Endodontic treatment varies in complexity, and accurate assessment of case difficulty is essential for clinical success, guiding referrals, and enhancing patient safety, particularly amongst general dental practitioners (GDPs). This scoping review aimed to identify and appraise the available tools and indices developed to assess endodontic case difficulty. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive search of seven databases (PubMed, MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar) was conducted for studies published between January 2000 and July 2025. Articles were included if they described, developed, evaluated, or validated tools specifically assessing endodontic case difficulty or complexity. Data were extracted and synthesised thematically to summarise tool characteristics, components, scoring systems, and validation methods. Out of 1134 initial records, 15 studies met the inclusion criteria. These studies were published between 2001 and 2025 across multiple countries. They evaluated various endodontic case difficulty assessment tools, including the American Association of Endodontists Case Difficulty Assessment (AAECDA) form, Endodontic Case Assessment Form (ECAF), Endodontic Complexity Assessment Tool (E-CAT), EndoApp, and Dutch Endodontic Treatment Index (DETI). Most studies identified tools designed for non-surgical root canal treatment; however, one specifically considered endodontic microsurgery. The tools varied in structure, scoring logic, and validation rigour. While most tools shared common domains, such as patient, tooth, and treatment-related factors, reliability assessments showed considerable variation in inter- and intra-rater agreement. Endodontic difficulty assessment tools are diverse and evolving, supporting clinical decision-making and educational development. Continually refining the tools, conducting psychometric validation, and ensuring global applicability will help to enhance their utility across various settings and user groups.

Investigating students’ learning effectiveness and success on business process analysis via mobile games: A formative assessment perspective

Medical humanities education is recognized as essential for fostering empathy, professional identity, and humanistic literacy in future physicians. However, in China, existing medical humanities courses often lack effective interdisciplinary integration, rely primarily on passive lectures delivered by humanities faculty with limited clinical connection. There is an urgent need for evidence-based interdisciplinary curricula to cultivate medical students' empathy, humanistic literacy, and professional identity. We developed and implemented an interdisciplinary medical humanities course "Melody of Genes", which employs a student-centered flipped‑classroom, discussion‑based model co-taught by medical and arts instructors. A single-group post-course observational study was conducted over three rounds (2022-2024), enrolling 113 medical undergraduates. Quantitative data were collected using an anonymous post‑course questionnaire (Cronbach's α = 0.821), and qualitative data from students' written reflections and final reports were analyzed using thematic analysis. Of 109 valid respondents (96.5% response rate), 101 (92.7%) reported perceived improvements in humanistic and philosophical literacy; 91 (83.5%) reported enhanced self-learning ability and critical thinking; and 92 (84.4%) reported increased empathy for patients and stronger professional identity as future physicians. Thematic analysis revealed that students valued the interdisciplinary discussions, the integration of real-clinical perspectives, and the opportunity for reflective writing. An interdisciplinary medical humanities course using co-teaching, flipped classroom, and formative assessment is feasible and associated with positive self‑perceived improvements in empathy, humanistic literacy, and professional identity among Chinese medical undergraduates. These findings offer a replicable model for the construction and innovation of medical humanities curriculum in Chinese medical education.

The article substantiates the need to purposefully develop bachelor of education students’ (teachers’) skills for managing the e-learning educational process. The relevance of the study is determined by the expansion of teachers’ professional functions caused by the widespread use of digital platforms, synchronous and asynchronous learning formats, learning analytics, and artificial intelligence. A teacher is expected not only to use digital tools but also to design the learning structure, organize interactions, coordinate learners’ activities, monitor their progress, and adjust the educational process in a timely manner. The purpose of the article is to provide a theoretical justification for the development of these skills, clarify the meaning of educational process management in e-learning, and determine their structure. The study is theoretical and employs the analysis of scholarly literature, comparison, generalization, systematization, and abstraction. Educational process management in e-learning is a purposeful teacher activity aimed at designing, organizing, coordinating, monitoring, and adjusting learners’ activities in a digital environment. It is argued that this activity is not limited to the administration of a digital platform. It requires aligning learning objectives, content, digital resources, forms of interaction, assessment, and learner support. The structure of future teachers’ skills has been identified. It includes design and organizational skills, communication and coordination skills, monitoring and analytical skills, assessment and regulation skills, ethical and safety-related skills, and reflective skills. The interrelationship between these groups and their cyclical manifestation in teachers’ professional activity has been substantiated. The findings indicate that digital competence is a necessary but insufficient condition for effective e-learning management. The results may be used to update bachelor-level teacher education programs, develop diagnostic tools, and conduct further empirical research on the formation of the identified skills.

