Burnout During Residency: A Thematic Analysis of Stressors, Coping, and Organisational Challenges Among Nursing Residents

COVID-19 has been a major challenge for the healthcare sector, but also an opportunity for innovation and learning. The training and education of healthcare professionals during viral epidemics are crucial to ensure their safety, competence, and confidence. These innovations have the potential to improve the quality and efficiency of healthcare delivery, not only during the pandemic but also beyond. Published data on the training of healthcare professionals were obtained and reviewed to produce this article. The review analyses the various innovation that was adopted in the training of healthcare professionals during the COVID-19 pandemic. The COVID-19 pandemic has globally amplified the utilization of information technology in education. The limited physical access to classrooms and healthcare facilities triggered an immediate surge in the adoption of digital platforms to cater to the educational requirements of students across all healthcare disciplines. During the COVID-19 pandemic, healthcare professionals witnessed several significant changes in their training. In conclusion, the COVID-19 pandemic has acted as a powerful catalyst for innovation in the training of healthcare professionals. Here are the key takeaways: adaptive solutions, remote monitoring, embracing innovation, collaboration and research and resilience and adaptability. As we move forward, these innovations will continue to shape healthcare education, ensuring that professionals are well-prepared to face future challenges.

Background As in the general population, the use of Electronic Nicotine Delivery Systems (ENDS) and Heated Tobacco Products (HTPs) is rising among healthcare professionals. Because health care professionals are trusted sources of information, role models for the public, and influential in shaping health policies, understanding their experiences has direct implications for clinical practice, health education, and tobacco control policy. Objective This study aims to explore health care professionals’ experiences with ENDS/HTPs. Methods This study employed a qualitative descriptive phenomenological design. Semi-structured online interviews were conducted with 16 healthcare professionals across Türkiye between 8 January and March 24 2025 and were reported according to COREQ. Interviews (≈20 minutes) were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis in MAXQDA. Results Five themes emerged: Patterns and habits, Reasons for initiation, Perceived health effects, Professional role and identity, and Cessation process. ENDS/HTPs used among health care professionals is shaped by convenience and workplace context, often co-occurs with cigarette smoking, and generates perceived adverse effects and role conflict. Conclusions Findings highlight the need for evidence-based training for health care professionals, tailored cessation services specific to ENDS/HTPs, and policy measures that strengthen health care professionals’ role-model and leadership functions in tobacco control. Future longitudinal and mixed-methods studies should track knowledge, behavior, and cessation outcomes over time.

BACKGROUND The practice of providing patients with digital access to clinical narrative documentation by healthcare professionals (HCPs) is known as open notes. In mental health care, this innovation has the potential to increase transparency and foster greater trust in the treatment process. While open notes may improve quality of care and patient engagement, some HCPs are concerned that it may change the nature of clinical documentation and compromise its quality. OBJECTIVE This study aims to examine potential objective and subjective changes in clinical documentation following the implementation of open notes. METHODS Clinical notes written before and after the implementation of a patient portal with open notes function in 3 psychiatric outpatient clinics in Germany were collected. A total of 876 notes (453 pre-notes and 423 post-notes) were independently rated by two raters on 16 linguistic features using a Likert scale. Differences were analyzed using the Wilcoxon rank-sum test. In addition, 10 in-depth qualitative interviews with psychiatric HCPs were conducted and analyzed using reflexive thematic analysis. RESULTS Post-implementation significant differences were found in several linguistic features. Notes changed in monoglossic (P = .002) and less heteroglossic (P < .001); comprehensible (P < .001) and incomprehensible (P < .001); demeaning (P < .001) and resource-oriented (P < .001); positive emotional (P = .047); controlling (P = .002); stigmatizing (P < .001); personal (P < .001) and factual (P < .001) language. Interviewed HCPs reported noticeable changes in both their clinical notes and documentation practices. They described reducing the use of medical jargon, providing more detailed explanations, and tailoring documentation to better meet patient needs, resulting in slightly longer notes. However, in the subjective perception of the HCPs, the information they documented in the clinical notes remained mostly the same. HCPs noted an increase in time and workload associated with the new documentation approach, partly due to the workflow adjustments required to adapt to open notes. CONCLUSIONS To our knowledge, this is the first study to systematically analyze objective documentation changes in the field of mental health. The implementation of open notes seems to result in both objective and subjective changes in clinical documentation and documentation practices. Quantitative and qualitative findings from our study suggest that HCPs generally strove to create more patient-friendly notes. In practice this may benefit both patients and the therapeutic relationship. For open notes to be sustainable in practice, they must be seamlessly and efficiently integrated into HCPs' daily workflows. This requires not only structural changes, but also training of HCPs - both during their training and in clinical practice - on how to write open notes in a way that is both effective and patient-friendly. CLINICALTRIAL The study was registered with the German Register of Clinical Studies (No. DRKS00030188).

