The Influence of Clinical Clerkship Rotation Sequence on Emergency Simulation Performance: A Cohort Study on Sixth-year Medical Students

Script concordance test: Insights from the literature and early stages of its implementation in osteopathy

Nearly half of US medical students report experiencing stress within the first few months of training, with the highest stress experienced as they transition into the clinical learning environment. Medical students unprepared to address the stressors can have decreased academic performance, increased mental health concerns, engage in self-destructive behaviors, withdraw from school, and express suicidal ideation. Inadequate skills to cope and manage stress and stressors can persist through medical school into clinical practice as they complete their graduate medical education training and then into their roles as attending physicians. Medical schools recognize their responsibility to understand the stressors and provide formal curriculum interventions to develop skills that can help process the stress of clinical training and better prepare them for entry into clinical practice. This phenomenological research study aimed to examine existing medical school stressors and gain insight into how medical schools' curricula could help strengthen their medical students' preparedness for clinical practice. Recognizing that medical students may not have the appropriate insight about the stressors while actively training, data was collected through a qualitative research design using semi-structured interviews of recent graduates of an allopathic medical school in Pennsylvania. Research questions included: What experiences in medical school cause stress that may negatively affect medical students' training and preparedness for clinical practice? How do medical schools mitigate the causes of stress (stressors) on medical students during their training? Do medical students feel they are adequately prepared for clinical practice upon completion of medical school? What could medical schools do to help mitigate the stressors during training and strengthen medical students' preparedness for clinical practice?

University of Virginia School of Medicine

The aims of this study were to examine associations between heightened vigilance and perceived discrimination on readiness for clinical practice and to examine the mediating effects of social support and resilience. A survey was distributed to dental trainees (dental and dental hygiene students) enrolled at a US dental school located in the mid-Atlantic region. The survey assessed readiness for clinical practice and included measures of perceived discrimination, heightened vigilance, and the following wellness measures: perceived stress, resilience, anxiety, social support, and coping. Adjusted for gender, and race/ethnicity, we regressed heightened vigilance and perceived discrimination independently on students' readiness for clinical practice. To assess mediation, we computed the direct effects of heightened vigilance and perceived discrimination and potential indirect effects mediated through social support and resilience. A total of 250 students who completed the survey had complete data on all variables. Five percent identified as Black or African Americans, 34% as Asians, and 8% as Hispanic/Latino. Sixty-two percent were female and 91% were dental students. The overall mean (SD) heightened vigilance and perceived discrimination scores were 18.9 (4.9) and 10.5 (7.6), respectively. Only the mean score for heightened vigilance differed significantly by race/ethnicity (p=0.02). Higher heightened vigilance (odds ratio [OR]=0.75 95% confidence interval [CI]: 0.25, 2.23), and perceived discrimination (OR=0.52, 95% CI: 0.33, 0.88) scores were independently associated with lower adjusted odds of reporting high confidence in readiness for clinical practice even after adjusting for the mediating effects of social support and resilience, although the association for heightened vigilance was not statistically significant. Heightened vigilance and perceived discrimination appear to negatively impact dental trainees' career readiness. Intentional efforts to prioritize an anti-racism approach within dental education programs and patient care across the nation are warranted.

Healthcare professionals' (HCPs') accurate knowledge of and positive attitudes toward immunization greatly influence society's acceptance of it. Early and appropriate immunization education for HCP students is vital. This study aimed to understand current immunization education and vaccine hesitancy among medical, nursing, and pharmacy students in Japan. An anonymous self-administered online questionnaire was administered to final-year medical, nursing, and pharmacy students in Japan between 6 and 31 March 2023. Survey items assessed current immunization education, preparedness for clinical practice, immunization knowledge, and the degree of vaccine hesitancy. Overall, 525 students (127 (24.2%) medical, 252 (48.0%) nursing, and 146 (27.8%) pharmacy) responded, of whom 39.8% raised concerns regarding new vaccine risks (24.4%,15.9%, and 23.3%, respectively; p = 0.22) and adverse effects (14.2%, 12.7%, and 17.1%, respectively; p = 0.57), including trust in government information (61.4%, 50/4%, and 56.8%, respectively; p = 0.337) or recommended vaccines (57.5%, 4.7%, and 43.8%, respectively; p = 0.113). Preparedness for future clinical practice varied significantly among schools, with medical students (54%) feeling more prepared compared to nursing (34.3%) and pharmacy students (39.1%) (p < 0.001). The average correct immunization knowledge rate was 59.9%, with significant differences between schools (medical 62.7%, nursing 57.6%, and pharmacy 59.6%; p < 0.001). There was no significant correlation between knowledge level and self-assessed preparedness (r = 0.066, p = 0.132). The HCP students wished to receive more immunization education and sought improvements in comprehensive knowledge, communication skills, and practice-based content. For Japan's HCP students, the enhancement of immunization education focusing on hesitancy and risk-benefit communication is necessary.