Family Nurse Practitioner (FNP) programs often lack structured preclinical competency verification, which delays identification of learning needs and creates patient safety risks. Although registered nurses demonstrate sophisticated clinical judgment within team-based practice, FNP practice demands autonomous diagnostic reasoning, generating differential diagnoses and formulating management plans. This shift requires intentional educational support through formative assessment. At one Western United States public university FNP program, students entered practicum without standardized preclinical evaluation. Faculty observed wide variation in preparedness, from overconfidence to hesitation. This single-cohort, mixed methods pilot educational program evaluation implemented a formative preclinical Objective Structured Clinical Examination for 12 FNP students to evaluate confidence in primary care assessment and diagnostic reasoning while exploring curriculum integration feasibility. Students rated confidence using the Simulation Effectiveness Tool-Modified; faculty used the Lasater Clinical Judgment Rubric. Structured debriefings and surveys captured qualitative data. Two 30-minute standardized patient encounters, an adult and pediatric wellness visits incorporating anemia recognition, followed International Nursing Association for Clinical Simulation and Learning standards. Prebriefing, encounters, documentation, and debriefing integrated Kolb's experiential learning and Tanner's clinical judgment frameworks. Students reported moderate confidence in primary care assessment (M = 2.32) and diagnostic reasoning (M = 2.26), with lower confidence in clinical decision making (M = 1.70). Faculty ratings paralleled student self-assessments: highest in noticing (M = 2.7), lowest in reflecting (M = 2.0). Students (M = 3.90) and faculty (M = 4.89) rated the Objective Structured Clinical Examination as educationally valuable and appropriate; however, faculty expressed sustainability concerns (M = 2.44). The preclinical Objective Structured Clinical Examination provided structured opportunity for diagnostic reasoning practice and identification of learning needs before practicum entry, demonstrating feasibility within competency-based FNP education.

ABSTRACT This study examines second-year law students’ experiences of evaluating administrative decisions across two successive course implementations. In 2023 (N=250), students were randomly assigned to either an Independent Scoring Format (ISF), where they rated individual decisions, or Comparative Judgement (CJ), where they compared pairs of decisions. Post-activity survey data, including open-ended responses, were analysed for both groups. In 2024 (N=270), Adaptive Comparative Judgement (ACJ) was introduced with a larger pool of decisions and structured written justifications. Ratings of perceived usefulness were positive, with no statistically significant differences between CJ and ISF. The qualitative analysis suggests that comparative formats supported learning through contrast and prioritisation, while ISF highlighted difficulties in applying overlapping criteria consistently to individual texts. ACJ made students’ grounds for preference more explicit, but also increased cognitive demand, underscoring the need for scaffolding and calibration. The findings inform the design of formative assessment for fostering evaluative judgement in legal education.

