To sit or not to sit? A Danish mixed-methods study of a bedside sitting-intervention among cardiological patients.

Hepatobiliary surgical training in a changing educational landscape: An 18-year longitudinal analysis of a high-volume international fellowship programme.

Infection prevention and control (IPC) professionals played a vital role during COVID-19, yet their experiences remain largely unexplored. Understanding these experiences is crucial for strengthening health system preparedness for future outbreaks/pandemic. This study investigates IPC professionals' preparedness, response capacity, knowledge base, and barriers/enablers during COVID-19 to inform future pandemic planning. A cross-sectional online survey was conducted in 2024 among IPC professionals worldwide through WHO's Global Outbreak Alert and Response Network partners and professional IPC organisations. The survey was translated into five languages, comprising 30 questions that covered demographics, professional preparedness, response capacity, and pandemic experiences. Quantitative data were analysed descriptively using SPSS, while qualitative responses underwent thematic analysis. Eighty-six responses from 19 countries were analysed, with participants mainly from Australia (48.8 %), Canada (17.4 %), and the United Kingdom (8.1 %). Most worked in government hospitals (54.7 %) with dedicated IPC roles (57.0 %) and over five years of experience (73.2 %). Four interconnected themes emerged: establishing IPC as vital expertise, confronting the psychological toll of IPC work, navigating shifting guidance and policy, and managing resource scarcity and workforce strain. Participants reported a lack of recognition as "front-line" staff, significant psychological burdens including post-traumatic stress, challenges with rapidly changing guidance undermining staff trust, and overwhelming workloads without additional resources. IPC professionals showed remarkable dedication despite facing structural neglect and emotional difficulties. Findings highlight the urgent need to formalise IPC leadership roles within health systems, ensure proper recognition and resources, and incorporate psychosocial support measures to enhance pandemic preparedness and response capacity worldwide.

Chest radiograph interpretation is a foundational skill in physician associate (PA) education, and competence in diagnostic imaging is an accreditation standard. While a larger body of research on radiology education exists in undergraduate medical education, considerable variability in instructional approaches limits clear conclusions regarding the most effective method. Growing evidence supports the use of active learning strategies in radiology instruction. However, little published research specifically addresses radiology education within PA programs. Team-Based Learning (TBL), an active learning approach grounded in social constructivism that emphasizes preparation, collaboration, and application, may be well suited to teaching image interpretation. This study evaluates the effectiveness of TBL compared with traditional lecture-based instruction for chest radiograph interpretation. A mixed-methods, quasi-experimental cohort comparison using a pre-post design was conducted with two consecutive PA student cohorts at a single institution. One cohort received a 90-minute lecture-based session; another cohort participated in a 90-minute TBL session. Academic performance was assessed using validated pre- and post-tests. Student satisfaction and self-efficacy were evaluated using post-session surveys derived from the Kirkpatrick model and Bandura's self-efficacy theory. Independent sample t-tests compared quantitative outcomes, and qualitative responses were analyzed thematically. Both cohorts demonstrated improvement in chest radiograph interpretation scores, with no statistically significant differences between groups in post-test performance or score improvement (p = 0.841). Survey results indicated favorable perceptions of both instructional approaches. The TBL cohort reported significantly higher ratings for engagement and peer interaction (p = < 0.001). Self-efficacy ratings were higher among TBL participants for selected confidence-related items (p = 0.003, p = 0.021, p = < 0.001). Qualitative responses on what contributed most to self-efficacy emphasized peer discussion in the TBL group and structured explanations in the lecture group. TBL produced academic performance comparable to lecture-based instruction while supporting greater learner engagement and confidence. These findings support TBL as a feasible instructional approach for chest radiograph interpretation in PA education.

