BMC Medical Education

M.D.-Ph.D. programs in the United States have traditionally followed a "2-n-2" curricular model, with the graduate phase occurring between the pre-clerkship and clerkship portions of medical training. While well established, this format can limit trainee autonomy in shaping their physician-scientist training trajectories. In response, some programs have introduced a "3-n-1" model, allowing students to complete clerkships before beginning Ph.D. training. Our institution implemented multiple flexible curricula in 2017. Understanding why trainees choose one pathway is important as programs consider implementing more adaptable training structures. To investigate these factors, we surveyed M.D.-Ph.D. students at our institution, which offers multiple flexible curricular alternatives, about contributions to their curricular decisions. Responses supported that trainees weigh considerations across medical education, scientific development, and integrated physician-scientist training domains. Although the traditional pathway was a popular option, most students pursued one of the flexible pathways. Our findings suggest that introducing flexibility in the timing of undergraduate medical education and graduate training can support diverse educational, logistical, and personal priorities while maintaining the rigor of physician-scientist training. Offering multiple pathways empowers trainees to design trajectories that best fit their needs. Continued longitudinal studies are needed to assess the long-term impacts of flexible curricula on physician-scientist career outcomes.

Abstract Background: Artificial Intelligence (AI) is increasingly integrated into healthcare systems worldwide and medical schools worldwide have begun integrating AI into their curricula. The healthcare system in Iraq is currently undergoing development and AI has not yet been adopted in clinical practice in Erbil; in addition, no formal AI instruction has been incorporated into the medical education curriculum. The aim of this study was to assess knowledge levels, attitudes, and perceptions regarding AI among medical students and healthcare professionals in Erbil, Kurdistan Region of Iraq. Methods: A mixed-methods survey was distributed to medical students and residents in Erbil, Kurdistan Region of Iraq. The survey was adapted from Teng et al, and modified to reflect the local context. The survey was translated into Kurdish and Arabic. Convenience sampling was used. Statistical analysis was conducted using IBM SPSS (Statistical Package for Social Sciences), Version 26.0. Chi-square and Fishers exact tests were used to test associations between categorical variables. Mann Whitney U test was used to compare mean ranks between groups in the non-normally distributed data. A P value <0.05 was considered statistically significant. Thematic analysis was applied to open-ended qualitative responses by two independent reviewers. Results: A total of 368 participants participated in this study. The majority (85.6%) of participants felt that AI should be taught in schools and universities, and 90.8% reported using AI. ChatGPT was by far the most commonly used AI tool (85.3%). Participants aged 20-24 years (93.2%) and 25-29 years (90.2%) showed the highest prevalence of using AI. Participants that used AI previously, had higher scores for support for AI development in their field (U = 3744.5, P=0.001), feelings of hope towards AI in their field (U = 4406.5, P = 0.004) and thinking that students should learn the basics of AI (U = 4022.5, P = 0.03). Male participants were more likely to use AI in comparision with women (P=0.045). The most common concern regarding AI was loss of jobs (33.0%), followed by overreliance on AI (22.8%). Qualitative analysis revealed themes of guarded optimism, and concerns regarding the ethical implications of AI use in medicine. Conclusion: Medical students and physicians in Erbil are early adopters of AI in spite of any formal training. In parralel, most participants expressed dissatisfaction with their understanding of the ethical implications of AI in healthcare and emphasized the need for formal AI education in healthcare curricula. The majority of participants expressed guarded optimism regarding the future of AI in healthcare. A gender gap in AI was identified, consistent with global trends with implications for professional equity.

Objective Structured Clinical Examinations (OSCEs) are widely used to assess medical students clinical skills, including non-technical abilities such as communication and empathy. However, the potential influence of individual psychological traits--such as personality dimensions, empathy, and stress-related mindset--on OSCE performance remains understudied. This study investigated associations between personality traits, empathy levels, stress mindsets, and performance in OSCEs among medical students. An online questionnaire (including the Big Five Personality Traits Inventory 2, the Jefferson Scale of Physician Empathy (Medical Student version), the Growth Mindset Scale, the Stress Mindset Measure) was provided to all fifth-year medical students enrolled at the Universite Paris Cite for six weeks before undertaking graduation summative OSCEs. Their scores were correlated with OSCE performance using Spearmans correlation and linear regression analyses. A total of 99 questionnaires were included and analysed. None of the psychometric tests we assessed showed a significant correlation with OSCE scores. The strongest predictors of success in OSCEs were higher scores in written examinations, previous OSCE performance, and being female. In non-interactive OSCE stations, conscientiousness was the only significant predictor, with a positive association (p=0.001). Neuroticism was positively associated with performance improvement between OSCE sessions (p=0.042). Personality traits, self-reported empathy, and stress-related mindsets do not predict success in OSCEs as isolated traits. Further research is needed to determine whether it holds true for all kinds of OSCEs. Multidimensional psychometric assessment may be relevant when investigating performance outcomes in OSCEs.

