When resuscitation fails-Nurses' emotions and coping mechanisms after unsuccessful cardiopulmonary resuscitation: An integrative review.

To explore allied health students' perspectives on rural immersion placements facilitated by the University of Newcastle Department of Rural Health (UONDRH), and how these experiences influence learning quality and rural career intent. Four rural UONDRH sites across New South Wales, Australia, where students undertook extended placements ranging from 12 weeks to a full academic year. Sixty final-year allied health students from nutrition and dietetics, occupational therapy, medical radiation sciences, physiotherapy, and speech pathology programs. A qualitative study using semi-structured interviews was conducted post-placement. Data were analysed using qualitative content analysis, supported by field notes and student co-analysis to enhance rigour and authenticity. Four themes emerged: (1) Focusing inwards-students initially prioritised their own needs; (2) Focusing nearby-support networks and interprofessional learning enriched the experience; (3) Focusing outward-community engagement fostered critical reflection and cultural awareness; (4) Focusing forward-considered their career intent, but now with a knowledge of rural health care context. The extended duration of placements enabled deeper immersion, reflective practice, and a broadened understanding of rural health contexts. Rural immersion placements offer transformative learning experiences that foster clinical competence, interprofessional collaboration, and rural career interest. Addressing structural barriers and enhancing rural job opportunities are essential to harnessing this intent and strengthening the rural allied health workforce.

Introduction: The practice of self-regulated learning and reflection has played a key role in the achievement of lifelong learning, continuous professional development and the delivery of standard healthcare. Self-regulated learning skills may be cultivated among medical students from the onset of their medical career through the diligent practice of specially designed tools of self-regulated learning, such as Personal Learning Plans (PLPs). Previous research has recommended the study of PLPs programs in different settings to observe the effectiveness of such programs. Aim: To study the impact of PLPs’ regularity and near-peer mentoring on first-year medical students through their academic performance. Materials and Methods: This randomised, single-blinded, educational interventional study was conducted among 346 first-year students (batch 2023-24-172, batch 2024-25-174) of Jawaharlal Nehru Medical College (JNMC), Wardha, Maharashtra, India, from April 2023 to August 2025. Cases and controls were selected using simple randomisation. The cases were trained and used PLPs for Anatomy lectures for six months. Trained near-peer mentors were assigned to cases 2024-25 batch. Regular users in both batches were noted. Three assessments were taken per batch and scores were recorded. Students’ post-intervention feedback was documented. The collected data were analysed using Python-based statistical scripts. Results: Academic scores of trained students who submitted PLPs regularly were consistently higher than those of trained students who did not, especially in the later assessments (cases regular 2023-24 vs cases irregular 2023-24 was 11.90±1.73 vs 8.79±2.02 and cases regular 2024-25 vs cases irregular 2024- 25 was 17.27±0.75 vs15.60±0.83, respectively, in the third assessment). There was a significant performance gap between cases 2023-24 and 2024-25, with an extremely large effect size for the third assessment (d=3.4560, where d denoted Cohen’s d effect size), which suggested that the use of near-peer mentors in PLP intervention had a substantial impact. Post intervention feedback on cases of both batches was positive. Conclusion: There was a significant improvement among students with PLPs intervention and near-peer mentors when compared to the students taught using traditional teaching methods

Teaching philosophy statements (TPS) are concise, reflective narratives that articulate an educator's beliefs, values and approaches to teaching and learning. In health professions education, TPS can serve as tools for promotion and tenure, teaching portfolios and professional identity formation. Despite their potential to enhance reflective practice and teaching effectiveness, the prevalence and application of TPS in health professions education remain unclear. A scoping review was conducted in which six databases were searched for English-language peer-reviewed articles published from 2003 to 2024. Inclusion criteria required that articles address health professions education, include the concept of philosophy and reference an educational process. Data extraction included publication characteristics, educational and career contexts and described uses of TPS. Fourteen articles met inclusion criteria, representing medicine, nursing, basic sciences, occupational therapy, medical sciences and interprofessional education. Thirteen journals were represented; eight articles were research-focused, with the remainder descriptive, theoretical or narrative reviews. Most commonly, TPS were described as artefacts for teaching portfolios (n = 8), reflective guides (n = 7) or components of promotion packets (n = 6). Few studies examined the impact of TPS on teaching effectiveness, learner outcomes or faculty development. TPS appear infrequently in the health professions education literature and are often discussed superficially. While recognised for their reflective and professional development potential, empirical evidence of their direct impact is lacking. Future research should explore longitudinal effects of TPS adoption, their role in faculty identity development and strategies for integrating TPS meaningfully into faculty development programmes.