Self-perception of readiness for clinical practice: A survey of accelerated Masters program graduate registered nurses.

Curriculum Management and Governance Structure Case Western Reserve University (CWRU) School of Medicine (SOM) has two collaborative and innovative educational tracks: University track and College track. ♦ University-based program (University track) was established in 1843 and Cleveland Clinic-based Cleveland Clinic Lerner College of Medicine (College track) was established in 2002. ♦ University track implemented a major curriculum revision in 2006, focusing on development of lifelong learners and incorporating themes of scholarship, clinical mastery, leadership, and civic professionalism. A dedicated four-month research requirement culminating in an MD thesis was incorporated into the four-year curriculum. A hybrid of active, student-centered PBL groups and teacher-centered large and medium group sessions form the backbone of learning venues. ♦ Five-year competency-based College track is designed to train graduates with excellent clinical skills, expertise in research, and a passion for scientific inquiry. Students complete a master's level thesis and graduate with an MD degree with Special Qualification in Biomedical Research. ♦ While course format, assessment approaches, and curricular topics beyond core content of University and College tracks differ, clinical rotations for both tracks were designed collaboratively and implemented jointly. Curriculum Management and Governance Structure ♦ SOM faculty Committee on Medical Education evaluates, reviews, and makes recommendations concerning overall goals and policies of medical education programs for University and College tracks. ♦ Curriculum Monitoring Council (University track) and Curriculum Steering Council (College track) have responsibility for (1) defining and allocating educational objectives, (2) approving teaching methods and instructional formats, (3) monitoring coordination and integration of curricular content, (4) selecting assessment methods to document student performance, (5) monitoring quality of teaching, (6) overseeing curricular and program outcomes. ♦ Basic science leadership groups for each track facilitate sharing of best educational practices among course leaders, design and implement programs to ensure basic science mastery, and facilitate smooth implementation of methods of student assessment. ♦ Joint Clinical Oversight Group (JCOG) monitors and evaluates clinical experiences at affiliated teaching hospitals of CWRU SOM. JCOG oversees curriculum design, program evaluation, educational quality, student assessment, and compliance with LCME and institutional requirements for the clinical curriculum. ♦ The Dean is chief academic officer responsible for both education tracks. ♦ The Dean delegates day-to-day responsibility for both tracks to the Vice Dean for Education and Academic Affairs. The Executive Dean for the College track reports to the Vice Dean for Education and Academic Affairs. The Executive Dean for the College track is also accountable to the Chief of Staff of the Cleveland Clinic with regard to Cleveland Clinic resources and support for the College track. Curriculum Support Offices ♦ Offices of Curricular Affairs for each track include an associate dean for curricular affairs, MD and PhD educational leaders, and administrative staff who provide support for their respective educational programs. These offices support curriculum development and implementation, ongoing quality improvement, student assessment, and program evaluation. They work collaboratively with respective offices of information technology to develop, improve, and maintain extensive electronic curricula, student assessment resources, and program evaluation methodologies. ♦ Each track has a director of undergraduate clinical education, support staff, and physician and nonphysician educators to support components of clinical curriculum for each track and collaborate on the joint clinical program. ♦ Both tracks have robust faculty development programs to support teaching and implemented initiatives to encourage educational scholarship. Financial Management of Educational Programs ♦ When the Dean committed to revision of the University track's curriculum in 2004, a new curriculum budget was established to support University track curriculum development, implementation, ongoing program maintenance, and improvement. ♦ CWRU School of Medicine has affiliation agreements with its major teaching hospitals. As a part of affiliation agreements with three teaching hospitals, faculty are expected to contribute 100 hours annually to medical school teaching activities. University track established a faculty-teaching database that provides ongoing reports about faculty teaching effort to department chairs. ♦ All College track faculty are salaried employees of a central Cleveland Clinic budget, allowing Department Chairs to allocate release time for teaching and service activities. Valuing Teaching ♦ Qualifications for faculty appointments include “a high level of teaching effectiveness,” with documentation of quality and quantity of teaching activities within teaching portfolios. ♦ Nontenure track faculty appointments are based on an area of excellence: teaching, clinical service, or research. ♦ In addition to schoolwide and departmental teaching awards, faculty are invited annually to submit applications for Scholarship in Teaching awards. Applications are peer-reviewed, and each year 20–30 faculty are recognized by the Dean at the Annual Education Retreat. ♦ Cleveland Clinic faculty are recognized for teaching as part of annual performance reviews, which are used to determine promotion and salary decisions. College track maintains a database of faculty leadership and teaching activities for all components of the curriculum; summary information is provided to faculty members and chairs as part of the reviews. Curriculum Renewal/Development Process University Track Curriculum Development ♦ Major curriculum transformation, Western Reserve2 (WR2), launched July 2006. ♦ Key Objectives for Curriculum Development Process Medical education will be experiential and emphasize skills for scholarship, critical thinking, and lifelong learning. Educational methods will stimulate an active interchange of ideas among students and faculty. Students will be immersed in a graduate school educational environment with flexibility and high expectations for independent study and self-directed learning. Learning will be fostered by weaving scientific foundations of medicine and health with clinical experiences throughout the curriculum. These scientific foundations include basic science, clinical science, population-based science, and social and behavioral sciences. Every student will have an in-depth mentored experience in research and scholarship. Recognizing obligations of physicians to society, central themes of public health, civic professionalism, and leadership will be longitudinally woven throughout the curriculum. Systems issues of patient safety, quality medical care, and health care delivery will be emphasized and integrated throughout the curriculum. Students will acquire a core set of competencies in knowledge, mastery of clinical skills, and attitudes that are prerequisite to graduate medical education. Learning Outcomes/Competencies ♦ WR2 Curriculum is based on nine core competencies with well-defined achievement levels for each that serve as educational objectives (medical knowledge, patient care, communication skills, professionalism, lifelong learning–personal development, research and scholarship, civic professionalism–health