ABSTRACTTo explore how nurse educators in bachelor's nursing programmes perceive the meaning of nursing theories in nursing education.BackgroundNursing is situated between a professional discipline and an academic discipline. Nurses' professional values significantly influence nursing practice, playing a key role in shaping their behaviour and decision‐making and the quality of care provided.DesignA descriptive qualitative study was conducted and reported on in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ).MethodsFour focus groups with 17 educators at three universities and one university college were conducted between September 2021 and September 2023. Data were analysed using reflexive thematic analysis, in accordance with Braun and Clarke's approach.ResultsThree themes identifying nurse educators’ perceptions of the meaning of nursing theories in Norwegian bachelor's nursing programmes: nursing theories define what nursing is and refer to core elements in nursing practice; nursing theories strengthen nursing students’ self‐understanding and professional identity and nursing theories—a vital yet marginalised part of nursing education.ConclusionsNursing theories strengthen nursing students’ self‐understanding and identity as nurses and provide them with the knowledge needed for empathetic caring and relational competence. While nursing educators acknowledge the importance of nursing theories in nursing education, discipline‐specific nursing knowledge often competes with knowledge from other disciplines. The interdisciplinary approach emphasised in the training of health and social care professionals can overshadow the unique contribution of nursing theories. As a result, nursing theories may appear less important.

The unpredictable coronavirus disease and complexity of healthcare settings have caused emotional exhaustion and burnout among healthcare professionals globally. Building resilience at work training can facilitate a change in healthcare professionals’ overall ability to bounce back from adversity. The study aimed to develop, validate, and evaluate a digital resilience training (BRAW) for healthcare professionals in Singapore. Considering the multifactorial nature of resilience at work, the content of the 6-session resilience training was developed based on systematic reviews and psychological theories. The overall rating was 85% of the total points across five experts using the Conduct and Health-Related Website Evaluation Form, indicating valid content. A two-armed randomized controlled trial was used among 410 healthcare professionals. Primary outcome was resilience, and secondary outcomes included work engagement, intention to leave, and counterproductive work behavior. Three study time points were assessed. A generalized estimating equations model showed that the healthcare professionals in the BRAW had significant improvement in resilience, at the post-intervention and/or 3-month follow-up. Findings suggested that BRAW can be considered as supplementary training for healthcare professionals to equip themselves for handling unpredictable pandemics in the future. Further research is needed to examine the long-term effects and generalizability of digital resilience training.Clinical trial numbers: (ClinicalTrials.gov Identifier: NCT05130879, first registration date: 23/11/2021)Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-28028-z.

BackgroundPrevious evidence showed that Healthcare Professionals (HPs) working with rheumatic and musculoskeletal diseases (RMD) from Mediterranean countries have higher educational needs than Northern-European ones [1]. Hence, it is necessary to...

Mistrust and conflicts in patient-provider relationships (PPR) have become prevalent in China. The frequency of verbal and physical violence against healthcare workers has been increasing, but few interventions seem to be effective. Limited prior research has focused on the perspectives of healthcare professionals in training. This paper aimed to understand their viewpoints and conceptualize potentially actionable areas for future policy interventions. We analyzed de-identified training registration data of a convenience sample of 151 healthcare students and 38 junior professionals from 20 provinces in China. One open-ended question in the registration form asked the participant to comment on PPRs in China. We used qualitative thematic coding to analyze the narrative data. All answers were categorized into three overarching frames: patients, providers, and external agencies/regulations. Frequently mentioned themes in each frame were evaluated to generate an overall theoretical framework. Although fewer than 25% indicated that current PPRs are "good" or acceptable, 98% of respondents were optimistic about the future improvement of these relationships. The leading factors of PPRs mentioned as patient-relevant were eroding trust in the physician, unrealistic expectations, and ineffective communication. The provider-relevant themes highlighted were poor service quality, ineffective communication, and heavy workload. Leading themes relevant to external agencies or regulations were dysfunctional administration system, negative media reports, and disparity in healthcare resource distribution. Healthcare professionals in training had a negative view of the current situation but had confidence in future improvement. Patient, provider, and societal factors all contributed to the tension between patients and providers. All aspects of the healthcare sector should be carefully considered when contemplating policy or social interventions to improve the patient-provider relationship.

