Clinical Competence Research Articles

Training and supervision of physical health professionals to implement mental health care in paediatric epilepsy clinics

BackgroundChildren and young people with epilepsy are more likely to experience multiple mental health problems than those without chronic physical health conditions, yet they often do not receive evidence-based (or indeed any) psychological interventions. Integrated healthcare is recommended as a solution to address these inequalities, but remains limited in the United Kingdom. This is partly due to the lack of training and availability of ongoing supervision for clinicians to ensure the safe and effective delivery of treatments. This study aimed to train and provide supervision for health professionals to deliver a modular cognitive-behavioural intervention for common mental health problems, optimised for use in paediatric epilepsy. Specifically, this study aimed to measure therapist competence and evaluate the acceptability of training and supervision. MethodsFifteen health professionals working in paediatric epilepsy services were trained over a six-month period. Training included face-to-face training workshops and completing at least one training case of a young person with epilepsy and anxiety, depression and/or behavioural problems under close clinical supervision. Throughout the training, health professionals were offered weekly one-hour supervisions with an experienced Clinical Psychologist. Clinical competence was assessed using a widely used measure of therapist competence in cognitive-behavioural therapy. Rates of attendance at supervision sessions and therapist ratings of satisfaction were recorded. ResultsAt the end of the six-month training, 14 health professionals reached clinical competence in delivering the mental health intervention. One person left the service and therefore did not complete the training. Overall, health professionals were satisfied with the training and supervision. However, 14 % of supervision sessions were cancelled and a further 11 % were not attended. Supervision sessions were also often shorter than the standard hour used in mental health settings (M = 41.18 min, SD = 10.30). ConclusionsOur findings suggest that health professionals working in paediatric epilepsy services can be trained to deliver a psychological intervention with proficiency. However, the supervision model typically used in mental health may need adaptation to be sustainable in physical health settings. Future research is needed to evaluate the impact of training and supervision on patient outcomes and to ensure that ethical delivery of psychological interventions by health professionals without a mental health background.

Readiness levels of intern nursing students during the transition to professional practice within the Al Jouf Region in Saudi Arabia

BackgroundThe transition of newly graduated nurses into the workforce is recognized as a complex undertaking and has been examined extensively in the literature.ObjectiveThis study aimed to assess the readiness levels of intern nursing students and investigate the factors affecting their transition to professional practice within the Al Jouf region in Saudi Arabia.MethodsThe study employed a combination of descriptive, correlational, and qualitative methodologies to conduct its investigation. Data were acquired via an online questionnaire that included demographic information, the Nursing Practice Readiness Scale (NPRS), and two open-ended questions. A total of 135 nursing intern students were recruited to participate in the study. Benner’s “novice-to-expert” theory of clinical competence was utilized to guide the theoretical underpinning of the study.ResultsFindings revealed that most intern nursing students (63.7%) exhibited a moderate level of readiness. Furthermore, 70.4% and 55.6% of the students showed moderate readiness in terms of their professional attitudes and patient-centeredness, respectively. More than one-third of the students demonstrated a high level of readiness in the self-regulation domain (36.3%), while a similar proportion indicated a high level of readiness in the domain of collaborative interpersonal relationships (33.3%). The students underscored their reliance on the education system as pivotal in enhancing their preparedness for clinical practice.ConclusionNursing internship programs contribute to a more comprehensive readiness of nurses for active participation in clinical practice as compared to traditional educational programs.

Evaluating the efficacy of simulation-based training on clinical competency transfer

Introduction. Efficient learning transfer is crucial for training specialists to ensure the provision of quality medical services. This study investigates the impact of simulation-based training on the transfer of medical students' clinical competencies in parenteral drug administration: subcutaneous (SC), intramuscular (IM), and intravenous (IV). Material and methods. Using a quasi-experimental design, the research incorporates pre- and post-intervention testing, observational assessments, and a satisfaction survey to evaluate the educational impact. Results. The results indicate significant improvements in theoretical knowledge and practical skills post-intervention, with notable score increases for all types of injections (SC: from 50% to 83.33%, IM: from 57.14% to 85.71%, IV: from 42.86% to 85.71%; p<0.001). Similarly, improved clinical performance was demonstrated, highlighting the transferability of the learned competencies to real settings. Student satisfaction recorded a score of 4.71 (95% CI 4.64; 4.79), reflecting strong acceptance and appreciation of the training. Conclusions. The study emphasizes the crucial role of simulation in competency-based medical education, bridging the gap between theoretical knowledge and practical application, and advocates for the systematic integration of simulation into the medical curriculum, suggesting future research directions for optimizing the design and implementation of simulations.