Naungan Kasih (NK) is a hybrid positive parenting program for parents and caregivers of preschool-aged children that blends digital, in-person, and remote support to strengthen parenting skills and promote children's healthy development. This paper documents the development, evaluation, and scaling pathways in which academic institutions, Malaysian government agencies, and international organizations collaborated as a consortium to translate evidence-based parenting principles into a locally feasible, culturally responsive delivery model. NK progressed through a three-phase implementation journey. It began by strengthening and standardizing in-person parenting support in response to a government request, then shifted to digital delivery during COVID-19 through ParentText and ParentChat, and is currently focused on embedding hybrid NK within the government preschool platform to support scalable, sustainable delivery. The development process involved formative assessment, co-design, and pilot testing of the program. NK is being tested through a cluster-randomized controlled trial with effectiveness outcomes including caregiver parenting practices, mental health, and relationship quality, as well as child developmental and behavioral outcomes, alongside process measures of reach and engagement. The scaling pathway leverages evaluation outputs by building a train-the-trainer system, supervision and quality-assurance mechanisms, standardized monitoring for continuous improvement, a technology-transfer process, and modular materials that can be adapted across local contexts without diluting core components. The NK collaboration framework demonstrates how a multi-stakeholder partnership can produce an evidence-informed, implementation-ready intervention, while simultaneously establishing the operational infrastructure required for rigorous evaluation and scalable delivery within government agencies.

Educational transformation in the era of artificial intelligence requires schools to build a humanistic-digital, reflective, collaborative, and data-driven learning ecosystem. This study aims to map the implementation quality of deep learning in State Senior High Schools adopting the Deep Learning, Coding & Artificial Intelligence (DLCAAI) model in Central Java and formulate its implications for evidence-based policy development (baseline assessment), involving 316 teachers from all DLCAAI model schools in the region. The research instrument was a 5-point Likert-scale questionnaire with 75 items covering deep learning principles, learning experiences,t he deep learning framework, graduate profiles, and learning assessment. Validity tests showed all items were valid (corrected item-total correlation > 0.30), while instrument reliability was very high (Cronbach’s Alpha = 0.992). Data analysis employed means, percentages, categories, and comparative dimensional analysis. Results indicate that the quality of deep learning implementation is 93.43%. The strongest dimensions include student-centered learning, psychological safety, character development, inclusivity, and digital integration. However, metacognitive reflection, formative assessment, learning differentiation, cross-disciplinary learning, and the utilization of learning data still require strengthening. The novelty of this research lies in developing the Baseline Architecture of Humanistic-Digital Deep Learning Ecosystem framework, which integrates deep learning, AI, reflective pedagogy, student agency, and evidence-based educational policy. This study confirms that baseline assessment functions as an educational diagnostic, a compass for school transformation, and a policy navigation system in the humanistic and sustainable AI-based educational transformation.

This study aims to propose gamification as an active methodology to strengthen digital competencies in teachers at the Babahoyo Educational Unit. Using a quantitative-descriptive approach, a survey was conducted with 15 purposefully selected teachers to diagnose the current use of playful techniques, knowledge about gamification, level of digital competencies, and the prevalence of traditional methodologies in their pedagogical practices. Results showed that most teachers still use traditional methodology (lectures, blackboard, posters), are unaware of gamification as a pedagogical strategy, and have significant limitations in mastering digital tools and educational platforms. In response to this diagnosis, a teacher training program is proposed, structured in four training units: institutional diagnosis, pedagogical foundation of gamification, gamified instructional design with digital tools (Kahoot, Genially, Quizizz, Wordwall, Educaplay), and implementation and evaluation of gamified strategies. Each unit includes pedagogical phases, participatory activities, digital resources, and formative assessment criteria. The proposal seeks to transform teaching practice through active methodologies that increase student motivation and develop digital competencies in both teachers and students. It is concluded that gamification, applied with a pedagogical approach and comprehensive training, represents a strategic tool to overcome the limitations of the traditional approach and innovate educational practice in technical contexts.