Objective: Studies suggest that healthcare professionals often feel unprepared to deal with mental health issues in refugees and asylum seekers. The aim of this qualitative study was to examine the experiences of refugees and asylum seekers in relation to mental health and healthcare, to inform cultural competency training for undergraduate medical students. Method: Focus groups were conducted with 16 refugees and asylum seekers and staff from relevant charity organisations in Wales. We explored participants’ experiences in relation to mental health and healthcare, and training for healthcare professionals. The data were thematically analysed using an inductive approach. Results: Three overarching themes were identified: (1) recognition of the specific mental health needs of refugees and asylum seekers, (2) barriers preventing effective mental healthcare delivery for refugees and asylum seekers and (3) authentic learning experiences for medical students. Conclusion: To our knowledge, this is the first study to actively involve refugees and asylum seekers, along with individuals who work closely with this population, in considering the development of cultural competency training for healthcare students and professionals in relation to mental health. If we are to reduce the risks of exclusion from healthcare for refugees and asylum seekers, training in this area is essential. Findings from this study have informed the development of a guide for healthcare educators with a focus on refugee and asylum seeker mental health.

Cancer care--a stress for health professionals.

Dementia care: Research and clinical innovation.

C hildren experience a wide variety of acute, recurrent and chronic pains.A recent epidemiological study in southwestern Ontario found that the majority of schoolaged children (96%) experienced acute pain (eg, injuryrelated pains, headache, sore muscles, toothaches) over the past month, 57% reported having at least one recurrent pain (eg, headaches, stomach pains and growing pains), and 6% were found to have chronic pain (eg, illness-related pain, back pain) (1).Pain complaints are one of the top reasons for patient-doctor encounters in primary care settings.Pain in children is now recognized as a major health problem because of its prevalence (1,2), negative impact on all aspects of quality of life (3) and economic burden (4).The treatment and alleviation of pain is a basic human right (5).Researchers have demonstrated that well-managed acute pain is associated with faster recoveries, fewer complications and decreased use of health care resources (6).However, research continues to uncover and document the prevalence of unrelieved pain in infants and children, despite evidence of physiological and psychological negative consequences (7,8).For example, two surveys (9,10) in Canadian paediatric hospitals indicated that there has been no significant change in the levels of pain experienced by infants and children or the frequency of the administration of pain-relieving interventions over the past decade.In

Background: Although the elevated attention has been drawn to sexual and gender minority (SGM) people and their mental health, those who are currently and formerly incarcerated remain largely overlooked. To understand both their psychological well-being during and after incarceration and their re-entry challenges is critical for health equity and inclusion. Methods: A systematic review was conducted following the PRISMA guidelines to identify peer-reviewed articles published between 2000 and 2025 from Scopus and Pubmed, with additional relevant records retrieved from EBSCO. Studies conducted outside the United States were excluded to ensure consistency in legal and correctional contexts. Eligible studies were analyzed to offer key themes by using thematic analysis approach. Results: Of the 42 studies identified in this research, 15 articles were included in the final review. Ten out of fifteen studies examined mental health issues, such as depressive symptom, anxiety and psychological distress. Six studies highlighted that the need for policy reform and inclusive training for healthcare professionals and staff is necessary. Disrupted social support and intersectional discrimination were observed among incarcerated SGM individuals. Four themes were synthesized: (1) Intersected stigma (2) Institutional harm and mental health consequences (3) Post-release challenges (4) Coping and reintergration strategies. Conclusions:The findings suggest that community, peer and social support network resources are critical for fostering resilience and optimizing mental health outcomes for this SGM group during community re-entry. Policy reform, inclusive training for correctional healthcare professionals, and enhanced community-based re-entry program are essential to alleviate institutional harm and promote mental health improvement for this vulnerable population.