Enhancing nursing students' clinical competency using a multi-patient simulation learning model: A randomized controlled study

BackgroundFor nurses, clinical competency is paramount in ensuring that patients receive safe, high-quality care. Multi-patient simulation (MPS) in nursing education is gaining attention, and evidence shows its suitability for real-life situations. MPS can be an effective solution for nurses' continuing clinical education. ObjectivesThis project compares the effectiveness of MPS (involving both a standardized patient and a high fidelity simulator) and a single high-fidelity simulation (single HFS; only involving a high fidelity simulator) for enhancing the clinical competency of nursing students. DesignA stratified, permuted, block randomized controlled study design was used.Settings and participants.Sixty undergraduate nursing students in years 3, 4, and 5 were selected to participate. Subgroups with each comprising three undergraduate nursing students from different years were formed. MethodsThe participants were randomized to receive either an MPS (intervention group) or single HFS (control group) for 1 day; they later received the same intervention after a 30-day washout period. One objectively measured questionnaire and two self-reported questionnaires were used to measure clinical competency: the Creighton Competency Evaluation Instrument (CCEI), Clinical Competence Questionnaire (CCQ), and Simulation Effectiveness Tool – Modified Questionnaire (SET-M). ResultsThe results revealed significant between-group differences. Specifically, the intervention group showed greater improvement than the control group in both the CCQ (linear contrast [d] = 71.4; 95 % confidence interval [CI] = 53.407, 89.393; P < 0.001) and CCEI total scores (d = 7.17; 95 % CI = 5.837, 8.503; P < 0.001). The SET-M results indicated that 85 % of the participants (n = 51) strongly agreed that they felt more confident about performing a patient handover to the healthcare team after the simulation. ConclusionsThe study findings indicated that both the MPS and single HFS effectively enhanced students' clinical competency. However, MPSs have superior educational outcomes relative to traditional single HFSs.

Analysis of satisfaction levels and perceptions of clinical competency: a mixed method study on objective structured clinical examinations in undergraduate dental students

ObjectiveTo analyze the satisfaction levels, perceptions of developing clinical competencies through objective structured clinical examination and to explore the experiences, challenges, and suggestions of undergraduate dental students.MethodsThe study adopted a mixed-method convergent design. Quantitative data were collected from 303 participants through surveys, evaluating satisfaction levels with objective structured clinical examination (OSCE). Additionally, qualitative insights were gathered through student focus group interviews, fundamental themes were developed from diverse expressions on various aspects of OSCE assessments. The Chi-Square tests, was performed to assess associations between variables. Data integration involved comparing and contrasting quantitative and qualitative findings to derive comprehensive conclusions.ResultsThe satisfaction rates include 69.4% for the organization of OSCE stations and 57.4% for overall effectiveness. However, a crucial challenge was identified, with only 36.7% of students receiving adequate post-OSCE feedback. Furthermore, a majority of students (50%) expressed concerns about the clinical relevance of OSCEs. The study showed a significant associations (p < 0.05) between satisfaction levels and years of study as well as previous OSCE experience. Student focus group interviews revealed diverse perspectives on OSCE assessments. While students appreciate the helpfulness of OSCEs, concerns were raised regarding time constraints, stress, examiner training, and the perceived lack of clinical relevance.ConclusionThe students anticipated concerns about the clinical relevance of OSCEs, highlighting the need for a more aligned assessment approach. Diverse perspectives on OSCE assessments reveal perceived helpfulness alongside challenges such as lack of feedback, examiner training, time constraints, and mental stress.

Entrustable Professional Activities in Postgraduate General Surgery Training: A Scoping Review.

To provide an overview of the current use of Entrustable Professional Activities (EPAs) in postgraduate general surgery training internationally. Entrustable Professional Activities (EPAs) were introduced to connect clinical competencies and the professional activities to be entrusted to trainees on graduation. The popularity of EPAs as a framework for assessment is growing globally, including in general surgery. Anecdotally, there appears to be substantial variation in how they are implemented, yet a formal comparison of their use in postgraduate general surgery training is lacking. A scoping review was performed, based on the original five-stage approach described by Arksey and O'Malley with the addition of protocol-specific items from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR). Twenty-nine published and grey literature sources were included in the review. Entrustable Professional Activity use in postgraduate general surgery training was identified in 11 unique contexts, including from North America, South America, Europe, Asia, Africa, and Australia. There were substantial differences in the scope and number of EPAs, tools used for EPA assessment, and how EPAs were sequenced through training. Despite wide variation, eight distinct EPAs were common to the majority (>80%) of countries. Several articles described findings of EPA use in postgraduate general surgery training, allowing identification of multiple barriers and facilitators to integration. This review provides guidance for certification and regulatory bodies, program directors, and institutions with ambitions to implement EPAs for assessment and curricular design. In settings where EPAs are already used, the data may facilitate refinement of programs and strategies.