This study examined the moderating role of sociodemographic characteristics and health behaviours in the relationship between daily living activities and postoperative recovery in patients who underwent coronary artery bypass graft surgery. This descriptive, cross-sectional, and analytical study was conducted with 200 patients who underwent coronary artery bypass graft surgery in two training and research hospitals in Istanbul between December 2024 and April 2025. Data were collected using the Patient Assessment Form, the Barthel Activities of Daily Living Index, and the Postoperative Recovery Index. Pearson correlation analysis and moderation analyses via PROCESS Macro (Model 1) with 5,000 bootstrap resamples were performed. A significant negative relationship was identified between daily living activities and postoperative recovery (r = - .453, p < .01). Physical activities recorded the highest subscale mean (2.52) and the strongest correlation with ADL scores (r = - .834, p < .01). BMI (B = - 0.214, p = .016), educational status (B = 0.036, p = .034), income level (B = - 0.023, p = .042), smoking status (B = - 0.039, p = .018), alcohol consumption (B = - 0.018, p = .009), and previous surgical experience (B = - 0.042, p = .023) each significantly moderated this relationship. The relationship between daily living activities and postoperative recovery is significantly shaped by individual sociodemographic and behavioural characteristics. It is recommended that individualised care approaches be strengthened by incorporating patients' sociodemographic profiles and health behaviours into postoperative nursing care planning.

ABSTRACT Introduction Programmatic assessment is being increasingly used in medical education with an expanding evidence base. The aim of the study was to explore student and teacher perspectives of a novel clinical, programmatic assessment model set within a Longitudinal Integrated Clerkship (LIC) across both primary and secondary care settings. Methods An explorative, interpretative approach was taken to explore participants’ views and experiences of the assessments, including focus groups of undergraduate medical students and interviews of faculty. Results A total of 14 students participated in two focus groups and nine faculty members were interviewed: four based in primary care and five in secondary care. In general, the new assessment model was perceived by teachers and students to be a positive step, with both benefits and challenges highlighted. Three key themes emerged: the impact on student well-being was complex and variable; predominantly positive attitudes towards programmatic assessment; and challenges of exam practicalities. Discussion Our study has explored student and teachers’ views of a novel, clinical, programmatic assessment; both sets of participants generally valued increased opportunities for feedback and positive impacts on well-being due to the reduced stress of lower-stakes assessments. However, there was some acknowledgement that it ‘spread the stress’ throughout the clinical year and that there were some challenges related to the introduction of a new form of assessment. We would commend this and similar forms of programmatic assessment to colleagues in other undergraduate healthcare professional institutions.

The Need for Unification: Assessing Variability in Top 200/300 Drug Lists at Seven Schools of Pharmacy.

This narrative review analyzes 25 studies published between 2018 and 2026 on educational planning and the competency-based approach in secondary education. The findings are organized into six thematic categories: foundations of the competency-based approach, didactic planning, teaching strategies, competency assessment, teaching competencies and pedagogical practice, and curricular management. The results show that planning constitutes a strategic axis for competency development, although challenges persist such as disciplinary fragmentation, insufficient teacher training, and the gap between normative discourse and classroom practice. Active strategies (PBL, collaborative learning, case studies) and formative assessment emerge as key tools. It is concluded that strengthening teacher planning, with institutional support and continuous training, is essential to transition towards quality competency-based education.

ABSTRACT English-medium instruction (EMI) is increasingly adopted in higher education worldwide, often accompanied by English-only policies that pose unique challenges for teachers, especially in multilingual contexts. However, little is known about how EMI teachers exercise agency in navigating these policies in non-Anglophone settings. This study adopts an ecological perspective to investigate how EMI teachers in Bangladesh navigate English-only policies, focusing on their perceptions of role, pedagogical challenges, and agency-mediated language practices. The study utilises semi-structured interviews, classroom observations, and stimulated recall interviews with six EMI teachers to examine their role perceptions, pedagogical challenges, and agency-mediated language practices. Thematic analysis revealed two situated role orientations: content-focused practitioners who reproduced English-only policies, and multilingually aware facilitators who strategically integrated Bangla and multimodal scaffolding resources. Teachers reported interlocking challenges, including inadequate English proficiency, limited training in interactive pedagogy, large classes that constrained participation, and limited formative assessment. Classroom practices ranged along a continuum from policy reproduction to strategic resistance, including spontaneous translanguaging for clarification, humour, participation scaffolding, device-mediated vocabulary support, and trans-semiotizing via visuals and gesture. We argue for context-sensitive EMI policies and discipline-specific professional development that builds multilingual pedagogical content knowledge and expands multimodal scaffolding repertoires.