ABSTRACT Practitioners’ preparedness for working with technology-facilitated child sexual abuse (TF-CSEA) has attracted limited attention in Australia. This study maps the capacity of the Australian sexual assault sector to support victims of TF-CSEA, including victims of child sexual abuse material (CSAM) and online child sexual extortion. A national survey of 124 practitioners was conducted to assess individual, organisational, and systemic dimensions of sector capacity. Practitioners’ self-reported experiences were treated as indicators of the sector’s collective readiness. Quantitative data from closed questions were analysed descriptively, and qualitative responses were coded thematically. Most practitioners reported only moderate preparedness to support victims, and few had access to specialist training or TF-CSEA-specific resources. Services predominantly relied on traditional “in-person” child sexual abuse (CSA) frameworks that offer limited guidance for managing digital evidence, online harms, and cross-jurisdictional issues. Practitioners identified systemic barriers, including fragmented interagency coordination, unclear referral pathways, and insufficient policy support. The findings highlight that sector capacity limitations reflect structural and policy constraints rather than practitioner deficits. This underscores the need for investment in specialist training, national coordination frameworks, and updated service systems that address online forms of abuse in Australia. IMPLICATIONS Advanced, accredited training can help social workers and related professionals keep pace with effective supports for children and adults who have experienced technology-facilitated child sexual abuse. Extending existing child sexual abuse practice frameworks to include online harms can strengthen social work and allied practice in responding to legal, digital, and psychological complexities. Clearer collaboration between social workers, law enforcement, and online safety agencies can improve referral pathways and reduce uncertainty for victims seeking support.

ABSTRACT The behaviour generally referred to as ‘infidelity’ or ‘cheating’ occupies a contradictory site within current Western culture; it is both widespread and regarded as largely unacceptable. Its social and cultural repercussions are typically linked to dominant constructions of what constitutes appropriate (heterosexual) relational practices and male and female sexual conduct when in committed relationships. The current study, located within the critical sexualities and critical social psychology fields, examines such extra-relational sexual involvements (ERSI) in depth. This paper reports on a qualitative, exploratory, and discursive analysis of ERSI amongst heterosexuals in Aotearoa/New Zealand, using qualitative survey responses from 10 men and 24 women. Data were analysed using a Foucauldian mode of discourse analysis and identified ‘acceptability’ discourses (irresistible attraction; sexual experimentation) and ‘problematising’ discourses (moral transgression; ERSI as catastrophic). The analysis demonstrates how participants portrayed ERSI in contradictory, contested, gendered and moralising ways. The discourses of ERSI were heavily intertwined with heteronormative understandings of relationality and reinforced a mononormative structure as the ideal and most ‘normal’ way to engage in love/sex relationships, marginalising singlehood and non-monogamies. This illustrates how heterosexuality may be locked in a dyadic scenario that both creates a desire to stray from it and makes such straying challenging.

Psychoactive substance use among adolescents represents a growing public health concern in sub-Saharan Africa. This study examined alcohol and illegal psychoactive substance use among secondary school adolescents in Yaoundé, Cameroon, with particular attention to associated factors, including family relationships. A school-based cross-sectional study was conducted among adolescents enrolled in Forms 3 to 5 in three secondary schools in Yaoundé. Data were collected using a self-administered questionnaire. Quantitative analyses estimated 12-month prevalence and associated factors using robust Poisson regression for alcohol use and complementary log-log regression for illegal psychoactive substance use, complemented by bootstrap resampling and Firth's penalised regression to assess robustness in a rare-event context. Qualitative open-ended responses were analysed using thematic and lexical co-occurrence approaches (Jaccard C and T coefficients) to explore adolescents' representations of substances and perceived consequences. A total of 352 adolescents were included (54.3% girls). The median age was 15 years (IQR: 14-17; observed range: 12-20). The 12-month prevalence of alcohol use was 32.7% (95% CI: 27.8-37.8), while 3.7% (95% CI: 2.0-6.2) reported illegal psychoactive substance use. Marijuana and cocaine emerged as the most salient illicit substances within adolescents' cognitive representations, forming the strongest co-occurrence pattern (Jaccard C = 0.24; T = 0.389), while other substances such as tramadol, heroin, tobacco, and alcohol were mentioned less prominently. Perceived consequences were predominantly negative, encompassing neuropsychological, somatic, behavioural, and social effects, although limited positive representations persisted. Multivariable analyses showed that alcohol use was independently associated with increasing age, availability of drugs around the home, and illegal substance use. When illegal psychoactive substance use was the outcome, alcohol use was inversely associated. Family relationship variables were not independently associated with either outcome after adjustment. These findings underscore the central and asymmetric role of alcohol use in adolescent substance involvement. In parallel, they indicate that alcohol use among school-going adolescents is more strongly influenced by age and environmental exposure than by family relationship factors. They support multi-level prevention strategies focusing on early school-based psychoeducation, regulation of alcohol availability in home and community settings, and longitudinal research to clarify substance-use trajectories.