Janet Kinson practised as a Diabetes Specialist Nurse in Birmingham and demonstrated a remarkable commitment to diabetes education by developing a programme to support what was then the newly-emerging profession of diabetes specialist nursing. She was forward thinking and saw the potential to do things differently, but insisted on high quality. As the nominated speaker for the Janet Kinson lecture I want to reflect upon my own experiences of working in diabetes and of some important changes that have happened over the last 25 years based on an ethos and value system which is fundamentally patient centred. If we consider the perspective of an individual with a long-term condition such as diabetes (Figure 1), it reminds us that all of the important activity to manage and look after diabetes takes places outwith the 20–30-minute, two to three times a year consultation (Figure 1: orange lines). And yet, as health care professionals, we sometimes expect that these regular visits to clinics will be enough to enable the person to manage their own health, claiming credit when people do ‘well’ and throwing our arms up in despair when targets aren't being achieved. In reality, we aren't in charge, we have a relatively limited role in managing diabetes, and outcomes are by and large driven by the person. I qualified as a dietitian in 1989 with a keen interest in diabetes, and I wanted to make a difference. However, I found my early career hugely frustrating because at that time there were no specialist diabetes posts and dietetics was usually delivered separately from the rest of diabetes care, with very little clinical information to draw upon to support decision making or to feed back to the person. People were sent to the dietitian as a form of punishment and as a last resort. I certainly didn't feel valued and I can't imagine the people who used the service found it as useful as it could be. It didn't really utilise any of the knowledge or skills I had spent four years learning at university. For me this all came to a head when I arrived at a general practice clinic and was faced by a receptionist who had forgotten I was coming and hadn't booked a clinic room. She showed me to the cleaning cupboard! I felt I might leave dietetics altogether. However, in 1994 I went for an interview at North Tyneside for a newly-created diabetes specialist dietitian post – one of the first of its kind. The post had been created following a local (unpublished) study which had developed a new role called a ‘Diabetes Advisor’. In the study, people with type 2 diabetes had been randomised to ongoing care with a nurse or a dietitian which turned out to be equally effective and acceptable to patients. Interestingly, the funding for this study had been obtained from Kellogg's since the usual sources of research funding felt it unethical to allow dietitians to be responsible for individual patient care. It was here that I met Dr Sue Roberts, who has been an inspiration to me and to so many people who have worked alongside her. The service she developed was unique and there were always opportunities to challenge the way things were done. There was a strong focus on organised and systematic care, with good links between primary and specialist care, facilitated by training and close working relationships. There were clear pathways; everyone knew their role and how things worked and we spent time examining data, reflecting on practice and tending to our training needs. The philosophy, principles and aims of the service were clear and written down (Figure 2). Every year we went to the local lighthouse and had a productive awayday. It was also an effective service, and I suspect one of the first examples of a properly integrated diabetes service. In 2004, one of the local GPs published data from the comprehensive diabetes register, which demonstrated that the outcomes across the whole population were as good as the intensively-controlled arm of the UKPDS trial.1 However, this was achieved with significantly less weight gain than expected. In our model of care, not only were dietitians seeing people and supporting lifestyle change, they were also supporting and up-skilling general practice staff in diabetes while keeping the specialist service appraised of what was happening in routine primary care. The team of nurses, doctors, podiatrists, physiologists and administrators were committed and passionate about what they did. What really stood out was the way the team talked about and related to patients, with a huge amount of respect for the way they chose to manage their lives. We tried to use psychological rationale to understand behaviours and health beliefs to help us best know how to support people. I learnt a new phrase – unconditional positive regard. This was exemplified by the training and support we received from our psychologists: Dr Peter James and Dr Yvonne Doherty. They trained the whole team to understand and deliver much more psychologically-informed services and consultations. This wasn't just about motivational interviewing. We all had to develop new ways of consulting with people and a whole host of methods to maintain positive therapeutic relationships with patients and to challenge and support different ways of thinking. Working in this way has cemented for me the critical nature of high-quality consultation and communication skills within diabetes and long-term conditions care. This is demonstrated in our local Dove Data which show a strong association between patient involvement, good glycaemic outcomes and lower costs for prescribing. Perhaps as a result of this environment, I began to think about people who were starting insulin and the local and national data that showed people weren't seeing the improvements they expected. It's a huge step for someone to make the transition to an injectable therapy and so, if it doesn't work, it reduces their confidence in making a difference to their own outcomes. It also diminishes their trust and relationship with the diabetes team. So I led the trial of a very structured approach which we called a ‘pre-insulin assessment’. This included a detailed assessment, giving consistent messages and information about choices, leading to a plan to maximise all current therapy (lifestyle and medication). At the same time, we learnt about the concerns the individual might have about current and future treatment – a form of supported shared decision making. The impact was clear – only 50% of people needed to start insulin and, for those who did, glycaemic goals were achieved with much less weight gain than predicted.2, 3 This is now part of our routine care pathway for people with type 2 diabetes. Our dietitians make decisions to directly refer people to groups or 1:1 injectable starts, avoiding unnecessary appointments and delays and freeing up space in outpatient clinics for people who really need to see a consultant. This was developed in specialist care but now happens in general practice and has become a ‘next steps assessment’ due to the broader range of therapeutic options now available. The next steps assessment is an example of several dietetically-led initiatives which have improved the outcomes and involvement of those with diabetes in our patch – our expertise is about food, but we integrate that into discussions about other diabetes treatments and medicines and psychological approaches which are, in turn, integrated into the rest of routine diabetes care. As a result of leading on this, I became the first consultant diabetes dietitian. This is all in stark contrast to my beginnings as a newly-qualified dietitian (trying to avoid the cleaning cupboard!), but it does demonstrate that dietitians can make a huge contribution to the overall work in diabetes and how important it is to ensure this sometimes underutilised group of professionals are integrated into routine diabetes care and given the chance to develop and lead. We now have 10 whole-time-equivalent dietitians working across primary and specialist care, and the team continues to develop new effective approaches based on our learning. One of these, which had a huge impact on our professional group, was structured patient education, starting with DAFNE. At the time, we were first looking at the intensified insulin programme developed by Michael Berger's team in Germany; carbohydrate counting had been assigned to the dusty shelves of history. At that point, carbohydrate counting was associated with very restrictive, inflexible diets in which a daily prescription of carbohydrate was made up from a fairly limited ‘exchange’ list. These diets were not in keeping with nutritional guidelines for the general population. As a result, the dietetic profession had shunned the approach and instead focused on qualitative dietary regimens (low glycaemic index and healthy eating). In addition, the food messages for both type 1 and type 2 diabetes were the same. The