Active learning methods are increasingly used in medical education to enhance engagement and retention; however, limited evidence links performance on embedded formative assessments to summative examination outcomes in large-group pre-clinical settings. Interactive Learning Activities (ILAs) incorporating low-stakes quizzes were implemented in a first-year Cardiopulmonary-Renal (CPR) systems course. This study aimed to determine whether ILA quiz performance was associated with summative examination outcomes and to explore student perceptions across academic performance tiers. A sequential explanatory mixed-methods study was conducted across two academic years (2022: n = 156; 2023: n = 160). ILAs included pre- and post-session quizzes, contributing 5% to the final course grade. Linear regression and correlation analyses examined associations between mean ILA quiz scores and summative examination performance. Students were stratified into tertiles of final course grade for survey comparisons. An anonymous post-course survey collected Likert-scale and open-ended responses. Quantitative survey data were analyzed using chi-square tests, and qualitative responses were analyzed using Braun and Clarke's thematic analysis framework. The ILA quiz scores demonstrated consistent moderate-to-strong positive correlations with overall examination performance in both cohorts (2022: R = 0.641; 2023: R = 0.672). Combined analysis confirmed a stable association (R = 0.632). Association was evident early in the semester, by the 6th ILA. Survey responses (25.6% response rate) indicated generally positive perceptions of ILAs. Lower-performing students reported comparatively high perceived learning benefits, whereas middle-tier students more frequently expressed concerns about quiz-related stress and workload (p < 0.05 for selected items). Qualitative themes highlighted engagement, retrieval practice, and timely feedback as strengths, with graded timing and stress as primary concerns. Performance on low-stakes ILA quizzes was consistently associated with summative examination outcomes in a large-group pre-clinical course. Embedded formative assessments may serve both instructional and early indicator functions, supporting early identification of students who may benefit from additional academic support.

AimThis study evaluated the effect of a Roy Adaptation Model (RAM)-based educational intervention on A1C levels and adaptive behaviors in adolescents with type 1 diabetes, and its contribution to physiological, psychosocial, and behavioral adaptation within a holistic nursing framework.MethodsThis randomized controlled trial included 60 adolescents aged 11 to 18 years followed in a pediatric endocrinology clinic. Participants were randomly assigned to an intervention group receiving structured RAM-based education, individualized tasks, and follow-up support (n = 30), or a control group receiving an educational brochure (n = 30). Data were collected at baseline and three months postintervention using a Sociodemographic Form, the Diabetes Knowledge Assessment Form, and clinical A1C records.ResultsCompared with the control group, the intervention group showed significant improvements in diabetes knowledge, adaptive behaviors, and A1C levels (p < .05). Interventions targeting RAM's adaptive modes contributed to glycemic control by strengthening psychosocial adaptation.ConclusionRAM-based nursing interventions promote physiological, psychosocial, and behavioral adaptation in adolescents with type 1 diabetes. Structured education enhances self-care, glycemic control, and coping. Integrating holistic nursing approaches into pediatric diabetes care is essential for improving outcomes.

Aim: The aim of this study was to evaluate the effect of Cardiopulmonary Resuscitation (CPR) training on the knowledge levels of male and female participants and to compare knowledge levels before and after the training. Materials and Methods: In this repeated cross-sectional study, the knowledge levels of individuals who participated in examinations before and after CPR training were evaluated. The CPR training was implemented as a structured 6-hour theoretical education program in accordance with current international guidelines. Although the individuals who participated in the pre-training and post-training assessments were drawn from the same population, analyses were conducted using independent samples because individual-level matching was not possible. Knowledge level was measured using a knowledge assessment form consisting of 31 questions and total knowledge scores were calculated. Appropriate parametric and non-parametric statistical tests were applied according to data distribution and correct and incorrect response rates were compared using the chi-square test. Results: After the six-hour CPR training, no significant change was observed in the total knowledge scores of male participants (p&gt;0.05). In contrast, post-training knowledge scores increased significantly among female participants and across all participants (p&lt;0.001). The effect of training on knowledge level was determined to be of moderate magnitude for female participants and for the overall group. Conclusion: CPR training significantly increased knowledge levels among female participants and across all participants. The findings indicate that the effectiveness of CPR training may differ by sex.

