Entrepreneurship and innovation: A comparative analysis of social representations among nursing students

The American Board of Emergency Medicine (ABEM) has recently introduced a new Certifying Exam, which incorporates assessment of performance in a simulated clinical environment. Simulation-based assessments allow for reproducible, controlled evaluations. The residency program has a responsibility to prepare residents for the Certifying Exam and to verify resident competency. We sought to determine the feasibility of a simulation-based assessment program encompassing three domains (resuscitation, procedural skills, and communication) with assessments against pre-determined Minimum Competency Scores (MCS) to provide evidence for program director attestations of competence. Eight stations were chosen based on ABEM's Certifying Exam content, the Accreditation Council for Graduate Medical Education (ACGME) Milestones, and proposed Entrustable Professional Activities. Simulation-based case scenarios and assessment checklists were created with standard settings performed using the Mastery Angoff process. These stations were categorized into three different domains: resuscitation (Adult Medical, Pediatric Medical, Trauma, and Neonatal), procedural skills (Direct Laryngoscopy, Cricothyrotomy, and Central Venous Catheter Placement), and communication (Breaking Bad News). Results were summarized with descriptive statistics. Thirty emergency medicine residents at an academic Midwestern residency program underwent assessments over one year. None of the residents achieved the MCS on all eight assessments. Residents achieved the MCS on an average of 4.24 stations. There was large performance variability, particularly for the Pediatric Medical (27%-100% items correct), Neonatal Resuscitation (30%-100%), and Breaking Bad News (31%-100%) scenarios. A greater percentage of residents met the MCS for procedural assessments. This pilot study demonstrated the feasibility of a simulation-based assessment program designed to provide objective evidence of clinical competency. Assessment outcomes and associated feedback can be used by learners to guide the development of educational plans forperformance improvement. Educators can use the resulting data to assess readiness for independent practice, prepare for the Certifying Exam, and identify content areas that may require additional program-wide education.

Entrustable Professional Activities in Dutch General Surgical Training: Perspectives of Surgeons and Trainees.

Postgraduate training to become a surgical oncologist involves a general surgery residency and a Complex General Surgical Oncology (CGSO) Fellowship, with most graduates spending approximately 9years in training. This paradigm remains dependent on devoting a specific, fixed amount of time to training. A competency-based medical education (CBME) approach acknowledges that learners progress through different milestones at variable paces. Currently, several oversight organizations are involved in training surgical oncologists, which are still dependent on time-based training. A narrative review was conducted reviewing literature and current guidelines on CGSO training. The interplay between the various organizations was outlined in hypothetical models. Many organizations are involved in the ultimate oversight of surgical oncology training, including at the residency, fellowship, match, and board certification level. These organizations still rely on time spent in training for the ultimate approval of a trainee through each step of training. New initiatives are slowly introducing CBME, notably the Entrustable Professional Activity initiative through the American Board of Surgery. Our current training environment faces many challenges, including duty hours, increasing use of technology, and employment models that are quite different from those present at the outset of CGSO as a specialty. To improve our approach to training surgical oncologists, it is necessary to understand the current framework for oversight. We have reviewed the most relevant oversight bodies to allow for a better understanding of the machinery involved in any attempt to modify CGSO Fellowship towards a CBME model.

Leveraging Simulation to Support Competency-Based Surgical Training.

competencies of master teachers in Region I and their implications on teaching effectiveness. Employing a descriptive-correlational research design, the study involved master teachers and teachers in public elementary schools in Region I. Data were gathered using validated survey instruments aligned with instructional leadership constructs, supervision competency domains, and the DepEd RPMS–IPCRF framework for teaching effectiveness. Descriptive statistics were used to describe levels of instructional leadership styles, supervision competencies, and teaching effectiveness, while inferential statistics, particularly Pearson r and Spearman rank correlation, were employed to assess significant relationships among variables. Findings revealed that the instructional leadership styles of master teachers — namely, authoritative, collaborative/participative, coaching/mentoring, transformational, distributed/shared leadership, instructional monitoring and feedback, and servant leadership — were highly evident. Supervision competencies in planning and organizing instructional supervision, classroom observation and feedback, coaching and mentoring, monitoring and evaluating instructional practices, and facilitating professional development activities were highly competent. Teachers’ level of teaching effectiveness based on RPMS–IPCRF indicators was also rated highly effective. Results further showed significant positive relationships between instructional leadership styles and teaching effectiveness, as well as between supervision competencies and teaching effectiveness. Selected profile variables were also significantly related to supervision competencies. These findings underscore the critical role of instructional leadership and effective supervision in enhancing teaching performance. Based on the results, a capacity-building program for master teachers was proposed to strengthen leadership and supervision practices and sustain improvements in teaching effectiveness.