This mixed-methods study explored the impact of community-based arts programming on psychosocial outcomes associated with trauma recovery among adults with low-to-no-income engaged in active recovery from homelessness, domestic abuse, substance use, and other forms of trauma. Conducted in partnership with Path with Art, the study assessed mental well-being, social connectedness, and self-efficacy using validated pre- and post-intervention surveys alongside qualitative exit-surveys. Participants (N = 80) demonstrated statistically significant improvements in mental well-being (p < .01), loneliness (p < .01), and self-efficacy (p = .02), following participation in 8-week community-based arts classes. Analysis of qualitative responses (N = 103) revealed five interconnected themes: social connection and community; mental and emotional well-being; personal growth and empowerment; motivation and purpose; and creative and educational engagement. Participants reported feeling less isolated, more confident and motivated, and described the arts as a meaningful tool for navigating challenges related to trauma recovery. The findings suggest community-based arts engagement supports psychosocial processes central to trauma recovery. While limitations such as self-selection bias and lack of a control group should be addressed in future research, the study contributes to growing evidence that arts programming can positively influence health outcomes in trauma-affected populations. These insights may inform public health strategies and community-based care models focused on recovery and resilience.

Communication of difficult news is a core competency in oncology education. How accurately medical students self-assess their communication performance shapes formative learning and curriculum design. To examine differences between self-assessment and peer assessment of bad-news communication skills in a video-assisted standardized patient (SP) examination, and to characterize student perceptions of video-based feedback. A mixed-methods pilot study enrolled 49 third-year medical students (10 examinees, 39 peer assessors) in a mandatory oncology course at a Brazilian federal university. Communication was assessed using a structured ten-domain checklist (10-60 points) informed by the SPIKES protocol, the Calgary-Cambridge Guide, and the MAAS-Global Manual. Checklists were completed before and after video review. Condition effects were quantified using effect sizes (Cohen's dₚ) and 95% confidence intervals. Written qualitative responses underwent categorical content analysis. All ten examinees rated themselves below the corresponding peer mean (self: 36.5/60; peer: 43.2/60; mean difference = 6.73 points; 95% CI (0.30, 13.16); Cohen's dp = 0.75). Video review did not alter scores (mean change = - 0.10; 95% CI (- 1.56, 1.36); dp = 0.05). Qualitative categories identified empathy, SPIKES adherence, and step-by-step video evaluation as the dominant themes. All students rated video-based feedback positively. In this pilot sample, all ten examinees rated themselves below the corresponding peer mean - a pattern of discrepancy that diverges from the overestimation pattern more commonly reported in international meta-analyses. Video-based feedback was qualitatively valued, with no statistically detectable effect on checklist scores over a single review session. These hypothesis-generating findings warrant larger, instrument-validated studies.

Social media plays an increasing role in professional visibility, communication, and advocacy across health care; however, limited research has examined how nurse leaders use these platforms in professional contexts. To describe current patterns of social media use among nurse leaders, including perceived benefits, barriers, and leadership-specific applications. A mixed-methods design was used, combining a national online survey distributed through professional networks, organizational listservs, and social media platforms with qualitative analysis of open-ended responses. Descriptive statistics summarized quantitative data, and thematic analysis was applied to qualitative responses. A total of 257 nurse leaders participated. LinkedIn was the most frequently used platform for professional purposes, whereas other platforms were used more cautiously or passively. Participants identified networking, knowledge sharing, recruitment, and advocacy as key benefits. Major barriers included time constraints, digital literacy gaps, perceived professional risk, and restrictive organizational policies. Nurse leaders recognize the professional value of social media but remain constrained by individual, organizational, and structural barriers. Targeted education, clearer institutional guidance, and leadership support are needed to optimize strategic and ethical social media engagement.

