The story beneath the scores: A mixed methods study of communication skills self-assessment.

Complementary, alternative, and integrative medicine (CAIM) has gained popularity among patients experiencing pain, used alongside conventional medical treatments. This study aimed to explore the perceptions of pain clinicians and researchers on CAIM interventions. An anonymous, online survey was distributed to 46,223 authors who had published pain-related research in MEDLINE-indexed journals. The survey included multiple-choice questions and open-ended sections to gather detailed opinions. A total of 1024 participants responded, 900 of which were eligible to participate; most identified as either pain researchers (n = 435/900, 48.33%) or both researchers and clinicians (n = 398/900, 44.22%). Many held senior positions (n = 549/892, 61.55%). Among the CAIM modalities, mind-body therapies such as meditation, yoga, and biofeedback were viewed as the most promising for pain prevention, treatment, and management, with 68.47% (n = 569/831) of participants endorsing these approaches. While (n = 341/777, 43.89%) of the respondents believed that most CAIM therapies are safe, only 25.55% (n = 198/775) disagreed with the idea that such therapies are effective. There was broad agreement on the need for more research into CAIM therapies, with 45.88% (n = 356/776) agreeing and 42.53% (n = 330/776) strongly agreeing that further investigation is valuable. Additionally, many respondents supported the inclusion of CAIM training in clinician education, either through formal programs (n = 361/778, 46.40%) or supplementary courses (n = 409/776, 52.71%). Mind-body therapies received the most positive feedback, while biofield therapies were met with the most skepticism. These findings highlight the interest in CAIM among pain researchers and clinicians and emphasize the need for more research and education tailored to this area.

To map and critically appraise anticipatory guidance interventions and resources for parents following PICU discharge, examine how they address recovery challenges, and identify gaps to inform parent-centred resource development. Database search across EBSCO (MEDLINE, CINAHL, PsychINFO), Embase, Scopus, Web of Science, and Cochrane Library for studies published January 2000-June 2025. Environmental scan via targeted and Google searches. Five tools assessed delivery, understandability, actionability, quality, and readability. Of 1752 records, four studies and nine digital resources met inclusion criteria (n=271 parents). Formats included phone calls, brochures, in-person conversations, plus websites, webpages, downloadable content, and videos, from university children's hospitals (n=10), and organisations (n=3) across the US (n=9), UK (n=3), and Australia (n=1). Three key findings emerged: (1) support for how parents' access, understand, and use information was inconsistent; (2) resources prioritised functional (reading/comprehension), over interactive (communication, application) or critical health literacy (evaluation, advocacy); (3) system-level health literacy strategies were limited. There is an urgent need to strengthen anticipatory guidance by embedding health literacy principles across design and delivery. This includes addressing organisational barriers to access and equity through co-design, plain language, and culturally responsive approaches. Beyond information provision, a deliberate focus on capability building can empower parents as active partners in care, ultimately improving outcomes for children and families. Anticipatory guidance following PICU discharge must move beyond information provision toward capacity building that supports parents to apply, evaluate, and act on information. Embedding health literacy principles - plain language, readability testing, co-design, and cultural responsiveness - into resource development is critical to ensure accessibility and equity. Clinician education and integration into routine workflows are equally important to optimise resource impact. A universal precautions approach offers a practical strategy for health services to ensure all families, regardless of literacy level, receive clear, actionable, and supportive guidance.

Electronic portfolios (e-portfolios) are increasingly used in healthcare professional education (HPE) to support learning, reflection and professional development. Despite their broad adoption, there is limited synthesis on how e-portfolios are structurally designed and pedagogically implemented across healthcare programmes and on the implications for clinical teachers. A narrative review was conducted following the Scale for the Assessment of Narrative Review Articles (SANRA). Literature search was conducted in PubMed, Web of Science, Scopus and CINAHL between January and February 2025. Twelve studies published between 2012 and 2024 were included. Data were analysed to explore e-portfolio structures, educational uses and reported effects on reflection and learning. E-portfolios were implemented in various educational and clinical settings, showing considerable variation in platform design, structural components and curricular integration. Common features included reflective writing, documentation of clinical experiences, feedback mechanisms and assessment rubrics. Studies reported that e-portfolios integrated into structured pedagogical frameworks and supported by training and mentoring promote reflective practice, student engagement and professional identity development. Conversely, inconsistent implementation, technological barriers or checklist-oriented designs were associated with superficial engagement and limited educational value. The educational value of e-portfolios in HPE lies less in the technology itself and more in how these tools are pedagogically designed, supported and contextualised within clinical education. For clinical educators, attention to flexibility, relevance to practice and ongoing guidance may be key to promoting meaningful reflection rather than procedural completion. Further research is needed to identify best practices and improve adaptability in different healthcare education contexts.