Traditional point-of-care ultrasound (PoCUS) teaching that relies on hands-on practice faces challenges of limited scale and infection-control constraints during pandemics. We designed a low-contact curriculum integrating near-peer teaching (NPT) with faculty remote supervision (RS) and evaluated its effectiveness versus on-site faculty-led teaching. In this randomized controlled pilot trial, 69 senior medical students were assigned to NPT+RS (n=34) or faculty-led control group (n=35). Both groups received identical didactic and hands-on training, with the NPT+RS group incorporating multi-camara telemedicine supervision by the faculty to support NPT. The primary outcome was the Entrustable Professional Activity (EPA)-based Objective Structured Clinical Examination (OSCE) score with four major domains measured 1 month after training. The secondary outcomes included the technology acceptance model (TAM) survey and the OSCE feedback. Total OSCE scores (74.9 vs 76.8; p=0.614) and the Indication-Acquisition-Interpretation-Medical decision domain scores did not differ between two groups. For single items, only a lower interpretation performance at the posterolateral alveolar/pleural syndrome in NPT+RS group (4.6 vs 6.5; p=0.013) was found. The NPT+RS group reported higher perceived usefulness (efficiency, usefulness, performance, productivity; all p<0.05), with no between-group difference in perceived ease-of-use. The OSCE was more often perceived by the NPT+RS group as revealing weaknesses (p=0.002) and meriting routine post-training implementation (p=0.034). A low-contact PoCUS curriculum integrating NPT with RS achieved overall EPA-based OSCE performance comparable to traditional faculty-led instruction while enhancing perceived usefulness and assessment acceptance. Implementation of this model allows for greater training capacity and decreased contact. The capacity of NPT for image-interpretation skills warrants investigation.

Objective Structured Clinical Examinations (OSCEs) are an increasingly popular method for assessing medical students, aiming to foster a curriculum that emphasizes the development of clinical skills during medical studies. This study aimed to identify the factors influencing student performance in both OSCEs and written exams to better understand students' needs and refine educational strategies. We hypothesized that the determinants of success may differ between these two modalities, which evaluate partly distinct competencies. A survey was conducted among fifth-year medical students from Université Paris Cité, collecting data on demographics, personal context, educational background, and exam preparation methods. Statistical analyses included univariate and multivariate regression models to examine the association between student characteristics and mean grades in OSCEs and written exams. The study involved 441 medical students, of whom 310 were women. Factors independently associated with better grades in written exams included the absence of concurrent professional activity, no previous repetition in the curriculum, regular attendance at faculty theory courses, use of reference textbooks, participation in private training conferences, and higher exposure to OSCEs during hospital rotations. For OSCE performance, better grades were independently associated with the subscription to online exam preparation platforms and attendance at private training conferences. Our findings reveal distinct factors influencing success in OSCEs compared to written exams. Targeted educational strategies, like encouraging OSCE practice during hospital rotations and supporting access to training conferences, may benefit students. A comprehensive understanding of student needs should extend beyond refining teaching strategies to include considerations like scholarship eligibility for students balancing professional work with their studies. These insights highlight the need for a holistic approach in medical education, addressing both academic and personal factors to fully support student achievement.

Patient care is inherently collaborative, yet traditional assessment methods often emphasise individual performance. This study explores how the concept of interdependence can be used for assessment within clinical settings by examining how faculty in Emergency Medicine (EM) and Paediatrics identify interdependence and distinguish between the different types when assessing residents. We employed a mixed-methods survey design, recruiting board-certified faculty from EM and Paediatrics across Canada and the United States. Participants watched three different videos, each ranging from 3 to 7 minutes that depicted interdependent performances. After watching the videos, participants completed relevant Entrustable Professional Activity (EPA) assessments. Then, each video was broken down into smaller clips for participants to watch again. After watching each of the individual video clips, participants answered questions regarding their observations of interdependence, which included the type and appropriateness. After watching all the videos and their associated clips, participants provided Milestone ratings. A total of 126 faculty members participated, evenly split between EM and Paediatrics. Descriptive statistics revealed that participants were able to precisely identify interdependence, but notable differences in distinguishing between supportive and collaborative interdependence existed based on specialty. Open-ended responses support the notion that faculty conceptually understand the interdependence they observed in clinical scenarios. Correlation analyses indicated various relationships between interdependence assessments, EPAs and Milestone ratings. This study highlights the complexities of assessing interdependence. Although faculty demonstrated an understanding of interdependence and were able to identify it, challenges remain with classification during real-time assessments. These findings underscore the need for faculty development and reflection on how to best use assessments of interdependence to measure residents' performance and contributions to collaborative patient care.