Dusseldorf team had demonstrated that their programme supported people to achieve clinically-significant improvements in glycaemic control without an increase in severe hypoglycaemia.4 Our visiting team from King's, Sheffield and Northumbria observed their type 1 training programme, which focused entirely on carbohydrate counting and insulin dose adjustment to achieve both flexibility and better clinical outcomes. We were amazed at how well it worked. On our return, although we were very enthusiastic, the dietetic profession was unsure and took a lot of persuading and retraining to take on the approach. Carbohydrate counting is now the acknowledged dietary strategy and evidence-based practice in terms of nutritional therapy in type 1 diabetes and is recommended in all national and international guidelines.5 DAFNE was accepted by professionals because we were able to use the UK feasibility study to show that it improves glycaemic outcomes without a deterioration in weight and cardiovascular risk.6 It also improves quality of life, and has subsequently been shown to reduce unplanned health care utilisation.7 However, what makes DAFNE important to me is that it gives people with diabetes the knowledge, skills and confidence to manage their diabetes on a day-by-day basis. I was asked to join a kick-off meeting for type 2 structured education and was keen to use my experience from DAFNE to support people with type 2 diabetes. At a local level we wanted to retain a high-quality approach but the numbers of those with type 2 diabetes were increasing significantly. In developing the DESMOND programme, we were particularly aware of the impact of health beliefs and behaviour change in the management of type 2 diabetes. We therefore focused on a patient-centred philosophy and underpinning psychological theories. The programme uses an approach in which people are given information and are supported to make their own decisions around goals and actions in order to manage their own diabetes.8 In the same way that Janet Kinson had applied rigorous standards to the training of diabetes nurses, both the DESMOND and DAFNE group felt that the same principles should apply to the development and roll-out of structured education. In order to do this we developed rigorous methods of training and quality assuring the programmes. In my role as chair of the DAFNE educator group, I worked alongside a strong team who developed a train-the-trainer and quality assurance process for educators and DAFNE courses.10 This was supported by the development of national guidelines for structured education.11 Sadly, the importance of standards in education is still not accepted everywhere. We would never prescribe half doses of medication; it is still common practice to deliver education programmes which do not meet national standards and have no evidence. From a personal perspective I find it hard to believe that my daughter has had more hours of driving lessons than my nephew, who has type 1 diabetes, has received in education about how to manage his diabetes. North Tyneside joined the Year of Care programme in 2007. I was keen to get involved as it seemed to fit with the ethos and values of our diabetes service, and also seemed the next logical step to support people who have attended structured education. I had also seen at first hand the impact of Quality and Outcomes Framework on the behaviours and attitudes of professionals towards people with diabetes. In some instances, the focus on ticking boxes seemed to dominate the need to develop good therapeutic relationships with patients. It felt as if the focus had shifted away from supporting people with their diabetes and talking about their concerns, health beliefs or ideas. I saw the Year of Care approach as a means to address this. I am now the National Director for this programme and our small team of trainers, clinical leads and programme managers has worked with a significant number of organisations to provide support, training and practical tools to implement this approach in primary and specialist care. If you consider the perspective of a person living with a long-term condition, highlighted in Figure 1, it emphasises the significance of the person being in the driving seat of their own care, with a need for the system and the professions within it to support the person to be in charge of their own health and wellbeing. The Year of Care approach was designed with people living with diabetes who wanted to get more out of the time they spend with health care professionals. The approach introduces care and support planning and links with support for self-management. This is enabled by a change in how care is organised and through training of health care professionals. The changes that need to take place at both a practice and system level are detailed in the Year of Care house (Figure 3). Care and support planning requires a redesign of the traditional annual review, splitting it into a two-step process (Figure 4). This involves an initial disease surveillance review with a trained health care assistant (where all care processes are completed in a single appointment) and then a conversation a few weeks later focused entirely on involving and supporting the individual.12 The whole process is enabled by the sharing of information with the patient between the disease surveillance review and the care and support planning conversation. One of the key differences with this approach is the introduction of information sharing where agenda-setting prompts and routine results are shared with the person with diabetes before their care and support planning conversation. While some practitioners can be sceptical about this additional step, people with diabetes and other long-term conditions find this really helpful and feel it makes them more equal to the health care professional during the care and support planning conversation. It saves time, helps people see what is happening and reminds us all about who these results actually belong to. Some of the comments from people with diabetes who have experienced care and support planning are shown in Box 1. The purpose of changing the process is to create the space for a more useful conversation for the person with a focus on planning. People find it a completely different experience and it supports their understanding of their condition. The impact has been positive in terms of how valuable it feels for both the staff involved and the individuals with diabetes. It has improved care process completion and has improved outcomes. However, not all health care professionals find these new conversations easy and our training and support programme aims to help with this. The approach is now being used for many other conditions, including those relating to people who live with multiple long-term conditions. I have learnt some key lessons as I have tried to develop my role and that of my dietetic colleagues, while considering how best to go about supporting people with diabetes. These apply at a number of levels and are exemplified in the Year of Care house (Figure 3). The house needs all elements to be embedded and happening systematically, with care delivery and systems designed with the focus of people with diabetes as the central care givers.13 If we think about ‘whose diabetes it is’, we are more likely to design and deliver services which recognise that individuals with diabetes take on most of the actions that can deliver better outcomes in diabetes. This can therefore be supported by activities around the left-hand wall of the house (engaged, informed patient) with routine implementation of high-quality care and support planning so that people can have better conversations about their health. Education should be embedded into core care pathways and throughout the patient's journey. We should also be aware that support and activities embedded in communities can have a profound impact on how people live well with their diabetes. For health care professionals (right-hand wall of the house), all of our effort and activities should be geared towards supporting the person to understand and manage their diabetes. Having a patient-centred philosophy of care and good communication skills is as important as being up to date with the evidence base. Teams need to work together and squeeze out the contribution of all team members. Creating systems (the roof and the foundation of the house) that support improving the knowledge, skills, confidence and motivation of people with diabetes to live their lives and manage their conditions will make the biggest difference to health care. Outcomes ultimately depend on the individual; however, our systems of care and quality of care can be barriers or enablers. The most important people in a service are those with diabetes and so our systems of care need to be designed around the central role that people with diabetes play in managing their own care.