Mortality surveys in conflict-affected settings are essential for documenting the human cost of armed conflict, guiding the humanitarian response, and promoting accountability. The success of such studies relies on the participation of the affected populations. Yet, we know little about how the public in conflict-affected countries perceives such studies, their willingness to participate, or the barriers they face to participate. This study aimed to explore public perceptions, willingness and barriers to participate in mortality surveys in six conflict-affected countries of the Eastern Mediterranean Region. An exploratory, cross-sectional mixed-methods study was conducted in Sudan, Somalia, Syria, Lebanon, Iraq, and Yemen between March and June 2025. An online self-administered questionnaire captured both quantitative and qualitative data. Quantitative data were analyzed using descriptive statistics and bivariate tests, while qualitative responses underwent inductive content analysis. Among 3455 participants (median age 29 years; 56.5% female), 94% (n = 3254) considered mortality surveys during armed conflicts important. Two-thirds (66.7%, n = 2306) expressed willingness to participate in mortality surveys, with a preference for electronic surveys. Willingness to participate was positively associated with older age, male sex, nationality, presence in the country during conflict, comfort with data sharing in social media, and absence of perceived cultural and religious barriers (p < 0.05). More than 40% of respondents reported trusting to provide death data to the government (44.3%, n = 1529) and international organizations (43.8%, n = 1515). Respondents reporting no trust to provide this data mentioned lack of credibility and political bias were the main reasons for distrust. Only 13.1% (n = 453) of the respondents perceived mortality surveys as harmful; key concerns included retaliation, political manipulation, and psychological distress. 19% (n = 658) cited cultural or religious barriers, most linked to sectarianism, honor, and the sanctity of death, as an obstacle to participation. Perceptions captured across the six conflict-affected EMR countries among the digitally-active adult respondents reflect both recognition of the importance of mortality surveys and concerns about safety, trust, and cultural sensitivities. Enhancing confidentiality, engaging trusted institutions in data collection, and adopting culturally sensitive approaches are critical to strengthening participation and ensuring the ethical implementation of mortality surveys in conflict zones.

ABSTRACT Background and aim Telehealth is increasingly used within healthcare, including by Speech and Language Therapists working with people who have aphasia. Aphasia is a communication disability common post stroke that presents challenges for telehealth, (e.g. people with aphasia are more dependent on multimodal communication techniques), which can be difficult to interpret through videoconferencing platforms. Assessments are a core part of the SLT role, and can pose particular challenges for telehealth, (e.g. testing receptive language skills). This study explored how people with aphasia and clinicians experience telehealth in the context of completing assessments, including their priorities for future directions. Methods and procedures This study integrated four different research activities from the “Improving access to healthcare: Face-to-face And Telehealth Equivalence of assessments in Aphasia (FATE-A)” study. The four data sources used were: qualitative responses to a survey (n = 124 Speech and Language Therapists), a focus group study (n = 14 Speech and Language Therapists), usability testing sessions (n = 4 Speech and Language Therapists, n = 6 advisers with aphasia) and Patient and Public Involvement and Engagement (PPIE) workshops (n = 7 advisers with aphasia). Findings from the four sources were inductively analysed to develop descriptive themes taking a meta-synthesis approach. Divergence and convergence of themes between sources was explored. Outcomes and Results There were three main themes: barriers, facilitators, and current and future preferences. Barriers and facilitators included severity of aphasia and other impairments; presence or absence of helpers; competence with technology (both clinician and person with aphasia); challenges around hardware and video-conferencing platforms; poor versus reliable internet connectivity; factors specific to assessments (e.g. lack of standardized assessment for online use); challenges setting up online assessments; and the emotional impact. Additional facilitators included preparation and support with set-up, and support with emotional wellbeing. Clinicians wanted more resources to facilitate online assessment, better hardware and platforms. While clinicians and people with aphasia perceived benefits to telehealth, both stakeholder groups wanted a flexible personalized hybrid service. Although there was broad congruence of themes, different data sources contributed uniquely, for example, the challenges of negotiating multiple steps to get online (usability testing), and preferred terminology (PPIE). Conclusions It is likely that telehealth will continue to be a component of Speech and Language Therapy services. Both people with aphasia and clinicians considered telehealth a valid model of service delivery, so long as it is tailored to the needs of the individual, and is part of a person-centred model of care.

Views and engagement with clinical research: A cross-sectional survey of New Zealand midwives and nurses.