Introduction: Early exposure to otolaryngology (ENT) procedural skills in undergraduate medical education is limited by patient safety concerns, restricted clinical opportunities, and the cost of commercial simulators. As a result, essential ENT skills are often underrepresented in structured, hands-on curricula for medical students. Methods: We developed a low-cost, multistation ENT simulation curriculum consisting of five reproducible task trainers: ear examination and otologic procedures, mirror laryngoscopy, rigid and flexible endoscopic navigation, introductory mastoid drilling, and emergency cricothyrotomy. The curriculum was delivered as a 2-hour, faculty-led workshop during a third-year medical student otolaryngology rotation. Learners rotated through stations in small groups. Pre- and post-workshop surveys assessed self-reported anatomical familiarity, procedural confidence, and educational value using a 5-point Likert scale, with additional qualitative feedback collected. Results: All participants completed pre- and post-workshop evaluations. Learners demonstrated increased confidence across all assessed anatomical and procedural domains, including otoscopy, endoscopy, mirror laryngoscopy, mastoid drilling orientation, and cricothyroid membrane identification. Educational value ratings were high across all stations, with mean scores ranging from 4.33 to 5.00. Qualitative feedback emphasized the realism, accessibility, and benefit of hands-on practice in a low-stakes learning environment. Conclusion: This low-cost, multistation ENT simulation curriculum provides a feasible and reproducible approach for introducing foundational otolaryngology skills to medical students. The structured format and affordable models support early procedural exposure and may enhance learner preparedness prior to supervised clinical encounters, particularly in settings with limited simulation resources.

Background Conventionally, infertility has been regarded as primarily a female issue, leading to misconceptions, stigma, and underrepresentation of male infertility in healthcare discussions. This study assessed the knowledge, attitude and perception of Undergraduates towards male infertility in Osun State University. Methods A descriptive cross-sectional design was employed to select 300 undergraduates via multistage sampling. Qualitative data were collected using a focus group discussion guide covering the knowledge, attitude and perception, while quantitative data were collected using a self-administered questionnaire covering socio-demographic characteristics, knowledge, attitude and perception towards male infertility. Qualitative analysis was performed using NVivo software, while IBM SPSS Statistics version 27 was used for the quantitative analysis, with thematic analysis and chi-square tests to determine the association between variables (significance at p < 0.05). Results Respondents were predominantly females (64.0%) with a mean age of 20.99 {+/-} 2.31 years. Overall knowledge was low (47.7%), while more than half had a negative attitude (52.3%). Significant predictors of attitude include faculty (0.049), level (p=0.031), and formal education on male infertility (p=0.007). Conclusion Students demonstrated a poor understanding of male infertility, and their attitudes remain influenced by cultural norms surrounding marriage, masculinity, and gender roles. Hence, the need to foster open dialogues, promote gender-inclusive narratives, and strengthen healthcare support systems.

BackgroundHigh workload among healthcare workers has increasingly been correlated with poor patient outcomes, inefficient operational and financial outcomes, and burnout. Despite growing literature exploring causes of attending physician workload, there is limited understanding of trainee-specific measures. ObjectiveWe aimed to characterize elements contributing to trainee workload and perceived challenges and satisfiers to the trainee workday as a foundation for better understanding and measuring trainee work experience. MethodsInternal Medicine and Medicine-Pediatrics residents at an academic medical center were invited to participate in focus groups discussing contributors to inpatient workload and work experience between March and April 2024. A qualitative content analysis identified key metrics of trainee workload and work experience, which were then consolidated into overarching domains. A structured, multi-round rating process ranked the perceived relevance of each metric. ResultsTwenty residents participated across six focus groups. Analysis of focus groups yielded 297 workload metrics across 28 unique domains. Seventeen domains had metrics identified as highly relevant (median 6-7; IQR < 1) including autonomy, communication, disruptions, task switching, documentation, emotional burden, patient factors, professional fulfillment, rounding, teaming, and work-life balance. ConclusionsResident physicians highlighted complex interactions between clinical factors, work design, and psychosocial dynamics that contribute to their sense of workload. This creates opportunities to develop unique measures of workload to understand the trainee experience better. Further studies are needed to capture the generalizability of these findings and the relationship between these workload domains and patient, organizational, and trainee outcomes with the aim of implementing evidence-based work design.