VR-based Competence Training at Scale: Teaching Clinical Skills in the Context of Virtual Brain Death Examination

Teaching medical practical and soft skills in clinical routines is increasingly difficult, and manikin or actor-based simulations have gained popularity in the last decades. These simulations, however, hardly scale with the demand, are commonly insufficient to train crucial clinical competencies, and cannot portray complex visual and dynamic symptomatologies as required in, for example, brain death examinations. In this paper, we explore the requirements and challenges of integrating a large-scale high-throughput VR setup into a real medical curriculum and describe our approaches and implementation. Therefore we extend and evaluate an interactive virtual reality-based simulation for training brain death diagnostics in a virtual intensive care environment, featuring a fully reactive simulated patient. To enable the required scalability we integrated the simulation into a dedicated hardware and software framework, enabling 12 simultaneous VR trainings which are controlled by a centralized server system. Using this setup we continuously collected feedback on the application's usability and realism from hundreds of students to gain first insights into the applicability of large-scale VR-based learning systems in real course designs. After integrating this feedback, we conducted a controlled curricular study in which we compared the virtual brain death simulation with the classical manikin-based training approach. Our results indicate that the immersive learning experience is perceived to be more realistic and engaging and is overall preferred by the students while also providing the same learning effect as the alternatives.

729-P: Interactive, Online, Case-Based Education Effective at Improving Clinical Competence Related to Staging and Comprehensively Treating Type 1 Diabetes

729-P: Interactive, Online, Case-Based Education Effective at Improving Clinical Competence Related to Staging and Comprehensively Treating Type 1 Diabetes

Primary care physicians’ perceptions of artificial intelligence systems in the care of adolescents’ mental health

BackgroundGiven that mental health problems in adolescence may have lifelong impacts, the role of primary care physicians (PCPs) in identifying and managing these issues is important. Artificial Intelligence (AI) may offer solutions to the current challenges involved in mental health care. We therefore explored PCPs’ challenges in addressing adolescents’ mental health, along with their attitudes towards using AI to assist them in their tasks.MethodsWe used purposeful sampling to recruit PCPs for a virtual Focus Group (FG). The virtual FG lasted 75 minutes and was moderated by two facilitators. A life transcription was produced by an online meeting software. Transcribed data was cleaned, followed by a priori and inductive coding and thematic analysis.ResultsWe reached out to 35 potential participants via email. Seven agreed to participate, and ultimately four took part in the FG. PCPs perceived that AI systems have the potential to be cost-effective, credible, and useful in collecting large amounts of patients’ data, and relatively credible. They envisioned AI assisting with tasks such as diagnoses and establishing treatment plans. However, they feared that reliance on AI might result in a loss of clinical competency. PCPs wanted AI systems to be user-friendly, and they were willing to assist in achieving this goal if it was within their scope of practice and they were compensated for their contribution. They stressed a need for regulatory bodies to deal with medicolegal and ethical aspects of AI and clear guidelines to reduce or eliminate the potential of patient harm.ConclusionThis study provides the groundwork for assessing PCPs’ perceptions of AI systems’ features and characteristics, potential applications, possible negative aspects, and requirements for using them. A future study of adolescents’ perspectives on integrating AI into mental healthcare might contribute a fuller understanding of the potential of AI for this population.

The effect of outcome-based education on clinical performance and perception of pediatric care of the third-year nursing students in Mongolia.