This study explores Italian nurses' preferences and views regarding the disclosure and sharing of genetic risk information within families, focusing on their genetic literacy and responsibility, and comparing these perspectives with laypeople. A nested cross-sectional online survey, originally designed for the general population, included three hypothetical scenarios of inherited genetic risk (Cystic Fibrosis, Hereditary Cancer Syndromes, and early-onset Alzheimer's disease) and items assessing genetic literacy (awareness), family cohesion, disclosure preferences, and responsibility. Quantitative data were analyzed descriptively and inferentially, and qualitative responses were analyzed inductively using Reflexive Thematic Analysis. Among the 1,302 respondents, 501 were healthcare professionals (HCPs), including 315 nurses. Their genetic literacy was modest (mean 2.5/4), higher than laypeople's, with no differences by age or education. Nearly all (94.9%) wished to be informed of genetic risk for at least one condition, with 75.9% preferring to be informed for all three, similar to laypeople (78.1%). Most (97.8%) would undergo genetic testing if informed (95.6% of laypeople). Responsibility for disclosure was viewed as shared between relatives and HCPs (39.1%) or by everyone involved (themselves, relatives and HCPs) (25.1%), echoing laypeople's views. Qualitative findings from the few who did not wish to be informed (n = 16) emphasized anxiety, psychological self-protection, and scepticism toward predictive medicine, similar to laypeople. Italian nurses expressed views and preferences similar to laypeople. While they valued receiving genetic risk information and HCP involvement in family communication, limited familiarity with clinical applications of genetic testing highlights a gap in nursing education and practice, with implications for targeted training.

ABSTRACT Introduction The COVID-19 pandemic thrust telehealth practices, education, and clinical training into the professional conversation. However, regulations for telehealth practice are lagging. We sought to assess how music therapy (MT) educators include telehealth training in their curriculum. Method We globally distributed a cross-sectional online survey with 32 questions to MT educators covering four sections: (a) demographic information, (b) Telehealth Music Therapy (TMT) education and training at participants’ institution, (c) educator training/perspectives/perceptions on TMT, (d) resources participants use to teach TMT. We used descriptive statistics and correlation analysis for quantitative data and thematic analysis for qualitative responses. Results Sixty-one music therapy educators responded to the survey. Most respondents (n = 51, 85%) do not require students to practice TMT as part of their training nor offer opportunities for telehealth placements (n = 36, 60%), yet the majority believe TMT should be taught in all programs and therapists should offer accessible services for clients in isolated contexts. Several respondents reported that technology was the largest challenge in teaching TMT. Respondents also noted the complexities of building online relationships, along with balancing a busy curriculum. Finally, culture was highlighted, with differing perceptions and relevancy of TMT across the globe. Discussion While the professional music therapy associations responded quickly with guidance for clinicians during the COVID-19 pandemic, we found that education and training vary between institutions and across countries, which points to the need for TMT to be formally included in music therapy training and education programs.

ABSTRACT Special education teachers (SETs) provide critical care and developmentally-promoting environments for young children with disabilities. Crisis situations, such as war, can amplify SETs’ challenging work and harm their well-being. Grounded in Bronfenbrenner’s bio-ecological systems model, this study utilised a quantitative survey to examine how SETs’ psychological capital (PsyCap) and occupational self-efficacy ([OSE] microsystem), and social support (mesosystem) would predict their well-being in the context of the Iron Swords war in Israel (macrosystem), along with qualitative open-ended responses to explore SETs’ coping mechanisms. Participants were 282 female SETs (143 preschool, 139 elementary school) who completed self-report questionnaires and an open question. PsyCap, OSE, and social support significantly predicted SETs’ well-being. Teachers highlighted personal resources, social support, and professional aspects as key components for coping, with various subthemes emerging. Integrating both strands, the study illuminates how personal, social, and cultural systems dynamically interact to sustain SETs’ well-being during wartime.

This study evaluates the educational and social impact of a faculty-wide "Night of Skills" event for health professions students. The event combined short, hands-on medical skills workshops with opportunities for informal exchange and networking across disciplines. The event ran on a Friday from 5 pm to 3 am, with 35 workshops across medical disciplines with 332 workshop timeslots (30min each). The social program included information and networking booths, as well as food, drinks and a closing event. Feedback was collected with semi-structured oral interviews and a survey, collecting participant demographics and feedback using Likert-scaled questions and open questions. Quantitative data were analyzed using descriptive statistics, while qualitative responses underwent thematic analysis based on Mayring's inductive category formation. A total of 396 students participated, mostly from human medicine (91.2%, N = 361). We recorded 1524 workshop bookings. Most participants attended an average of five workshops and expressed a desire for additional sessions. The timeslots were seen as too short, but most participants (83.6%, N = 143) rated their learning outcome as "high" or "very high." Participants reported increased self-efficacy and preparedness for clinical clerkships. Networking opportunities and confidence building were highlighted in qualitative feedback. Of 189 respondents, 96.3% (N = 182) rated the event "very good" or "good", with 98.4% (N = 186) wanting it to be repeated. The "Night of Skills" demonstrated high perceived educational and social value among participants. It offers a prototype for supplementing medical curricula with practice-oriented, community-building experiences that can be adapted by other institutions. Future studies incorporating objective skill assessments are needed to confirm the educational benefits suggested by these self-reported outcomes. Not applicable.