Experiences of Clinical Skills Educators Working With Students With Specific Learning Difficulties: A Reflexive Thematic Analysis.

Nurse-led interventions targeting post-intensive care syndrome domains in adult intensive care unit survivors: A systematic review.

The surgeon advocate's role in shaping state and federal policy.

Peer-instructed tele-ultrasound has the potential to provide high-quality clinical ultrasound education to medical students. However, there is limited data evaluating the effectiveness of such methods in practice. The primary aim of this study is to evaluate how virtual tele-ultrasound teaching compares with traditional in-person teaching of peer-instructed pulmonary ultrasound in undergraduate medical students. In a preliminary single-center study, first-year medical students (n = 39) were randomized into 2 peer-instructed pulmonary ultrasound teaching groups: a traditional in-person group or a virtual tele-ultrasound group. Effectiveness was evaluated by 3 primary outcomes: (1) change in knowledge score on pre- and posttest, (2) performance in an objective structured clinical exam, and (3) subjective confidence surveys. The secondary outcome was participants' overall experience with the teaching method. Two one-sided t test was used to measure equivalence between the 2 groups (p < .05). The virtual teaching group was statistically equivalent to the traditional in-person group in all primary outcomes of knowledge change (37.4 vs. 37.8 point improvement out of 100, p < .001), OSCE score (12.7 vs. 12.4 out of 15, p = .002), and overall confidence (4.2 vs. 4.1 out of 5, p = .02). The tele-ultrasound group rated their experience highly overall, but not statistically equivalent to the traditional group (4.5 vs. 4.9 out of 5, p = .47). Peer-instructed tele-ultrasound may be an effective method of teaching pulmonary ultrasound to undergraduate medical students as compared with traditional in-person teaching.

Critical Care Billing: Doing it Right, Every Time.

The aim of this study was to scope published evidence on clinicians' knowledge of pulse oximetry. Vital signs' assessment is critical for the early detection of acute clinical deterioration. Oxygen saturation, measured using a pulse oximeter, is one of these signs. To use a pulse oximeter correctly, clinicians must have a thorough understanding of the principles underpinning this technology. Previous research has shown that clinicians often do not understand pulse oximetry at depth. A scoping review was conducted. A review of contemporary research was conducted to determine clinicians' understanding of how to use a pulse oximeter. Eligibility criteria included studies published in English from 2019 onwards which examined clinicians' knowledge of pulse oximetry. A search of CINAHL, MEDLINE, and PubMed databases identified 11 studies that met the inclusion criteria. Eleven relevant studies were identified. The findings of this review indicated that despite pulse oximeters being a commonly used clinical tool, clinicians using it often have little or no education regarding its use and therefore poor understanding of how to use it correctly. Clinicians' knowledge of pulse oximetry continues to be poor. Undergraduate and clinical education focused on pulse oximetry is therefore needed to address this significant knowledge gap. Clinicians using pulse oximetry should reflect on their knowledge of this technology and not just basic user functions and address any gaps in their clinical knowledge. Despite pulse oximetry being important for patient assessment, research indicates clinicians' understanding of this technology remains poor. It is time for educators to address this significant knowledge gap.

Artificial intelligence in emergency medicine: a narrative review.