This study aimed to determine the relationship between work attitudes and occupational resilience of teachers handling learners with special educational needs in Carmen District, Davao del Norte. Specifically, it sought to assess the levels of work attitudes and occupational resilience, examine the relationship between these variables, and identify which domains of work attitudes significantly influence occupational resilience. A quantitative descriptive-correlational design was employed. The respondents were seventy-eight SNED teachers, with total enumeration used to include all eligible participants. Data were collected through questionnaires administered face-to-face. Work attitudes were measured in terms of sense of efficacy, sense of community, and sense of professional interest, while occupational resilience was assessed through personal competence, tolerance of stress and adversity, and positive acceptance of change. Weighted mean, standard deviation, Pearson’s correlation, and multiple regression analysis were used. Findings revealed that these teachers exhibited strong work attitudes and high levels of occupational resilience. Overall work attitudes were significantly related to occupational resilience, with sense of community and sense of efficacy emerging as significant predictors. Sense of professional interest did not significantly influence resilience. These results highlight the importance of relational support and personal efficacy in sustaining teacher resilience in challenging contexts. Based on these findings, SNED teachers may enhance their community and efficacy through mentoring and professional learning activities. School heads may promote supportive climates, while policymakers may incorporate teacher well-being and professional development into education policies. Future research may explore other factors influencing occupational resilience and examine changes in work attitudes and resilience over time. Keywords: Carmen District; Davao del Norte; learners with special educational needs; occupational resilience; work attitudes

Infectious contamination of healthcare workers.

Programs worldwide are introducing programmatic assessment and Entrustable Professional Activities (EPAs) with strong theoretical foundations and growing research evidence regarding potential benefits. In Australia, the new National Framework for Prevocational Medical Training includes four EPAs for doctors in PGY1-2, who rotate through different specialties to gain broad experience: EPA1:Clinical assessment, EPA2:Recognition and Care of the Acutely Unwell Patient, EPA3:Prescribing, EPA4:Team communication. Little is known about how this new education model will work in practice. Hence a pilot study was conducted to (1) Investigate how feasibility, acceptability, educational value and overall utility of EPAs can be maximised, and (2) Clarify challenges and enablers of EPA implementation, operationalised via EPA assessments. The study was conducted during intern terms 2-4, 2024 (10 weeks each) in a metropolitan health service. EPA assessments (EPAA) were implemented for interns working in eleven medical units across four specialties (medicine, surgery, mental health, emergency). Change strategies were designed using Kotter's 8-step and COM-B models. Action-research methodology was used and each 5-week cycle involved: enacting plans, gathering user data, analysing data, and co-designing improvements with expert and stakeholder panels. Quantitative and qualitative user data were collected from all EPAA e-forms, plus surveys and focus groups conducted each cycle. In total, 738 EPAAs were submitted by 119 interns and 283 assessors. The frequency order was: EPA1(highest)-EPA4-EPA3-EPA2. The majority took 10min or less to complete, and most were assessed by registrars, except in Emergency where consultants predominated. EPAA activity varied substantially across individual units, even within one specialty. User perspectives indicated that EPAAs' educational value depended primarily on the quality of the feedback discussion. Key challenges identified were establishing a trained assessor cohort, fitting EPAAs into workflow, refining the form design and rating scale (National Framework scale used in Phase 1 and modified Ottawa-scale in Phases 2-3). Multiple revisions to implementation were co-designed and executed across the pilot. Practical strategies to support implementation were clarified. This large pilot provides valuable insights into EPA implementation according to the National Framework. Clarifying challenges and enablers may assist others. Optimising EPAA quantity, rating scale, form and feedback quality is important due to impacts on realising educational value and providing robust performance data for progress decisions.