advocacy–leadership, problem-based learning and improvement, systems-based practice). Components of the Curriculum Development Process ♦ Preclerkship basic science portion of WR2 curriculum is 20 months in length with six systems-based course blocks that integrate normal and abnormal content throughout (Chart 1).CHART 1: University Track Basic Science Curriculum♦ Weekly in-class basic science teaching is limited to 16 hours a week, paired with high expectations for self-directed learning outside the classroom. ♦ A wide range of dual-degree opportunities are available for students to pursue. ♦ One week of each block is dedicated to experiences in the clinical setting. During Clinical Immersion Weeks, students have opportunities to see how basic science concepts learned in the classroom translate to and impact on patient care. ♦ First block of the curriculum, five weeks in length, is “Becoming a Doctor.” It introduces students to medical school education at the macrolevel with a focus on social and behavioral context of health and disease. ♦ Themes from the first block and additional content in Health Policy, Bioethics, Doctor–Patient relationship, and sociobehavioral medicine are continued in weekly 2-hour seminars. ♦ Case Inquiry Groups (IQ groups), based on McMaster's revised PBL format, serve as a core teaching method for six of the formal teaching hours (three 2-hour sessions per week). ♦ Anatomy, histopathology, and radiology are integrated into a longitudinal “Structure” block. ♦ Learning from multiple sources is emphasized (including a rich array of web-based resources); previous extensive written syllabus was eliminated. ♦ Weekly Foundations of Clinical Medicine Seminars (Doctoring Course) integrates with IQ cases when appropriate. ♦ Sixteen-week mentored research experience with MD thesis is required for all students. Components of the Assessment Process ♦ Goal of deep learning, synthesis, and information transfer expected in WR2 requires that assessment strategies align with curriculum objectives. ♦ CWRU SOM's longstanding pass-fail, criterion-referenced assessment system in the preclerkship curriculum was maintained. ♦ Weekly formative assessments include 20–30 multiple choice questions and 2 synthesis essay questions primarily based on content of the week; these are open book, and group work is encouraged. ♦ End of block basic science summative assessment is a 4- to 5-hour synthesis essay examination; each essay is vignette-based and incorporates multiple concepts and transfer of knowledge to new contexts. ♦ There is an end of block summative anatomy and histopathology examination with practical, short answer, and multiple choice portions. ♦ At the end of each block, students take a formative multiple choice test developed through the NBME customized assessment services. Each test has questions specific to current block of study as well as questions assessing material from previous blocks. This enables students to monitor their progress in studying for USMLE Step 1. ♦ At midpoint of each block, students engage in a personal quality improvement exercise by defining an area for improvement and developing a Professional Learning Plan of action. ♦ Students complete an end of year reflective portfolio to assess progress in nine core competencies. ♦ IQ group performance within areas of (1) contributions to group content and process, (2) skills of critical appraisal, and (3) professional behaviors are evaluated by IQ group faculty facilitators; students engage in peer assessment as well. ♦ Performance in preclerkship clinical curriculum is integrated into the overall assessment process and incorporates formative OSCEs, preceptor feedback, and student reflections. New Topics in the Curriculum Since 2000 ♦ Quality improvement and patient safety, longitudinal theme across four years ♦ Leadership and teamwork, evolving as longitudinal theme across four years ♦ Population health ♦ Increased emphasis on longitudinal development of communication skills, both preclerkship and clerkship components with opportunities for peer teaching in fourth year ♦ Health policy and health care economics Changes in Pedagogy ♦ Student-centered problem-based learning groups (Case Inquiry Groups) ♦ No formal syllabus; rich electronic curriculum guides students to multiple sources for study ♦ Increased emphasis on self-directed learning ♦ Decrease in formal classroom time ♦ Selective videotaping of educational activities; 16 hours of core classroom time not videotaped ♦ Weekly formative assessment and integrative summative assessment ♦ Summative essay examinations focus on synthesis and integration of concepts ♦ Portfolios used to assess nine core competencies ♦ Increased emphasis on clinical context of basic science concepts through IQ cases and clinical immersion activities ♦ Developmental introduction of clinical reasoning skills and case presentations through IQ groups ♦ Integration and extension of basic science curriculum into core clinical clerkships Program Evaluation ♦ Students complete online confidential surveys assessing their perceptions of course faculty, content and instructional methods, and learning resources. ♦ Curriculum committees, individual faculty instructors and course leaders, education leaders, and department chairs receive reports following each course or rotation. ♦ Curriculum effectiveness is assessed by tracking USMLE scores, residency program directors' perceptions, and graduation questionnaire responses. Scores on the Cognitive Behavior Survey, Attitudes toward Social Issues in Medicine, Learning Climate Inventory, Research and Scholarship Checklist, and Case Lifelong Learning Scale are also tracked. College Track Curriculum Development Components of Curriculum Development Process ♦ Affiliation agreement between Cleveland Clinic and CWRU in 2002 ensuring compliance with LCME strategies and appropriate oversight by CWRU. ♦ Mission to train physician investigators who will advance biomedical research and medical practice. ♦ Series of faculty retreats Identified outcomes for College track graduates: independent thinkers, self-directed learners, team players, strong clinical skills, broad-based research skills, scientific inquisitiveness. Developed curricular principles that guided curriculum development: provide a graduate school environment where students are responsible for their learning and seminars focus on application of knowledge; use active learning methods; research is major curriculum thread culminating in master's level thesis; students guided in personal and professional development of physicians and researchers by faculty dedicated to these activities; sufficient time and flexibility in curriculum to accommodate independent study and investigation; basic science, research, and clinical experience integrated into all years of the curriculum. ♦ All students participate in 9- to 10-week summer research experience in basic/translational research (year one) and clinical research (year two) in addition to two-year organ-based basic-science curriculum (Chart 2).CHART 2: College Track Basic Science Curriculum♦ Each week of the curriculum has a theme around which three 2-hour PBL sessions, 8 hours of seminars, and one hour of Advanced Research in Medicine seminars are organized. ♦ Foundations of Clinical Medicine seminars are held weekly. ♦ Thirteen Thread Leaders (representing sciences basic to medicine such as anatomy, physiology, ethics, epidemiology, and biostatistics) charged with responsibility to develop learning objectives for their discipline and work with organ-system course directors to determine best placement of these objectives in the curriculum. Curriculum Steering Council monitors