behavior related to IPV in Ethiopia. Therefore, this study aimed to evaluate the effectiveness of community-based health education (CBHE) targeting couples on knowledge, attitudes, and controlling behavior among women in Hadiya zone, central Ethiopia. A community-based, parallel-group, two-arm cluster randomized controlled trial design was employed to evaluate the effect of a CBHE intervention on knowledge, attitude, and controlling behavior related to IPV in Hadiya zone, central Ethiopia. A total of 432 women (216 in the intervention groups and 216 in the control groups) were involved in the study. The intervention was provided for couples over a period of six consecutive months. Generalized Estimating Equation (GEE) and difference-in-difference analysis were conducted to evaluate the effectiveness of the intervention on the outcomes. About 94.4% of the mothers in the intervention groups and 95% of the women in the control groups were available for intention-to-treat analysis at the end of the intervention. Women in the intervention groups were about 5 times more likely to have good knowledge of IPV than those in the control groups (AOR = 4.8; 95% CI 2.9-7.9). Mothers in the intervention were 70% less likely to have a supportive attitude towards wife-beating compared to mothers in the control group (AOR = 0.3; 95% CI 0.2, 0.5). Likewise, mothers in the intervention groups were 60% less likely to justify controlling behavior from their husbands compared to those in the control groups (AOR = 0.4; 95% CI 0.3, 0.7). This study highlights that CBHE intervention led to a significant improvement in participants' knowledge of IPV against women. It also resulted in a marked reduction in the acceptance of wife-beating and justification of controlling behaviors. These findings provide strong evidence to support the broader scale-up of this intervention. This trial was recorded in the ClinicalTrials.gov registry with the identifier NCT05856214 on May 4, 2023.
Women, particularly those from widening participation (WP) backgrounds, remain underrepresented in surgical specialties. The educational pipeline is marked by limited exposure to relatable role models, which may discourage these individuals from pursuing surgical careers. Digital learning platforms offer a novel approach to address this gap. In collaboration with the Widening Participation Medics Network (WPMN), a UK-based charity supporting underrepresented medical students and doctors, we delivered a series of five free webinars. Each featured female surgeons-many from WP backgrounds-discussing surgical careers and personal barriers faced. Attendees ranged from pre-medical students to senior clinicians. Post-event surveys (n = 275, 75% response rate) collected both numerical and free-text responses to evaluate impact on understanding, motivation, and representation. The series reached 369 live attendees globally, with 60% identifying as WP and 27% reporting multiple WP characteristics. 73% of attendees agreed that there are many barriers preventing women from widening participation backgrounds entering into a surgical career and thriving as a surgeon. Exposure to WP-focused content of the webinars significantly improved insight into the challenges women face in surgery (Wilcoxon signed-rank test, p < 0.001, r = 0.74). A high proportion (84%) reported increased motivation to pursue surgery after attending the webinars. Presence of female speakers, surgical theme and WP narratives were the most cited reasons for attendance. Many (33%) had never previously attended an educational event featuring WP discussion. Webinars centered on lived experiences and diversity are effective in providing impactful surgical education and inspiration, especially for underrepresented students and doctors. These findings support the integration of inclusive, role model-led virtual teaching in medical education. Further longitudinal studies are needed to evaluate career progression and retention impacts.
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As third-year medical students transition into high-stakes, high-stress clinical environments like the emergency department (ED), they may experience significant personal trauma. However, little is known about how this trauma is experienced early in their training - specifically during the transition from preclinical to clinical learning environments. This study addresses that gap by exploring third-year medical students' experiences of trauma during the emergency medicine (EM) clerkship through the lens of Trauma-Informed Care (TIC) and identifies workplace factors and intersectional demographics influencing these experiences. This qualitative study used the critical incident technique to explore emotionally-significant events encountered by third-year medical students immediately after completing the EM clerkship as their first core clerkship at a single academic institution. We conducted a thematic analysis using the Substance Abuse and Mental Health Services Administration's six TIC principles. Data were triangulated with quantitative demographic data, and data saturation was confirmed through constant comparison and reflexive team discussions. Seventeen students participated, describing 19 critical incidents of trauma. The most common trauma types involved lack of peer support and lack of empowerment or voice. Intersectional factors such as race, gender, and age shaped both the type and nature of trauma. Clinical uncertainty, power differentials, and unprofessional behavior emerged as frequent triggers. Applying a trauma-informed framework to medical education reveals how structural and interpersonal factors contribute to student trauma when they transition to the clinical learning environment. These findings highlight opportunities for trauma-informed clerkship design and structured support to create safer, more inclusive learning spaces. Not applicable.
Although the World Health Organization (WHO) emphasizes patient safety as a core competency, formal educational opportunities in clinical settings remain limited. This study aimed to explore the perceptions of patient safety specialists regarding the informal learning opportunities that expose medical students to patient safety competencies during clinical clerkships. A descriptive qualitative study was conducted with 34 of 36 patient safety specialists at Japanese national university hospitals. Data were collected via an online open-ended questionnaire regarding safety-related behaviors students engaged in during clinical practice. The responses were analyzed using conventional content analysis. The analysis identified 14 learning categories situated within four clinical contexts: receiving instructions, invasive procedures, interprofessional communication, and incident response. These competencies are closely aligned with the WHO Patient Safety Curriculum Guide. However, the learning related to quality improvement was notably limited. Participants proposed specific support measures such as utilizing incident reports for education and facilitating student participation in safety conferences to further enhance these informal learning opportunities. Clinical environments provide latent opportunities for students to engage with essential patient safety competencies through informal participation in clinical practice and complementing formal curricula. Clinical educators should recognize the value of these situated learning opportunities and intentionally facilitate informal learning environments to complement formal education.