ABSTRACT Overqualification (defined as a situation in which workers’ formal credentials exceed job requirements) has become increasingly salient in Ecuador, especially among young workers. Using ENEMDU microdata for 5,150 employed young tertiary-educated workers, this paper estimates a logit model with an objective occupation-based mismatch measure. Average marginal effects indicate that women are 6.3 percentage points more likely to be overqualified than men. Relative to technical and technological tertiary graduates, university graduates show a 10.3 percentage-point higher probability of overqualification. Informality and microenterprise employment are also strongly associated with mismatch. Sectoral results reveal lower overqualification in education, professional activities, and health.

BackgroundCompetence by Design (CBD) is a model of medical education developed by the Royal College of Physicians and Surgeons of Canada. CBD emphasizes an outcomes-based approach to residency training, replacing traditional models of time-based training. CBD focuses on the achievement of Entrustable Professional Activities (EPAs), which are key tasks of a discipline. Misalignment of educational priorities between teachers and learners can negatively impact learning and quality of care. This study aims to compare the learning priorities of plastic surgery residents and attendings, as well as explore perceptions of CBD.MethodsAn online survey was administered to plastic surgery residents and attendings identified via the Canadian Society of Plastic Surgeons mailing list. Participants ranked milestones by learning priority using a 5-point Likert scale. Participants were also asked their opinions on CBD, and responses were analyzed thematically.ResultsA total of 76 participants (25 residents and 51 attendings) responded to the survey (15% response rate). Residents ranked gathering a relevant clinical history as less important than attendings (odds ratio = 0.38, 95% confidence interval 0.14-0.98, P = .049). Residents and attendings had comparable rankings for the other 18 EPA milestones. Thematic analysis revealed that while CBD is perceived to have benefits for trainees, concerns pertain to excessive administrative burden and subjective evaluation. There was also inconsistency in the way EPAs are utilized by attendings with regard to when they were initiated/completed and how milestones were scored.ConclusionsOverall, this exploratory study showed good concordance between resident and attending plastic surgeon prioritization of EPA milestones. Perceived benefits and limitations of CBD in plastic surgery are similar to those reported in other specialties. Many attendings have knowledge gaps in the implementation of EPA evaluations.

Despite the fact that Hungarian school healthcare has a history dating back 140 years, no comprehensive study has yet been conducted to analyze the historical development and impact of system, particularly the institutionalization of the role of health visitors in educational institutions and the development of cooperation between school doctors and health visitors. 1) To explore the historical development of school health services and the takes of school doctors, 2) to analyze the involvement and role of public health visitors in school healthcare, 3) to examine the role of cooperating professionals (doctors, public health visitors, and other professionals present today), 4) to explore the challenges that determine current operations. We studied the relevant legislation, professional regulations, and literature through research, and carried out systematic and analytical work. The role of school doctors shifted from monitoring and epidemic control to preventive care and health promotion tasks. The development of school healthcare is linked to the name of József Fodor, who laid the foundations for the regular health monitoring of school-age children by introducing a public health approach. Health visitors gradually became involved in healthcare within the legal framework, and their role became increasingly important in the areas of prevention, care, and health education. Health visitors initially appeared as professionals supporting the work of doctors. Today, this cooperation extends to all areas of health visitors' professional activities and plays a fundamental role in the effective functioning of school healthcare. The cooperation between school doctors and public health visitors is one of the cornerstones of Hungarian school healthcare and plays a key role in maintaining children's health, prevention, and health promotion. Orv Hetil. 2026; 167(19): 753-764.

Interruptions during triage: Characteristics and nurses' perception.

The transition to competency-based education (CBE) and entrustable professional activities (EPAs) reflects a growing emphasis on learner outcomes and clinical readiness. Despite this paradigm shift, few physical therapist education programs have operationalized these frameworks. This method/model presentation describes the development of a Competency- and Entrustment-Based Education (CEBE) model in a hybrid Doctor of Physical Therapy program designed to prepare workforce-ready graduates. Thirteen faculty members collaboratively designed the CEBE curriculum, using backward design and 8 guiding educational principles, including case-based learning, academic coaching, integrated content delivery, and flipped classrooms. Through iterative peer review, they defined 7 Domains of Competence (DOCs), related competencies, and 10 EPAs. Distinct scales were developed to assess both competence and entrustment levels. Faculty and 52 external clinicians provided feedback through a Likert-style survey to validate the framework. Most DOCs and EPAs received strong agreement ratings, reflecting strong perceived relevance to entry-level practice. External feedback led to minor revisions, especially within the Practice Management and Stewards of Societal Health domains. Based on stakeholder feedback, 3 EPAs were removed, 1 added, and 1 reinstated. This CEBE model offers a feasible, learner-centered framework for developing and assessing progressive competence and entrustment. Its innovative design promotes learner autonomy, aligns with current clinical standards, and responds to broader health system needs. Lessons from this implementation may guide broader adoption of CBE and EPA frameworks across the profession. Future work will focus on longitudinal implementation outcomes and interinstitutional collaboration to refine CEBE in physical therapist education.