Caregiver training is vital for drug administration in medical emergencies. Most training, in the UK, for paediatric epilepsy is delivered by specialist nurses, covering awareness and buccal Midazolam administration, the preferred management for paediatric status epilepticus. Training is predominately delivered face-to-face due to limited evidence supporting online methods. This project outlines e-learning use in caregiver training on paediatric rescue medication administration and its effectiveness on awareness in paediatric epilepsy and management. Two networks of Scottish epilepsy specialist nurses developed a standardised online module, accessible to multidisciplinary staff. A post-module quiz tested participants' knowledge and, engagement, module content and delivery method were evaluated through a Likert scale questionnaire. Average response per question and standard deviation was calculated for the entire cohort and using occupation as an independent variable. Over 24months, 3230 learners across Scotland accessed the module; 82.6% passed, 0.9% failed, and 16.5% ongoing, yielding a pass rate of 98.8%. Learners, mostly from teaching or educational roles, reported increased confidence in seizure management and safe Midazolam administration. All parameters assessed were highly rated, independent of learner occupation. Performance was high across all occupations, with learners in non-clinical jobs performing slightly better than those in clinical roles. The module likely improved accessibility, knowledge standardisation across professions and regions, and reduced training carbon footprint, making its principles applicable to other areas of clinical education.

Charting the Seven Cs of Clinical Education Careers.

Telerehabilitation is an innovative, technology-supported approach that enables the delivery of rehabilitation services remotely through information and communication technologies. It serves as a modern extension of conventional face-to-face rehabilitation, aiming to provide continued care for individuals of all ages following hospital discharge or in settings where access to in-person rehabilitation is limited. Telerehabilitation has been applied across a wide range of clinical conditions, including musculoskeletal and neuromuscular disorders, cerebrovascular accidents, pulmonary diseases, dermatological conditions, and sports-related injuries. The rapid expansion of telerehabilitation during the COVID-19 pandemic highlighted its potential to overcome geographical, temporal, and financial barriers to healthcare delivery. Technological advancements such as wearable sensors, digital health platforms, virtual reality, and artificial intelligence have further strengthened the role of telerehabilitation in clinical practice, sports physiotherapy, and physiotherapy education by enabling remote assessment, monitoring, and intervention. Community-based telerehabilitation programs have demonstrated the ability to improve equity in healthcare access, particularly in densely populated and underserved regions, while supporting sustainable health systems and addressing shortages of rehabilitation professionals. Despite these advantages, several barriers limit widespread implementation, including restricted physical examination, inadequate internet infrastructure, data privacy and security concerns, evolving regulatory frameworks, and the potential risk of misdiagnosis. Addressing these challenges requires the development of robust regulatory policies, legal protections, professional training programs, and public awareness initiatives. In Pakistan, strengthening digital infrastructure, expanding internet accessibility, and establishing clear national telerehabilitation guidelines are essential to promote trust and effective adoption. Telerehabilitation should be recognized as an integral component of rehabilitation services, with significant potential to improve patient outcomes and transform the future of rehabilitation care.

Intermittent mandatory ventilation (IMV) has evolved substantially from its original form, developing into 5 distinct types intended to enhance patient safety, comfort, and liberation from mechanical ventilation. Each form of IMV has different potential advantages and disadvantages that should be considered when selecting the mode of ventilation. IMV(1): the set mandatory breath rate is always delivered. IMV(2): mandatory breaths may be suppressed by spontaneous breaths if their frequency is high enough. IMV(3): mandatory breaths may be suppressed by spontaneous breaths if they achieve some pre-set goal (eg, minute ventilation threshold). IMV(4): individual mandatory breaths may be suppressed if inspiratory effort is high enough to change volume cycling into flow cycling for patient-triggered breaths. IMV(5): in Pressure Support, individual mandatory breaths are suppressed if the flow cycle threshold is met after the Ti-min setting has elapsed. This article offers a comprehensive review of the definitions and characteristics of these 5 IMV types, providing guidance on their identification based on information from ventilator manufacturers' information and by examining the actual ventilator waveforms produced by ventilating a high-fidelity lung simulator. The purpose is to clarify how the breath sequences called IMV are implemented in current ventilators and to build the reader's skill in identifying them. This skill is essential for clinical application, education, and research in mechanical ventilation. Ultimately, the goal is to improve the knowledge and application of IMV in clinical practice education and research.

Bridging theory and practice in generative artificial intelligence for medical education: insights from clinical teaching experience.