BackgroundThe global market for medical education is projected to increase exponentially over the next 5 years. A mode of delivery expected to drive the growth of this market is virtual reality (VR). VR simulates real-world objects, events, locations, and interactions in 3D multimedia sensory environments. It has been used successfully in medical education for surgical training, learning anatomy, and advancing drug discovery. New VR research has been used to simulate role-playing and clinical encounters; however, most of this research has been conducted with health professions students and not current health care professionals. Thus, more research is needed to explore how health care professionals experience VR with role-playing and clinical encounters.ObjectiveThe aim of this study was to explore health care professionals’ experiences with a cinematic VR (cine-VR) training program focused on role-playing and clinical encounters addressing social determinants of health, Appalachian culture, and diabetes. Cine-VR leverages 360-degree video with the narrative storytelling of cinema to create an engaging educational experience.MethodsWe conducted in-depth telephone interviews with health care professionals who participated in the cine-VR training. The interviews were audio recorded and transcribed verbatim. A multidisciplinary team coded and analyzed the data using content and thematic analyses with NVivo software.ResultsWe conducted 24 in-depth interviews with health care professionals (age=45.3, SD 11.3, years; n=16, 67%, women; n=22, 92%, White; and n=4, 17%, physicians) to explore their experiences with the cine-VR training. Qualitative analysis revealed five themes: immersed in the virtual world: seeing a 360-degree sphere allowed participants to immerse themselves in the virtual world; facilitated knowledge acquisition: all the participants accurately recalled the culture of Appalachia and listed the social determinants of health presented in the training; empathized with multiple perspectives: the cine-VR provided a glimpse into the real life of the main character, and participants described thinking about, feeling, and empathizing with the character’s frustrations and disappointments; perceived ease of use of cine-VR: 96% (23/24) of the participants described the cine-VR as easy to use, and they liked the 360-degree movement, image resolution, and sound quality but noted limitations with the buttons on the headsets and risk for motion sickness; and perceived utility of cine-VR as a teaching tool: participants described cine-VR as an effective teaching tool because it activated visual and affective learning for them.ConclusionsParticipants emphasized the realism of the cine-VR training program. They attributed the utility of the cine-VR to visual learning in conjunction with the emotional connection to the VR characters. Furthermore, participants reported that the cine-VR increased their empathy for people. More research is needed to confirm an association between the level of immersion and empathy in cine-VR training for health care professionals.