implementation. ♦ Each student is assigned to a family medicine or internal medicine longitudinal preceptor during years one to two; students develop clinical skills with preceptors in every other week half-day sessions in year one and weekly sessions in year two; additional experiences include pediatrics, geriatrics, and acute care. ♦ Formal curriculum hours limited to 21 hours weekly; curriculum changes are time neutral to maintain flexibility for students. ♦ Opportunities available to earn master's degrees (Public Health, Engineering, Biomedical Investigation in Clinical Research, Nutrition, Pathology, or Biochemistry). ♦ Cleveland Clinic provides full tuition scholarships to all College track medical students to avoid significant financial debt at graduation and thereby facilitate entry into research careers. Learning Outcomes/Competencies ♦ The curriculum is based on nine competencies; seven reflecting ACGME competencies (medical knowledge, clinical skills, clinical reasoning, communication, professionalism, health care systems, reflective practice) as well as research and personal development. ♦ Each competency has three to five specific standards for students to achieve by the end of years one, two, and five. Components of the Assessment Process ♦ Goal of the College track assessment process is to help students become reflective practitioners of medicine complemented by a critical approach to self-assessment and self-improvement. ♦ Faculty developed assessment principles that require frequent, formative assessments to enhance student learning and engage students in ongoing cycles of self-assessment, supported by mentoring from physician advisors. ♦ Assessments align with the College track's nine competencies and developmentally appropriate standards; there are no grades or class rankings. ♦ Assessments are collected from multiple sources (faculty, peers, self) and multiple methods (OSCEs, faculty observations, MCQs) and contexts to provide students with frequent narrative formative feedback across the curriculum to identify strengths and areas needing improvement and document students' achievement of competency standards. ♦ In basic science courses, weekly CAPPS (concept appraisal essays) require students to integrate and apply knowledge to solve problems related to course material. ♦ All assessments collected in an ePortfolio for students and their advisors to reflect on and monitor progress longitudinally. ♦ Students use their assessment data to construct both formative and summative portfolios that document achievement of competency standards. ♦ Students' formative portfolios are reviewed with their advisors to develop learning plans; summative portfolios are reviewed by a Medical Student Promotion and Review Committee for promotion decisions. New Topics in the Curriculum Since 2006 ♦ Clinical reasoning in year two. ♦ Integrated program in medical humanities. ♦ Bioinformatics taught as a component of the Genetics Thread progressively over first two years. Changes in Pedagogy ♦ Course directors have increased use of small group sessions (eight students per group) whenever possible to improve teacher–student and student–student interactions and increase student learning. ♦ Emphasis on faculty development to assist faculty in developing skills in small group, interactive teaching, and providing useful formative feedback. Program Evaluation ♦ College track uses a systematic approach based on principles (collect only essential information, and so on) to determine fulfillment of institutional goals, identify curricular strengths and areas requiring improvement, and contribute to educational research. ♦ Student feedback is collected for all courses and track-specific innovations (portfolio-based assessment, research thesis, and so on) using multiple methods (debriefing meetings, web-based questionnaires, performance assessments, focus groups). ♦ Office of Curricular Affairs for College track summarizes evaluation evidence for each course into formal reports for course directors and related committees to identify curricular strengths and limitations. ♦ Course directors reflect on this information and prepare written reports for presentation to respective curriculum committees and approval by College track's curricular governance committee. ♦ Office of Curricular Affairs uses external, track-specific data (AAMC Matriculation and Graduation Questionnaires, USMLE reports) for bench-marking purposes. ♦ Since College track's inception, assessment and program evaluation data maintained in IRB-approved data registry to ensure ethical practices for program evaluation and educational research. Clinical Experiences ♦ Clinical instruction and rotations for both tracks designed collaboratively and shared from third year onward. ♦ Four affiliated teaching hospitals: University Hospitals/Case Medical Center, Cleveland Clinic, MetroHealth Medical Center, Veterans Affairs Medical Center. ♦ Clinical rotations begin March of second year. ♦ Required clinical rotations: 40 weeks of basic core rotations, 8 weeks of advanced core rotations, and two subinternships Three basic cores, each completed at one site Basic Core 1 (medicine and surgery, 16 weeks) Basic Core 2 (pediatrics, OB–Gyn, family medicine, 16 weeks) Basic Core 3 (neuroscience and psychiatry, 8 weeks) Two advanced cores Aging and Society (4 weeks) Undifferentiated and Emergent Care (4 weeks) ♦ Robust electronic Clinical Assessment System (CAS) combines patient logs with real time formative feedback and summative assessment in competency-based format. ♦ Track-specific curriculum one afternoon a week at students' home base University track: IQ+ program to integrate reflection, basic science content, and advanced clinical skills into clerkships College track: programs in advanced research skills and medical ethics and humanities ♦ Challenges Achieving uniformity in student assessment across broad base of faculty Students' desire for more formative assessments from faculty; challenging to encourage busy faculty to provide more frequent written narratives Supporting clinicians' time for teaching Moving faculty and students to consider new models for clinical education Highlights of University Track ♦ High expectations for active, student-centered learning ♦ Case Inquiry Groups: new PBL variant with shorter, more focused cases ♦ Clinical immersion weeks embedded within basic science blocks ♦ Integrative essays to assess basic science knowledge ♦ Sixteen-week research and scholarship requirement with MD thesis ♦ Integration of SNAPPS case presentations across four-year curriculum to enhance expression and strengthening of clinical reasoning ♦ Portfolio assessment of competencies ♦ Integration of basic science into core clerkships through weekly IQ+ program Highlights of College Track ♦ Small class size promotes collaborative learning environments, interactive teaching methods, collegial relationships with faculty ♦ Five-year integrated research curriculum and required master's level thesis ♦ Reliance on formative assessments to document student achievement of competencies; no grades, no class ranking ♦ Portfolio approach for competency-based assessment system ♦ Institutional commitment to faculty development for teaching and assessment roles and full tuition scholarships for all College track students ♦ Comprehensive program evaluation activities Highlights of Shared Clinical Curriculum ♦ Clinical Assessment System featuring continuous formative assessment ♦ Clerkship groupings in 8- to 16-week integrated blocks ♦ Advanced cores introduce new, innovative curricular content ♦ Dedicated curriculum time during clerkships for program- specific educational goals