Mongolian government has set improvement of clinical proficiency of nursing students as one of its priorities. Nursing professionals have the sentinel role in providing healthcare services in rural areas. Outcome-based education (OBE) offers a promising pedagogical approach to actively mentally engage students to strengthen their clinical proficiencies. We implemented a pilot project with the objective of comparing students' clinical performance under OBE with our traditional didactic techniques. The researchers implemented a non-equivalent two-armed quasi-experimental post-test-only' design approach study. The intervention arm (n = 34) received OBE pediatric training, while the control arm (n = 32) received the traditional pedagogical pediatric nursing training. Each arm of the study completed 16 hours of theory, 32 hours of clinical skills practice and 32 hours of seminars in pediatric nursing care. Data were collected using a five-section instrument, Demographic, Competency Inventory, Nursing Students' Satisfaction, Course Experience, and Objective Structured Clinical Examination. Performance and knowledge proficiencies were evaluated by applying the two-sided independent T-test. The distributions of categorical variables were assessed by Fisher's exact test or chi-squared test of significance. The intervention arm had higher mean score value in the competency inventory ([Formula: see text] = 238.70, SD = ± 23.07) compared to the control arm ([Formula: see text] = 222.11, SD = ± 39.94) (P = 0.04); similarly, the mean value for nursing students' satisfaction was higher for the intervention arm ([Formula: see text] = 117.87, SD = ± 15.94) compared to the control group ([Formula: see text] = 109.76, SD = ± 16.94) (P = 0.049). Additionally, the difference in the mean value for course experience questionnaire between the intervention arm ([Formula: see text] = 125.33, SD = ± 19.30) and the control arm ([Formula: see text] = 110.41, SD = ± 11.28) was statistically significant (P = 0.0001). Finally, the intervention arm had a higher mean value ([Formula: see text] = 85.40, SD = ± 6.11) for objective structural clinical examination compared to the control arm ([Formula: see text] = 81.56, SD = ± 7.01) (P = 0.023). OBE pedagogical approach offers promising benefits to improving nursing students' clinical competencies; additionally, the OBE approach seems to increase students' satisfactions with their clinical curriculum.

Identifying training needs of practising community pharmacists in Jordan—a self-assessment study

BackgroundBeing the professional membership body for pharmacists in Jordan, the Jordan Pharmacists Association (JPA) took the initiative to establish a training centre for practising pharmacists. This study aims to identify the self-assessed training priorities of community pharmacists in Jordan.MethodsIn the period between August and October 2022, an online self-administered questionnaire was distributed using a variety of participants’ identification and recruitment approaches. The questionnaire targeted currently practising community pharmacists. Data were analysed descriptively and inferentially.ResultsIn total, 470 community pharmacists participated in this study. Of 470 participants, 307 (65.3%) were employees, of which 206 were full-time employees. Results showed that only 97 (21%) had access to an in-house training programme or scheme. Self-assessment of training needs highlighted differences between the three competencies clusters. While administrative and managerial skills and competencies were more frequently prioritised on average than the other two clusters, interpersonal and communication skills were needed the least. Evidence showed a significant difference between female and male participants regarding the need for training addressing maternity and early childhood health training issues. Lastly, the role-based comparison showed that, compared to pharmacy owners, employees had a significantly higher need for training related to bookkeeping and taxation returns preparation and how to handle and manage records of narcotic and controlled medicines.ConclusionsIf training and development programmes are tailored to address specific needs in administrative, clinical, and interpersonal competencies, community pharmacists have the potential to enhance public health, expand their role, provide patient-centred care, and support the national healthcare system.

Shifting paradigms: A collective and structural strategy for addressing healthcare inequity.

Healthcare inequity is a persistent systemic problem, yet many solutions have historically focused on "debiasing" individuals. Individualistic strategies fit within a competency-based medical education and assessment paradigm, whereby professional values of social accountability, patient safety, and healthcare equity are linked to an individual clinician's competence. Unfortunately, efforts to realise the conceptual linkages between medical education curricula and goals to improve healthcare equity fail to address the institutional values, policies, and practices that enable structural racism. In this article, we explore alternative approaches that target collective and structural causes of health inequity. We first describe the structural basis of healthcare inequity by identifying the ways in which institutional culture, power and privilege erode patient-centred care and contribute to epistemic injustice. We then outline some reasons that stereotypes, which are a culturally supported foundation for discrimination, bias and racism in healthcare, cannot be modified effectively through individualistic strategies or education curricula. Finally, we propose a model that centres shared values for leadership by individuals and institutions with consistency in goal setting, knowledge translation, and talent development. Figure 1 summarises the key recommendations. We have provided cases to supplement this work and facilitate discussion about the model's application to practice.