BackgroundIncreasing relevance of genetics and molecular biology in medicine necessitates greater genetic literacy among current and future healthcare workers. To assess the literacy level, a validated genetic literacy questionnaire is needed. Therefore, a standardised Indonesian-language genetic literacy questionnaire is essential. AimsWe aimed to translate and validate three genetic literacy questionnaires (PUGGS, iGLAS, and UNC-GKS) for use among Indonesian medical students. We then evaluated genetic literacy levels using one of the validated questionnaires. MethodsThe PUGGS, iGLAS, and UNC-GKS questionnaires were translated into Indonesian and then reviewed by an expert panel for translational accuracy and conceptual appropriateness. Back-translation was performed to confirm validity. Initial Indonesian versions of the questionnaires underwent cognitive pre-testing with 12 undergraduate medical students. After refinements, the questionnaires were validated among 34 first-to third-year medical students. The Indonesian version of UNC-GKS questionnaire was then used to assess genetic literacy of 486 medical students comprising 228 preclinical medical students, 187 clerkships, and 71 residents. ResultsThe Indonesian versions of PUGGS (Cronbachs = 0.819) and UNC-GKS ( = 0.809) demonstrated good reliability, while iGLAS showed poor reliability ( = 0.315). Among the 486 students tested, 56% demonstrated moderate overall genetic literacy, and only 15.2% demonstrated good overall literacy. Basic genetic concepts were relatively well-understood with 54.3% having good literacy. On the contrary, gene variants effects on health were poorly understood with only 9.7% having good literacy. Inheritance concepts were moderately understood with 24.9% having good literacy. ConclusionThe Indonesian translations of PUGGS and UNC-GKS are reliable tools for assessing genetic literacy among medical students. Using UNC-GKS, we observed predominantly moderate genetic literacy levels. Curriculum improvement to better integrate genetics education is essential to support its clinical applications. PRACTICE POINTSO_LIGenetic literacy is needed to fully utilize genetic and genomic application in medicine. C_LIO_LIAdaptation of PUGGS and UNC-GKS genetic literacy questionnaires into Indonesian language resulted in valid and reliable questionnaires to assess genetic literacy among medical students C_LIO_LIModerate genetic literacy level indicates the need for genetics curriculum update in medical schools in Indonesia, especially in the area of gene variants effect on health C_LI

BackgroundMultiple-choice questions (MCQs) are widely used in medical education, but are criticized for cueing and guessing. Very short answer questions (VSAQs), which require students to generate responses independently, may better assess knowledge. While VSAQs demonstrate higher item discrimination within individual exams, their effectiveness in distinguishing academic performance across multiple assessments remains unclear - representing a key gap in the validation of VSAQs under Messicks framework, specifically the category of "relations to other variables". This study examines whether VSAQs or MCQs more effectively distinguish students of varying performance levels across multiple summative examinations. MethodsWe analyzed retrospective data from six mixed-format examinations with VSAQs and MCQs of three cohorts of first- and second-year medical students. Academic performance was measured using grade point average (GPA) across assessments. Linear regression assessed the relationship of each question format with GPA, while ROC curves and C-statistics evaluated their ability to identify poor and excellent performing students (lowest and highest quintile of GPA). ResultsVSAQs showed higher item discrimination (Rir-values) than MCQs in all exams. VSAQs also had a stronger positive association with GPA compared to MCQs, and higher C-statistics, indicating superior discriminative ability. ConclusionVSAQs outperform MCQs in distinguishing academic performance levels across multiple assessments. Their integration into examinations enhances discriminative ability and may facilitate earlier identification of poor and excellent performing students, enabling targeted interventions and support of students.