Background: The clinical learning environment (CLE) provides student nurses with practical experience and skill development. However, COVID-19 restrictions have raised concerns about their readiness for clinical practice.Aim: This study examined student nurses’ readiness for clinical practice post-COVID-19 at two nursing institutions in South Africa.Methods: A qualitative, explorative, and descriptive approach was used to gather perspectives from 3rd- and 4th-year student nurses. Two focus groups were conducted at each institution, achieving data saturation with 31 participants. The data was audio recorded with their consent. Using Braun and Clarke’s framework, descriptive thematic analysis was employed.Results: The study identified two main themes: (1) Positive perspectives: Adaptation and Open-mindedness, and (2) Negative perspectives: Intimidation and Strained Relationships.Conclusion: Participants emphasised the necessity for adaptation and innovation during the pandemic. Although intimidation and strained relationships impacted their confidence, these challenges also promoted personal growth and development. Student nurses demonstrated significant adaptability and openness to innovation, which enhanced their learning and readiness for clinical practice (RtCP) post-COVID-19.Contribution: Despite facing intimidation and strained relationships, these experiences fostered both personal and professional growth, improving employability. The study underscores the critical role of adaptability and innovation in nursing education, particularly in the post-COVID-19 context. Mentorship and supportive environments can mitigate intimidation and strained relationships, thereby boosting confidence and autonomy, and resulting in more competent nursing professionals.