Development and Preliminary Validation of Health Service Measurement Scale (HSMS) for Measuring Effectiveness of Health Care Services in Universities

The aim of this study was to develop and validate a Health Service Measurement Scale (HSMS) for measuring the effectiveness of health care services in public sector universities. For data collection, a deductive method was used. Based on review of literature, a survey questionnaire was developed and administered to 484 teachers from three public universities of Malakand division: university of Swat, university of Malakand and University of Sheringal (SBBU) upper Dir. The scale was developed based on DeVellis (2003) four phase scale development procedure. Factor Analysis technique was utilized for assessing factors which affect the health care services in universities. This study identified four important factors affecting the health care services in universities. These factor were clear communication skills, professional behavior, clinical competency and patient satisfaction. The scale may be used to enhance the effectiveness of the health care units inside the universities regarding provision of necessary treatment as per the approved protocol of health industry. The findings of this study further provide key insights to the management to review the health services and policy makers to enact effective health care policies for the universities. The limitations of the study along with recommendations are provided for future research.

Rapid response systems, antibiotic stewardship and medication reconciliation: a scoping review on implementation factors, activities and outcomes

IntroductionMany patient safety practices are only partly established in routine clinical care, despite extensive quality improvement efforts. Implementation science can offer insights into how patient safety practices can be successfully...

Toward transgender health: Analysis of current barriers and theorizing interventions.

In the fields of medical and behavioral health care, there is a demonstrable scarcity of providers who possess the necessary levels of clinical and cultural competency required to serve transgender patients. As a result of this deficiency, many members of the transgender community engage in an avoidance of care. Among providers, there are observed deficiencies in awareness regarding specific acute and chronic health disparities experienced by members of the transgender population. We aim to demonstrate the unique and intersectional health disparities experienced by this community, to empower providers serving this community. Additionally, we endeavor to propose a range of potential clinical and political interventions and options for mobilization that providers can engage in. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Clinical competency of nurses trained in competency-based versus objective-based education in the Democratic Republic of the Congo: a qualitative study

BackgroundDesigning competency-based education (CBE) programmes is a priority in global nursing education for better nursing care for the population. In the Democratic Republic of the Congo (DRC), object-based education (OBE) remains mainstream in pre-service nursing education programmes. Recently, the Ministry of Health developed a self-assessment tool and quantitatively compared the clinical competency of CBE- and OBE-trained nurses. This study aimed to qualitatively triangulate the results of self-evaluation by exploring perception of supervisors, incumbent CBE-, and OBE-trained nurses in comparison with the competence of the two types of nurses, and to identify influential factors or barriers to their competence in clinical settings.MethodsA qualitative descriptive approach with conventional content analysis was applied. Twenty interviews with clinical supervisors who oversaw both CBE- and OBE-trained nurses, 22 focus group discussions (FGDs) with CBE-trained nurses, and 21 FGDs with OBA-trained nurses currently working in health facilities were conducted. Participants of the FGDs were selected from the participants of the DRC self-assessment competency comparison study where there was no statistically significance between CBE- and OBE-trained nurses in the demographic characteristics. Data were analysed in terms of the competencies identified by the Ministry of Health.ResultsThe supervisors recognised that the CBE-trained nurses had stronger competencies in professional communication, making decisions about health problems, and engaging in professional development, but were weak in clinical skills. This study identified challenges for supervisors in assuring standardised care in health facilities with OBE- and CBE-trained nurses, as well as barriers for CBE-trained nurses as a minority in the workplace in demonstrating their competencies.ConclusionsThe study results support the Ministry of Health’s policy to expand CBE in pre-service education programmes but reveal that its slow implementation impedes full utilisation of the acquired competencies at health facilities. Implementation could be accelerated by strengthening cooperation among the Ministry of Health’s three human resource departments, and developing and implementing a well-planned, legally binding, long-term CBE reform strategy, including an approach to the Continuing Professional Development system.

Virtual Objective Structured Clinical Examination (OSCE) Training in the Pandemic Era: Feasibility, Satisfaction, and the Road Ahead.

Objective Structured Clinical Examinations (OSCEs) are essential assessments for evaluating the clinical competencies of medical students. The COVID-19 pandemic caused a significant disruption in medical education, prompting institutions to adopt virtual formats for academic activities. This study analyzes the feasibility, satisfaction, and experiences of pediatric board candidates and faculty during virtual or electronic OSCE (e-OSCE) training sessions using Zoom video communication (Zoom Video Communications, Inc.,San Jose, USA). This is a post-event survey assessing the perceptions of faculty and candidates and the perceived advantages and obstacles of e-OSCE. A total of 142 participants were invited to complete a post-event survey, and 105 (73.9%) completed the survey.There was equal gender representation. More than half of the participants were examiners.The overall satisfaction with the virtual e-OSCE was high, with a mean score of 4.7±0.67 out of 5. Most participants were likely to recommend e-OSCE to a friend or colleague (mean score 8.84±1.51/10).More faculty (66.1%) than candidates (40.8%) preferred e-OSCE (P=0.006). Transitioning to virtual OSCE training during the pandemic proved feasible, with high satisfaction rates. Further research on virtual training for OSCE in medical education is recommended to optimize its implementation and outcomes.