ABSTRACT Although scholars have examined the linguistic features of foreigner talk (FT), its social and conversation-organizational aspects—especially in study-abroad contexts—remain largely untouched. To address this gap in research, this exploratory, mixed-method study draws on Communication Accommodation Theory to investigate how 11 sojourning U.S. American college learners of German evaluate how their L1 German peers talk to them at two timepoints during their stay in Germany. Participants used a bipolar scale from 0 (extremely FT-like) to 100 (extremely FT-unlike) to rate 29 language-use behaviors (LUBs). To contextualize results, qualitative responses related to the most likely characteristics of FT-like interactions were analyzed. Overall, this study provides evidence to support a more comprehensive view of FT that includes linguistic, social, and conversation-organizational features that relate to social positioning and ideological hierarchies while abroad. Implications highlight the need for L2 instruction to support learners’ transition out of the classroom and into naturalistic settings.

BackgroundNurses working in areas affected by the Great East Japan Earthquake and the subsequent radiation disaster faced prolonged and complex stressors.AimThis study aimed to describe nurses' subjective experiences and conflicts, and interpret them from the perspective of moral distress and relational loss.Research designThis is a qualitative descriptive study based on open-ended responses. Previous quantitative analyses suggested persistent posttraumatic negative cognitions among affected nurses. To deepen understanding of the experiences underlying these findings, this study qualitatively analysed open-ended responses from repeated questionnaire surveys conducted during the first two years following the disaster among nurses from two healthcare facilities. In each of the three survey waves, the participants were asked to describe the stress they experienced during the disaster. Data were analysed using qualitative content analysis and responses were segmented into meaning units, coded, grouped into subcategories, and synthesised into themes through iterative discussions within the research team.Ethical considerationsThis study was approved by the relevant institutional ethics committees. A written informed consent was obtained from all participants, and participation was voluntary and de-identified.FindingsSix themes were identified. Nurses' narratives depicted the layered impact of disrupted living foundations and ongoing threats, exhaustion from sustained emotional labour, and unavoidable choices under severe constraints. These experiences were interpreted as reflecting moral distress and, in some accounts, features suggestive of moral injury. Participants also described relational loss, including the erosion of trust, fragmentation within teams, and reduced mutual support in the workplace.ConclusionsNurses' experiences in a compound disaster setting were characterised by intertwined moral suffering and relational loss. Organisational approaches that validate nurses' responses as understandable in context provide psychologically safe spaces to reframe disaster-time actions, and intentionally support the repair of fractured relationships may help protect nurses' well-being during and after disasters. Preserving professional integrity through sympathetic presence may be particularly important in extreme conditions wherein action is constrained.

Neuroanatomy is widely recognised as a challenging discipline in medical education, with student engagement often limited by its complexity. Active learning strategies, such as pre-class tests, have been proposed to improve preparation and confidence, yet evidence on their impact on student behaviours and perceptions remains scarce. This pilot study explored the effects of pre-class tests on preparation, confidence, and learning strategies among 144 third-year undergraduate students enrolled in a neuroanatomy course at Afe Babalola University, Nigeria. A mixed-methods survey approach was employed, with quantitative data analysed for reliability (Cronbach alpha = 0.78) and qualitative responses subjected to thematic analysis. Most students (93.1%) reported appropriate test difficulty, and 41.0% rated the content as highly relevant. Pre-class tests prompted thorough preparation in 80.6% of participants, with 50.7% dedicating over two hours to study. Confidence improved for 63.9% of students, and 48.6% adopted new study strategies. However, 63.9% reported increased stress, with qualitative themes highlighting time constraints, inadequate feedback, and content misalignment. As a pilot study, these findings suggest that pre-class tests may be associated with enhanced preparation, confidence, and engagement in neuroanatomy, while revealing stress-related challenges requiring design adjustments. Recommendations include extending test duration, improving feedback, and ensuring content alignment. Future multi-institutional studies are warranted.