Medical training assessment frameworks have continued to evolve to effectively capture clinical competency and graduation readiness. Entrustable Professional Activities are being integrated into training programs and describe the activities expected in practice to guide education and assessment. U.S. Pediatric cardiology fellowship programs have been working on creating and implementing these since 2015. We sought to investigate the current landscape of EPA implementation and perceptions amongst fellowship training program directors. This was a mixed-methods study with grounded theory employing both qualitative and quantitative assessments utilizing a survey instrument distributed to the Society of Pediatric Cardiology Training Program Directors from August 2023 to October 2023. Open-ended prompts were manually coded by two independent team members followed by theme creation. Demographics and descriptive statistics were summarized by frequencies with percentages and Likert-scale responses were tabulated. 24 of 62 pediatric cardiology program directors (39%) completed the study. >80% of respondents used a competency-based framework with/without milestones with ~ 40% utilizing EPA-based assessments. Programs utilizing EPA-based assessment report high satisfaction with their ability to capture trainee performance longitudinally. There is overall good familiarity with the EPA framework amongst all participants. Qualitative analysis revealed three themes: (1) EPA-based assessments provide objective, practical, goal-oriented assessments; (2) Significant effort and time are required from faculty and program directors assessing EPAs; (3) Major limiting factors assessing clinical fellows include a lack of comprehensive and consistent assessment from evaluators that may not necessarily be solved by the EPA framework alone. Near half of pediatric cardiology fellowship programs who responded in this study have begun to implement the EPA framework to facilitate trainee assessment. While there are perceived strengths with the addition of EPAs, early reservations also exist and continued follow-up should be done for both programs and training cohorts who were assessed under the EPA model.

The present article examines the features of the formation of informal practices in the institute of the investigation of the police department. The theoretical framework of the study is the micro-sociological approach to the understanding of social actions of individuals, presented by works in the field of ethnomethodology, semiotics, symbolic interactionism. As an auxiliary theoretical concept, the systemic theory of Niklas Luhmann and his concept of trivial and non-trivial machines act. The main thesis put forward by the authors is that investigators of the Internal Affairs Department, who are supposed to be guided solely by regulatory legal acts in their daily professional activities, cannot help but be influenced by the social norms and conditions of the social situation in which their activities unfold. This is particularly evident in the research conducted by representatives of various micro-sociological schools. In conclusion, the authors argue that 1) informal practices are a part of social reality, and 2) such actions do not necessarily constitute examples of delinquent behavior.

Abstract Reconstructive microsurgery is central to contemporary reconstructive surgery, enabling complex restoration of form and function across multiple anatomical regions. As clinical demands increase and operative exposure declines, the need for effective, structured microsurgical training has become more pressing. Despite advances in simulation, assessment, and curriculum design, substantial variability persists in how microsurgical training is delivered, validated, and sustained worldwide. This narrative review synthesizes the current global landscape of microsurgical training, examining key challenges and evidence-based educational strategies. Core components of effective training programs are identified, including technical skills acquisition, objective assessment, theoretical knowledge, research engagement, structured training pathways, and mentorship. A high-volume, longitudinal training model at Chang Gung Memorial Hospital is presented as an illustrative example. Future directions in microsurgical education are explored, with particular emphasis on competency-based curricula and entrustable professional activities. Key challenges include global variability and inequity in training access, limited longitudinal validation of training outcomes, reduced operative exposure, overemphasis on isolated technical skills, and shortages in mentorship capacity. Effective microsurgical training requires integration of technical, cognitive, non-technical, and professional competencies within longitudinal, context-rich educational frameworks. Emerging approaches—including distributed simulation, advanced virtual reality technologies, structured supervision, and international training networks—offer potential solutions to current limitations. Microsurgical education must evolve beyond episodic technical training toward integrated, competency-based frameworks that support progressive autonomy, patient safety, and independent practice. Although no single model is universally replicable, transferable principles from established programs can inform curriculum design across diverse settings. Continued investment in trainer development, outcome-driven educational research, and international collaboration will be essential to ensure the sustainability, equity, and effectiveness of future microsurgical training.