ObjectivePalliative care is recognized as an essential component of humanitarian health response, yet its delivery in field operations remains limited. This study assessed perceived importance, readiness to deliver, training needs, and operational barriers among Red Cross and Red Crescent Health Emergency Response Unit (ERU) delegates. MethodsA cross-sectional, web-based survey (LimeSurvey) was conducted among health professionals with ERU deployment experience between 1 October and 31 December 2024. The questionnaire captured demographics, background, preparedness, barriers, and training preferences. Descriptive statistics summarized categorical variables, and free-text responses underwent content analysis by two reviewers. Quantitative and qualitative strands were analyzed separately and integrated in interpretation. FindingsOf 173 responses, 114 met inclusion criteria (including 11 partial [&ge;]50% complete). Half (50.9%) had over ten years of humanitarian experience. Most (71%) considered palliative care extremely important, yet only 49.1% reported providing it, usually limited to pain relief; 25.4% reported none. Barriers included insufficient time or resources (56.1%), lack of training (49.1%), absent policies (48.2%), cultural barriers (47.4%), limited knowledge (36.8%), and restricted opioid access (28.1%). Among prescribers, 85.1% felt comfortable prescribing opioids, but stockouts (54.2%) and regulations (44.9%) constrained use. Most delegates (75.4%) had delivered bad news without structured communication training. 83% reported no palliative care training, though 91.4% endorsed dedicated, blended learning combining online and practical components. ConclusionERU delegates view palliative care as essential yet under-implemented. Integrating core competencies, standard protocols, and medicine access pathways--supported by competency-based training--could strengthen humanitarian readiness and align with WHO Emergency Medical Team standards.

Background: Postgraduate medical residents frequently face difficulty in selecting appropriate statistical tests and preparing statistical analysis plans (SAPs) for thesis work. Existing resources often identify statistical tests without guiding implementation, reporting or software execution. Aims: To describe the development, features and content validation of ChooseMyStat, a free, open source, web based interactive tool for statistical test selection and SAP text generation in clinical research. Methods: ChooseMyStat was developed as a React based web application using an iterative, AI assisted development process under direct faculty supervision. The tool uses a branching decision algorithm covering 18 inferential statistical tests, two diagnostic accuracy measures, four agreement/reliability statistics, and four descriptive statistics scenarios. For each recommendation, it generates a SAP template paragraph, a results reporting example, step by step JASP instructions, and R code. Content validation was performed using 105 open-access original research articles from 15 broad medical specialties published in Indian journals during 2024 2025. Results: The tool covers commonly used statistical methods, including t tests, ANOVA, chi square variants, non parametric alternatives, correlation, regression (linear, logistic, ordinal), survival analysis, methods for clustered or repeated data, diagnostic accuracy measures, and agreement/reliability statistics. Among 365 statistical tests identified across 105 articles (excluding normality checking procedures), 346 (94.8%) were covered by the tool. Complete coverage of all statistical methods used was observed in 86 of 105 articles (81.9%). Conclusions: ChooseMyStat integrates statistical test selection with implementation guidance, SAP generation, reporting support and software instructions within a single interface. The tool may support postgraduate research training by improving accessibility to applied biostatistics guidance.

Microbiology education in veterinary curricula requires students to integrate complex foundational knowledge with clinical application, yet traditional lecture-based approaches often emphasize memorization over higher-order reasoning. In this study, we evaluated the impact of integrating clinically oriented, case-based instruction into a veterinary microbiology course within a Doctor of Veterinary Medicine curriculum. Using a quasi-experimental, multi-year design, student outcomes were compared before (2019, 2021) and after (2022-2025) implementation of case-based teaching while maintaining consistent course content, structure, and assessments. Introduction of clinical case examples was associated with significant and sustained improvements in student evaluations across multiple domains, including perceived relevance, critical thinking, and overall course value. Instructor-related evaluation metrics also improved. Student performance, measured by final course grades, increased following the intervention without evidence of grade inflation. These findings demonstrate that integrating clinically relevant case narratives into microbiology instruction enhances student engagement and student performance. This work highlights a practical and scalable strategy for improving microbiology education, particularly within veterinary and other health-professions curricula.