Assessing the Impact of Preceptorship on Nursing Education and Practice in Ghana

Objective: This analysis aimed to evaluate the impact of preceptorship programs on nursing education and practice in Ghana, considering challenges, opportunities, and outcomes. Method: A comprehensive literature review and synthesis of findings from studies and case examples from Ghana and other West African countries were conducted. Findings: Preceptorship programs have the potential to enhance student learning outcomes, clinical competence, and confidence. However, challenges such as resource limitations and inadequate support for preceptors need to be addressed. Case studies demonstrate the benefits of preceptorship, including improved patient outcomes and strengthened collaboration between academia and practice. Conclusion: Preceptorship programs can transform nursing education and practice in Ghana, but their success requires investment, support, and collaborative efforts from stakeholders. Recommendations: Nursing education institutions and healthcare facilities should prioritize preceptorship initiatives, allocate resources, provide support for preceptors, and engage students and educators in the planning, implementation, and evaluation of these programs to optimize their quality, relevance, and impact.

Effects of Length of Employment and Head Nurse Leadership Style on the Clinical Competency of Staff Nurses in Taiwan.

High-quality patient care requires nurses with strong clinical competency. Thus, it is essential to examine the factors associated with clinical competency. This study was designed to (a) investigate head nurse leadership, staff nurse demographics, and clinical competency; (b) examine the impact of demographics on the clinical competency of staff nurses; (c) analyze the correlation between head nurse leadership and staff nurse clinical competency; and (d) examine the effects of demographics on clinical competency after controlling for the head nurse leadership. A cluster sampling method was used to collect data from 200 staff nurses at a national medical center in Taiwan. Questionnaires were used to gather information on head nurse leadership style and staff nurse clinical competency. Descriptive and inferential statistical analyses were conducted, including Mann-Whitney U test, Kruskal-Wallis test, Spearman's rank correlation coefficient, and multivariate analysis of covariance. The average score for transformational leadership style among the head nurses was 2.89, whereas transactional leadership style scored an average of 2.49. The average scores for the components of clinical competency, listed from highest to lowest, were as follows: patient care (3.35), professionalism (3.28), communication skills (3.18), management (2.84), and knowledge (2.73). In addition, statistically significant differences were found in clinical competency based on demographic factors, including age, marital status, educational level, job title, and length of employment. Also, a statistically significant, positive correlation between the head nurse transformational leadership style and nurse clinical competency was found. The main effect of length of employment on the five competency components was statistically significant after controlling for transformational leadership. Furthermore, post hoc analysis of covariance revealed a significant effect of length of employment on patient care, knowledge, communication skills, and management. The findings of this study indicate transformational leadership and employment length impact the clinical competency of staff nurses, particularly in terms of patient care, communication skills, management, and knowledge. Providing education and training in leadership and management to current and prospective head nurses may be expected to enhance clinical competency in staff nurses and create a more nurturing work environment. Moreover, targeted training may help current head nurses gain insight into their leadership styles and acquire skills to promote transformational leadership. In addition, leadership development may help equip prospective head nurses with critical competencies before assuming leadership responsibilities.

Flipped Classroom Based on Outcomes-Based Education Improves Student Engagement and Clinical Analysis Competence in Undergraduates Ophthalmology Clerkship.

To investigate the effectiveness of flipped classrooms (FC) based on outcomes-based education (OBE) on clinical ophthalmology clerkships. Ninety-nine undergraduates were non-randomly assigned to the FC based on the OBE (FC-OBE) group or traditional lecture (TL) group in the ophthalmology clerkship. Pre- and post-tests were performed to assess student learning outcomes. Anonymous questionnaires were collected to compare students' attitudes and classroom engagements between the two groups. More participants agreed FC-OBE was helpful in developing teamwork ability and knowing the work standard. Teaching staff in the FC-OBE classroom received higher evaluations. More participants in the FC-OBE group had higher classroom engagement in skills and emotions than in the TL group. The post-class test scores, mainly case analysis scores were higher in the FC-OBE group than in the TL group. FC-OBE classroom improves student engagement and clinical analysis competence in undergraduate ophthalmology clerkship.