BackgroundStressors critically influence nursing students’ well-being, academic performance, readiness for clinical practices, and professional development. This study tests a hypothesized model examining the effect of stressors on first-year students’ readiness for clinical practice.MethodsA descriptive cross-sectional study was conducted with 553 first-year nursing students from three public universities in Türkiye between April 15 and May 15, 2024. Institutional permissions and ethics approval were obtained (March 29, 2024; no. 621). Data were analyzed using descriptive statistics, Pearson correlation, and path analysis.ResultsIt was determined that nursing students’ readiness for clinical practice increased as their stress related to education, relationships, confidence, and uncertainty, as well as their overall stress levels, decreased (p < 0.001). All stressors negatively impacted readiness for clinical practice of first-year nursing students, supporting all study hypotheses and explaining 73.5% of the variance in students’ readiness for clinical practice.ConclusionsThe findings of this study strengthen the importance of psychological support for students to prepare them for clinical practices. Novice nursing students need a well-organized educational process that helps them manage stress and connect theory with clinical practice.

Background: Preparedness of nurse interns to provide safe, competent patient care is a significant concern because of increasing work demands and complexities in health care systems. Aim of the Study: This study aimed at assessing nurse interns' preparedness for clinical practice during internship year. Design: Descriptive research design was used. Settings: This study was conducted at El-Fayoum university hospitals. Subjects: The study subjects included all nurse interns (212) enrolled in the internship year (2020-2021) at El-Fayoum university hospitals. Tool of data collection: Data were collected by using a self-administered sheet, namely Nursing Practice Readiness Tool. Results: Two-third of nurse interns perceived a high level of total preparedness for clinical practice. Majority of nurse interns perceived a high level of preparedness for all dimensions except both dimensions of professional satisfaction and stress. The highest percentage of nurse interns perceived a high level of preparedness for dimension of communication followed by professionalism. There was statistically significant relation between level of nurse interns' total preparedness and their pre-university education. Grade of 4th year and faculty follow-up were positive predictors for nurse interns' total preparedness score meanwhile, income was a negative predictor. Conclusion: Majority of nurse interns perceived a high level of total preparedness because nursing faculty well performed most of its roles but some improvements are needed meanwhile, healthcare settings had high defects in their roles. Recommendations: healthcare settings should provide nurse interns with productive work environment, structured orientation program and preceptorship model. To better preparedness, nursing faculty should make improvements regarding clinical placement, evaluation system and screening process for nursing students.