To identify and contextualize the determinants of long-term employment, health, and financial outcomes among individuals affected by Long COVID. Sequential explanatory mixed-methods study design guided by the social-ecological model. Adults with Long COVID who were employed before infection and returned to work during the three-year follow-up were recruited through in-person and virtual outpatient venues: ResearchMatch, a Long COVID clinic, and a peer support group affiliated with a medical center. Participants completed validated surveys assessing factors influencing sustained employment. Stratified semi-structured interviews were then conducted to explore how these factors shaped sustained employment. Quantitative data were analyzed using descriptive and inferential statistical methods, while qualitative data were analyzed through content analysis. Among 79 participants who returned to work, 58% (n = 46) remained employed after a mean follow-up of 1,077days. Those still employed reported reduced capacity and persistent uncertainty. Those no longer employed experienced worse physical health (p < 0.002), greater comorbidity burden (p = 0.01), more environmental barriers (p = 0.02), and increased financial hardship (p = 0.03). Qualitative analyses identified nonlinear return-to-work trajectories shaped by fluctuating and often invisible symptoms, alongside multilevel themes influencing employment sustainability, including misalignment between functional capacity and job demands, challenges obtaining workplace accommodations, stigma, limited policies, and labor market barriers. Employment sustainability among individuals with Long COVID is shaped by complex, multilevel barriers, with job loss further worsening health and financial hardship. Investment in comprehensive Long COVID care, including multidisciplinary clinical services, vocational rehabilitation, clinician education, public awareness initiatives, employer training, and policy reform, is critical to support long-term recovery and employment sustainability.

Researching feedback in clinical education: What might the problems be represented to be?

Anxiety disorders have increased over the past decade, affecting millions worldwide. Among veterans, the prevalence is at least double that of the general population. Despite growing recognition of the need for appropriate treatment, frequent labeling of patients with an "unspecified anxiety disorder" diagnosis hinders targeted treatments. This study examines why clinicians use unspecified anxiety disorder diagnoses without a subsequent specific anxiety disorder diagnosis and explores external factors that influence clinicians' diagnostic decisions. We conducted semistructured interviews in 2020-2021 with 32 Veterans Health Administration mental health clinicians across the United States from Primary Care Mental Health Integration and General Mental Health clinics. Qualitative content analysis revealed that external barriers fell into three primary areas: limited resources, logistics, and patient factors. Clinicians cited insufficient diagnostic tools, limited time, and inadequate patient history as barriers to diagnostic specificity. They also noted that referrals from medical clinicians provided limited information about the presenting problem, hindering the diagnostic process. Patient-related barriers to specific anxiety diagnosis included difficulty articulating internal experiences and mental health stigma. Suggested solutions included increased access to screening tools, expanded clinician education offerings, enhanced communication between clinicians, and collateral reports. Future research should examine environmental factors in integrated clinical settings beyond Veterans Health Administration medical centers and explore the impact of potential solutions on improving accurate diagnosis. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The training of health specialists is a strategic component for the operational, human, and territorial sustainability of the public health system. However, Chilean university training models-primarily oriented toward technical efficiency-have tended to marginalize the relational and ethical dimensions of care, weakening the experience of care and diminishing trust in health institutions. From a theoretical-reflective perspective, this article explores the possibilities and tensions that arise when transferring the principles of radical care and their performative version, Embodying Radical Care to the field of specialist medical training in Chile, proposing that these approaches may contribute to reconfiguring medical training processes toward an embodied ethics of care. From this perspective, the article develops a comparative analysis of theoretical approaches that integrates care ethics, the politics of interdependence, and performative practice. Incorporating these perspectives could strengthen relational and affective competencies in clinical teaching, deepening the learning process through the ethics of radical care and recognizing bodily experience and ethical sensitivity as dimensions of professional formation. At the same time, these principles could improve the experience of care by fostering a culture that acknowledges interdependence among people, institutions, and territories, thereby consolidating a more humane and sustainable medical practice. Ultimately, this reflection seeks to offer conceptual foundations for public policies on training and humanization in health that understand care not merely as a technical act, but as an ethical, political, and aesthetic practice essential for the sustainability of the health system.