Objectives: Electronic Health Records (EHRs) impose a significant time burden on physicians, often requiring work to be completed outside of scheduled hours. While this burden is well-documented, how it evolves throughout emergency medicine (EM) residency remains poorly understood. This study aimed to quantify EHR usage patterns, analyze the composition of after-shift work, and characterize the development of EHR efficiency across EM training. Methods: We conducted a retrospective cohort study of EM residents (postgraduate year [PGY] 1-4) using 5.5 years of EHR audit log data (2020-2025) at a single academic institution. We analyzed EHR time per new patient encounter, stratified by postgraduate year, and categorized activities into domains such as documentation, chart review, and orders. EHR work was measured both during and after scheduled shifts. Results: The analysis included 144 unique residents and 167,010 new patient encounters across 15,386 shifts. Encounter-attributed EHR time per encounter decreased by 52% from PGY-1 to PGY-4 (median 19.9 to 9.6 minutes, p<0.001), despite an 86% increase in patient volume per shift (median 7 to 13 encounters). This efficiency gain was driven primarily by a 69% reduction in documentation time (9.3 to 2.9 minutes), accompanied by shorter notes. After-shift work (EHR activity after the 9-hour clinical shift) was present in 89.9-94.4% of encounters. At the shift level, combined after-shift EHR time (encounter-attributed plus tracking board) was a median of 64.2 minutes per shift for PGY-1 and 104.2 minutes for PGY-4. Shift-level tracking board activity dominated the after-shift burden and increased with training (median 40.2 to 79.0 minutes per shift from PGY-1 to PGY-4). Conclusions: EM residents achieve substantial gains in on-shift EHR efficiency, with the largest reductions observed in documentation time, accompanied by shorter notes and faster input speed. However, a persistent after-hours workload, dominated by administrative and patient flow tasks, suggests that (at least at this single institution) system-level factors--not just individual skill--may contribute to this pattern. Monitoring these objective EHR metrics may help programs identify struggling learners and evaluate the impact of interventions aimed at improving resident well-being and workflow efficiency.

ObjectivesAcademic medical institutions are the gatekeepers of the physician workforce and shape the future of medicine by regulating medical school admissions as well as residency training. Although broadly the field of medicine is seeing more representation from traditionally underrepresented groups, the critical decision-making platform of academic medicine continues to be uncharacteristically homogeneous, represented mainly by white males. This is even more pronounced in surgical subspecialties, such as academic neurosurgery. This study aims to quantify this phenomenon, uncover its driving factors, and define opportunities for improvement. MethodsUsing a mixed research methodology, academic neurosurgical faculty in the U.S were identified, and their demographic data was collected. An internet search using Google Scholar and Scopus was conducted to determine scholarly activity using number of publications and h-index. ResultsWe found a significant increase in female faculty in academic neurosurgery within the last decade. Comparing the faculty rank amongst male and female faculty, we found that the majority of female faculty are at the assistant professor level (n=36/79; 45.6%) while male faculty are more at the full professor rank (n=265/582; 45.5%). A similar trend was seen for under-represented minority neurosurgery faculty. Strong scholarly activity corelated with a departmental chair position for male faculty, however, this trend was not true for female faculty. There was a significant difference in the number of publications and h-index in female vs male faculty, but only when including male faculty outliers at the full professor level. ConclusionSlowly but steadily, academic neurosurgery is making progress towards a more diverse and representative workforce in the U.S that better reflects the patient population. Facilitating timely progression of females and URM neurosurgeons into senior professorship and academic leadership roles will further advance this essential progress.

Background: Palliative care services improve quality of life and health outcomes for individuals living with chronic and life-limiting illnesses. Although these services have expanded considerably in urban areas, their availability remains limited in many rural communities. This study aimed to identify key components of integrated palliative care services and examine how these elements are implemented within rural healthcare systems in southern Minnesota. Methods: A qualitative case study using deductive content analysis was conducted. Semi-structured interviews were carried out with healthcare professionals involved in palliative and hospice care serving rural communities in southern Minnesota. Results: Participants identified several essential components of integrated palliative care, including multidisciplinary care teams, continuity of care across healthcare settings, interprofessional collaboration, and early identification of patients who may benefit from palliative care. Existing services in southern Minnesota incorporate several integrated elements, such as coordinated care teams, individualized care plans, nurse-led case management, professional training, and the use of virtual visits for geographically distant patients. However, participants also identified important gaps, including limited availability of palliative care services in rural areas, fragmented continuity of care, challenges in early patient identification, funding and insurance barriers, and the absence of a unified palliative care network. Conclusions: While palliative care services in southern Minnesota demonstrate important strengths, further efforts are required to improve service integration, coordination, and access for rural populations. Strengthening integrated PCSs may help reduce disparities in access to care and improve service delivery for rural patients and their families. These findings may inform the development of integrated palliative care models in rural healthcare systems beyond the study setting.