Nuclear medicine is a rapidly evolving diagnostic and therapeutic field in modern medical practice, offering innovative approaches for the early detection and management of a wide range of diseases, from oncology to cardiology. The increasing complexity of nuclear imaging and radiopharmaceutical technologies demands a deep understanding from healthcare professionals, particularly radiology students who will be at the forefront of their implementation. While the importance of a basic knowledge of nuclear medicine is widely recognized, recent data demonstrate significant gaps in the practical preparedness of radiology students at many institutions, potentially hindering the quality of care and patient safety. This research gap specifically lies in the lack of quantitative understanding of the extent to which the level of basic nuclear medicine knowledge correlates with the level of clinical practice readiness of radiology students, as well as the specific factors that influence this relationship. This study aimed to quantitatively quantify the relationship between the level of basic nuclear medicine knowledge and clinical practice readiness of radiology students and to identify key predictor variables within the framework of Bandura's social cognitive learning theory. The primary hypothesis was that a higher level of basic nuclear medicine knowledge would be positively and significantly correlated with better clinical practice readiness in radiology students. This study design employed a quantitative correlational approach with a transversal survey method, chosen for its efficiency in measuring relationships between variables at a single point in time. A total of 250 radiology students from various semesters at a leading university in Indonesia participated in this study, selected using a stratified random sampling technique to ensure adequate representation from each semester group. The research instrument consisted of a structured questionnaire consisting of two main parts: first, a previously validated basic nuclear medicine knowledge questionnaire with a Cronbach's Alpha value of 0.87, and second, a clinical practice readiness questionnaire developed based on the domains of clinical competencies in nuclear medicine, with high inter-rater reliability (ICC = 0.92). Data were collected through an online platform and analyzed using multiple linear regression analysis to test hypotheses and identify predictors. The analysis results showed a statistically significant positive relationship between the level of basic nuclear medicine knowledge and clinical practice readiness of radiology students (r = 0.65, p &lt; 0.001). The level of nuclear medicine knowledge was a strong predictor of clinical practice readiness, explaining 42.3% of the variance (R² = 0.423, F(1, 248) = 181.5, p &lt; 0.001). Secondary analysis revealed that previous practicum experience (β = 0.32, p &lt; 0.01) and perceived self-efficacy (β = 0.25, p &lt; 0.05) were also significant predictors of clinical practice readiness. A significant unexpected finding was that students who participated in nuclear medicine seminars or workshops outside the formal curriculum demonstrated substantially higher levels of practice readiness, even when controlling for basic knowledge levels. This study concludes that basic nuclear medicine knowledge is a crucial factor positively correlated with clinical practice readiness in radiology students. The theoretical contribution of this study strengthens social cognitive learning theory in the context of radiology education, while its practical contribution provides a basis for developing a more comprehensive curriculum and targeted learning interventions. Key recommendations include deeper integration of nuclear medicine content into the curriculum, as well as the development of active learning support programs such as simulations and case studies to enhance students' practice readiness.