Globally, chronic wounds resulting from diverse etiologies impose a significant physical, psychosocial, and economic burden and have remained a highly neglected public health challenge. Yet, people in rural Ethiopia have limited access to quality and comprehensive wound care. There is a marked paucity for an integrated, holistic care model in the primary healthcare settings. Hence, this study aimed to develop a context-tailored, integrated, holistic, chronic wound care package in Ethiopia. A multi-method approach was applied, including a scoping review, formative assessments, Theory of Change workshops and a qualitative validation study. Purposive sampling was employed to recruit participants. Collected data were transcribed, coded, and thematically analysed to generate insights for refining the intervention package. A total of 49 stakeholders participated in the Theory of Change (ToC) workshops, while 36 participants were included in the qualitative study. The intervention package is structured around six core thematic components: awareness-raising and stigma reduction, capacity-building, active case detection and follow-up, program and supply chain management, Institutional and community-based rehabilitation, monitoring, and evaluation. Implementation and scale-up of these components are designed to cascade across three levels of the existing primary healthcare system, specifically the health organization, the health facility level, and the community level. This study introduced a context-driven, integrated, and holistic wound care package aimed at managing chronic wounds alongside their associated mental health and psychosocial challenges. The package encompasses interventions that address the physical, psychological, and social impacts of chronic wounds in individuals affected by neglected tropical diseases of the skin and related conditions. It employs multilevel implementation strategies targeting individuals, communities, and the health system to reduce morbidity, disability, and the economic and psychosocial burdens linked to chronic wounds. This standardized, scalable, and sustainable care model provides a promising approach for Ethiopia and other low- and middle-income countries.

HIV, public health, and the "unwilling or unable" person living with HIV.

Novice health care staff often write case reports during early clinical training. However, many institutions lack structured feedback systems because of time constraints and instructor shortages. Large language models, a form of artificial intelligence (AI), offer new opportunities to enhance educational feedback, yet their application in clinical training requires careful design to ensure pedagogically appropriate and ethically sound outputs. This tutorial provides a practical guide for educators without programming experience to develop an AI-based feedback system using 3 accessible tools: Dify (an AI workflow platform), Slack (a messaging app), and Google Apps Script. The system balances educational quality with operational efficiency while incorporating data privacy safeguards for clinical educational content. We developed a feedback system comprising 4 AI chatbots with 2 distinct approaches: "loop-based" bots that promote clinical reasoning through iterative, comment-based feedback and "single-shot" bots for efficient proofreading and summarization tasks. The tutorial describes the system architecture; feedback design principles grounded in formative assessment theory; a step-by-step implementation guide; and data privacy safeguards, including a deidentification protocol and application programming interface-based data protection measures. To illustrate feasibility, we conducted a pilot implementation at a community care hospital from April to June 2024, involving 5 novice staff members and 5 instructors. A pilot implementation at a community care hospital demonstrated that the system was feasible to deploy and operate within routine clinical education workflows. Participant feedback indicated high usability and suggested that the iterative, comment-based feedback approach supported learner engagement while also identifying areas where feedback criteria required refinement to better match institutional educational goals. This tutorial provides a reproducible framework for building a customized AI feedback system that combines comment-based iterative feedback with human-in-the-loop oversight and a multilayered data privacy framework. By following this guide, educators can implement an adaptive system tailored to their institutional context and clinical domain.