Men who have sex with men have a disproportionately high prevalence of HIV worldwide. In Brazil, men who have sex with men account for over 15% of HIV cases, substantially higher than the general population prevalence of 0.6%. Pre-exposure prophylaxis (PrEP) is a critical biomedical strategy for reducing HIV transmission, yet adherence remains challenging due to stigma, logistical barriers, and the need for regular clinical follow-ups. TelePrEP, a telehealth-based approach to PrEP follow-up, has emerged as a potential solution to improve accessibility and reduce stigma. However, the perspectives of users and health care providers on this intervention remain understudied in low- and middle-income countries, such as Brazil. This study aims to examine the experiences and perceptions of users and health care professionals regarding TelePrEP, an asynchronous remote consultation model, in 5 PrEP services across 3 Brazilian regions (southeast, south, and northeast). We conducted 19 in-depth interviews with PrEP users (aged between 23 and 58 years) and 6 interviews with health care professionals (aged between 35 and 61 years). Users were recruited from 5 public health care services, including outpatient HIV clinics and testing centers. The interviews explored motivations for PrEP use, experiences with in-person and remote consultations, perceived advantages and disadvantages of TelePrEP, and overall satisfaction. Thematic analysis was conducted using NVivo software. Users reported greater convenience, increased autonomy, and reduced stigma, highlighting that the remote consultations eliminated the discomfort of discussing personal topics in person and minimized the need for frequent visits to health care facilities. Many felt that TelePrEP simplified HIV prevention, normalized PrEP use, and contributed to more sustainable adherence while also expressing confidence that periodic laboratory testing was sufficient for monitoring their health. Conversely, health care professionals raised concerns about the loss of personal connection with users, which they perceived as essential for detecting health issues and ensuring PrEP adherence. They also noted that TelePrEP could hinder the identification of sexually transmitted infections due to the absence of direct clinical assessments, and some questioned whether TelePrEP compromised the quality of care, fearing that users might delay reporting symptoms or other health concerns. To effectively address the needs of both groups, the successful implementation of telehealth PrEP services must consider these differing perceptions. Further research is essential to explore implementation in diverse settings and enhance the training of health care professionals to address the specific requirements of PrEP care.