Multi-Modal Simulation to Prepare Final Year Nursing Students for Transition to Clinical Practice: A Mixed Methods Study

BackgroundAlongside providing a knowledge base and practical skills, undergraduate medical education must prepare graduates to immediately begin practice as qualified doctors. A significant challenge is to provide safe learning opportunities that will optimise students’ preparedness to start work. This study examined UK graduates’ preparedness for clinical practice, and their exposure to real-life and simulated immediate care scenarios during final year placements.MethodA questionnaire measuring students’ perceived preparedness, and their exposure to immediate care scenarios, was distributed to all new Foundation Year 1 doctors (F1s) attending an induction session in one region of the UK.Results356 F1s responded to the questionnaire (91% response rate; 89% of cohort) and data from 344 graduates of UK medical schools were analysed. Respondents were generally prepared for practice, but many reported few ‘hands-on’ experiences of providing immediate care during final year placements (a median of 1–2 experiences).Those who had 1–2 experiences reported no greater preparedness for acute management than those reporting no experience. Several exposures are necessary for a significant increase in perceived preparedness. Real-life experience was a better predictor of preparedness than simulated practice.ConclusionsGaps still remain in medical students’ acute care experience, with a direct relationship to their perceived preparedness. The format and facilitation of placements may need to be addressed in order to enhance the quality of experience during final year.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6920-14-223) contains supplementary material, which is available to authorized users.

University of Missouri—Kansas City School of Medicine

The purpose of this study was to examine the effects of university- and clinical-level stress and satisfaction with the nursing major on clinical reasoning competence and readiness for clinical practice among nursing students who had completed clinical practicum within the previous six months. A total of 141 students participated, and the data were collected from July 11 to September 20, 2025. The mean scores were 2.64±0.82 (out of 5) for stress, 3.31±0.64 (out of 5) for clinical reasoning competence, and 2.84±0.38 (out of 4) for readiness for practice. Significant group differences were found across levels of satisfaction with the nursing major, indicating that students who were more satisfied with their major reported lower stress and higher competence and readiness scores. Correlation analysis revealed negative associations between stress and both clinical reasoning competence (r=-.258, p=.002) and readiness for practice (r=-.421, p&lt;.001), while clinical reasoning competence and readiness for practice were positively correlated (r=.659, p&lt;.001). Multiple regression analysis showed that, taking the group dissatisfied with their nursing major as the reference, students who were satisfied with their major demonstrated significantly higher levels of clinical reasoning competence and readiness for practice. In addition, lower stress levels were associated with significantly higher scores in both clinical reasoning competence and readiness for practice. The regression models explained 16% (F=9.63, p&lt;.001) and 26% (F=13.46, p&lt;.001) of the variance, respectively. These findings highlight the importance of educational and organizational strategies aimed at reducing stress and enhancing satisfaction with the nursing major to strengthen nursing students’ clinical reasoning competence and readiness for practice prior to entering the workforce.