BackgroundPeriodontal disease (PD) and diabetes mellitus (DM) have a well-established bidirectional relationship, affecting glycaemic control and chronic disease outcomes. However, the extent to which medical training supports physician awareness of this association remains unclear especially in resource-limited settings. ObjectiveTo assess exposure to oral health education and to identify predictors of awareness of PD-DM association among physicians. MethodsA cross-sectional study was conducted among 146 physicians managing diabetic patients at a tertiary teaching hospital in Ghana. A structured questionnaire assessed exposure to oral health education, periodontal disease knowledge (score range 0-5), and awareness using a 5-item Likert scale (score range 5-25). Multivariable linear regression identified predictors of awareness. ResultsAlthough 62.1% reported exposure to oral health content during undergraduate training, 59.2% rated its quality as poor. Mean awareness score was 20.6 (SD=2.8). Awareness was independently predicted by years of professional experience (p < 0.001) and periodontal disease knowledge (p = 0.008), but not by structured oral health curriculum exposure. ConclusionAwareness of the PD-DM link was high but was not explained by formal educational exposure. Awareness appears to develop through knowledge of PD and professional experience, suggesting a gap between curricular exposure and competency.

BackgroundThe COVID-19 pandemic significantly disrupted healthcare services globally, particularly in low-resource settings. This study explores the impact of the pandemic on physiotherapy services in Nepal. MethodsA cross-sectional study was conducted. Qualitative data were collected through semi-structured interviews with 12 physiotherapists, while quantitative data were gathered from an onsite survey of 29 health facilities at six different districts of Province III of Nepal. Inductive thematic analysis approach was used to analyze the qualitative data, and descriptive statistics were used for the closed ended questions. ResultsThe findings were categorized into sub-themes under two major themes: i) Pandemic effect on physiotherapy services and patient care and ii) Adaptation, innovation and collaboration. The study revealed a significant disruption in physiotherapy services with a notable decline in patient flow and service availability. Most patients, especially those with disabilities and post-operative needs, experienced worsening conditions due to limited access to care. There was an increased recognition of the role of physiotherapy in acute respiratory care and post-COVID-19 recovery. Tele-rehabilitation was explored as an alternative care method but faced challenges in implementation. More than half (62.07%) of the centers reported uninterrupted physiotherapy services, whereas almost one third (31.03%) experienced service suspension. Most centers (89.7%) had personal protective equipment available, and majority (86.2%) of the physiotherapists worked in multidisciplinary team: fever clinics, triage, emergency care, respiratory physical therapy, and nursing and administrative support were among the expanded roles. Several centers (37.9%) used virtual care with telephone consultation serving as the primary modality. Virtual service was mostly absent in centers where in-person services persisted. ConclusionThe COVID-19 pandemic significantly impacted physiotherapy services in Nepal, leading to service disruptions and compromised patient care. It highlighted the need to further incorporate physiotherapy into the healthcare system and enhance rehabilitation services to improve continued patient care.

Global healthcare is targeting patient-centred care, as it leads to better health outcomes and higher level of patient satisfaction. Patient-centred communication, is an important part of patient-centred care because it focuses on involving patients in their care. Recent surveys both nationally and globally have shown that patients are not involved enough in their own healthcare decisions. This problem is especially common among the elderly with chronic conditions. This study aimed to describe patient-healthcare professional interactions, expectations, and satisfaction in physiotherapy within an understudied context, thereby providing important, specific data on ICE dynamics and satisfaction in the specific setting. Cross-sectional study of participants in scheduled consultations was conducted. Two government physiotherapy centres, seven private physiotherapy centres and two trust centres with physiotherapy facilities in Gujarat, India. 232 patients (from various public and private physiotherapy clinics) participated in the study. Patients' ideas, concerns, expectations (ICE) and satisfaction were explored. Almost 88% of patients reported their thoughts and explanations about their symptoms during the consultation. Most patients described not having any concerns about the diagnosis/treatment, and more than two-third of patients consulting PTs expected explanation for their symptoms. Almost 90% patients were satisfied with the consultation. The study revealed that while most patients conveyed their thoughts during consultations, very few expressed their concerns. Overall, patients were satisfied with their consultations.

ABSTRACT Background: Student nurses satisfaction with their academic programme is crucial for measuring the success of nursing training institutions. However, in Ghana, studies on student nurses' satisfaction have mainly focused on clinical learning, neglecting their satisfaction with the academic programme as a whole. This study therefore, assessed the predictors of student nurses satisfaction with their academic programme. Methods: A quantitative cross-sectional study design was used in the study. A systematic random sampling technique was employed to recruit 241 student nurses from two Nursing Training Institutions in the Eastern Region of Ghana. The Nursing Student Satisfaction Scale (NSSS) was used for data collection and data was analyzed using Statistical Package for Social Sciences (SPSS) version 27 software. Results: Correlation analysis revealed significant positive associations between satisfaction with curriculum (r = 0.583, p<0.001), faculty role (r = 0.650, p<0.001), social interaction (r=0.680, p<0.001), and overall satisfaction with the academic programme. After adjusting for the school of the student nurses, the school environment (B=0.354, p =0.000) and social interaction (B=0.291, p=0.001) emerged as significant predictors of student nurses' satisfaction with their academic programme. Conclusion: The study highlights the need for interventions to enhance the school environment and foster positive social interactions to improve student nurses satisfaction with their academic programme.

BackgroundOnline professional learning offers a scalable alternative to traditional face-to-face learning, but there are doubts regarding how well it works and when it works best. This review assessed the effectiveness of online professional learning interventions on healthcare professionals knowledge and skill acquisition. MethodsWe conducted a systematic review and meta-analysis of randomised controlled trials that compared online professional learning against static controls or face-to-face controls. We searched MEDLINE Complete, Scopus, Embase, CENTRAL, and PsycINFO from inception to January 31, 2025. Eligible studies included practising healthcare professionals in any clinical setting that measured knowledge or skill acquisition related to patient care. Data was extracted in duplicate, with disagreements resolved through discussion or by a third reviewer. We used multilevel meta-analyses to estimate the overall effect size and conducted moderation analyses for pre-specified factors. The study protocol was pre-registered on the Open Science Framework (OSF; https://osf.io/46zav). FindingsOf 55,376 records; 171 studies (391 effects, 25,412 participants) met the inclusion criteria. Online learning significantly improved knowledge and skill acquisition compared to static controls (g = 0.93, 95% CI [0.78,1.07], p < 0.001; I{superscript 2} = 89.8%), with larger effects in lower-middle income countries (g = 1.30, 95% CI [0.88, 1.72]) than in high income (g = 0.75, 95% CI [0.63, 0.86]). Online learning also significantly improves outcomes compared to face-to-face instruction (g = 0.45, 95% CI [0.31,0.59], p < 0.001; I{superscript 2} = 85.92%), with larger effects for knowledge outcomes (g = 0.46, 95% CI [0.33, 0.59]) than skills outcomes (g = 0.20, 95% CI [0.04, 0.36]). Effects did not differ significantly by profession, clinician experience, clinical setting, intervention characteristics or the learning design features (all p > 0.05). No studies had low overall risk of bias, and some evidence of publication bias was found. InterpretationFrom this body of evidence, we identified that online learning appears to improve healthcare professionals knowledge and skill acquisition, exceeding traditional teaching methods. Healthcare organisations can be confident implementing or expanding online professional learning to improve knowledge and skill acquisition. FundingNo funding

Background: The quality of palliative care in non-designated cancer hospitals, where approximately 70% of deaths of patients with cancer occur, remains unevaluated. This study aimed to clarify the quality of palliative care in these hospitals by comparing patient characteristics and evaluating the quality of palliative care provided by bereaved families. Methods: A questionnaire survey was conducted among bereaved family members of patients with cancer who died in 2018 at designated and non-designated cancer hospitals (excluding palliative care units). We compared the two groups regarding patient and bereaved family characteristics, quality assessment of palliative care (including Memorial Symptom Assessment Scale [MSAS]), care satisfaction, and the presence of end-of-life discussions. Results: In total, 27,944 bereaved family members agreed to participate. The mean age at death was 73.2 ({+/-}11.9) and 79.7 ({+/-}10.9) years for designated and non-designated cancer hospitals, respectively (p < 0.001, Effect Size [ES] = 0.55). The mean MSAS total score (symptom intensity) was significantly higher for designated cancer hospitals than for non-designated cancer hospitals, even after adjusting for patient characteristics (p < 0.001, ES = 0.39). Conversely, the mean adjusted overall satisfaction was significantly higher in non-designated cancer hospitals (p < 0.001, ES = 0.21) than in designated cancer hospitals. Conclusions: Non-designated cancer hospitals had older and less symptomatic patients than designated cancer hospitals. However, there was no significant clinical difference in the quality of palliative care, as assessed by the bereaved families.