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

This study explored how the professional identity of psychologists was shaped during the crisis period characterised by the COVID-19 pandemic, accelerated digitalisation, and the war in Ukraine. Drawing on an existential-dialectical framework, the research examined how psychologists navigated practical contradictions and existential tensions involving meaning, purpose, and professional significance during widespread disruption. The qualitative study included 45 experienced Latvian psychologists (M=47.13years, 87% women) who began practising before the pandemic. Data were collected through semi-structured interviews conducted in October-November 2022. Reflexive thematic analysis was employed to identify patterns of professional identity transformation, with particular attention to dialectical tensions and existential challenges. Five themes emerged: (1) reconciling traditional practices with crisis-driven changes, where remote work created boundary challenges while proving effective; (2) balancing emotional vulnerability and professional responsibility, as rising demand intensified both strain and professional value; (3) navigating isolation and collaboration through enhanced supervision and peer support; (4) evolving professional practices through creativity and functional adaptations; and (5) experiencing professional growth through strengthened commitment despite initial uncertainty. The findings demonstrate that professional identity transformation during the crisis period involves navigating universal dialectical tensions while addressing existential challenges of meaning and purpose. Psychologists adaptively integrated reflective practices, digital competencies, and self-care strategies. The study contributes to professional identity literature by demonstrating that the crisis period serve as catalysts for comprehensive identity transformation, fostering more adaptive, reflective, and resilient professional identities through resolving both practical contradictions and existential uncertainties.

How AI agents transform reflective practices: A three-semester comparative study in socially shared regulation of learning

Radiography research has traditionally prioritised quantitative approaches, which are less suited to examining complex practice-based phenomena such as professional judgement, ethical tension, and relational aspects of care and education. Reflective analysis has been used to explore these issues but remains poorly defined as a research method in radiography, leading to inconsistency in application and reporting. This paper aims to establish reflective analysis as a recognised qualitative research method by defining its epistemic foundations, analytic procedures, and reporting requirements, and by distinguishing it from reflective writing for learning. A methodological synthesis drawing on qualitative research methodology literature, reflective practice theory, and radiography scholarship was undertaken. Within the included radiography literature (n=24), reflexive thematic analysis was the most commonly used analytic approach (n=15), followed by narrative inquiry (n=4), reflective analysis (n=2), analytic autoethnography (n=2), and interpretive description (n=1). Examination of these approaches clarified key differences in data sources, analytic focus, and methodological intent, highlighting the distinct contribution of reflective analysis. Reflective analysis is defined as a qualitative method that uses systematically documented first-person professional experience as data and applies explicit analytic procedures to generate practice-facing insights. From this synthesis, a seven-stage analytic workflow, Reflective Analysis for Radiography (RAD-RA), and discipline-specific reporting guidance aligned with established qualitative standards were developed. Reflective analysis provides a structured qualitative approach for examining complex aspects of radiography practice, education, and professional decision-making not readily captured through quantitative or multi-participant qualitative designs. The RAD-RA framework supports rigorous, transparent, and ethically accountable reflective research, enabling radiographers to examine professional judgement and practice-based challenges while supporting consistent peer review and qualitative scholarship within the discipline. As artificial intelligence increasingly shapes clinical workflows, decision support, and professional roles in radiography, reflective analysis provides a structured qualitative method for examining how practitioners interpret, negotiate, and respond to AI-supported practice. The RAD-RA framework offers a defensible approach for analysing these emerging interactions, supporting qualitative inquiry into human-AI relationships, professional accountability, and practice implications within radiography.

The study focused on investigating the transformative learning experiences of trainee teachers at one of the teacher training institutes of District Peshawar. Transformative learning is more than a simple technique; it is an effective path of self-analysis and professional development that empowers teachers to become inclusive, creative, and considerate. Through transformative learning, teaching becomes a meaningful mission that challenges presumptions and encourages critical thinking. The present study aimed to investigate transformative learning experiences in teacher training through a narrative of teachers and was delimited to a particular group in District Peshawar. The researcher followed the interpretivism philosophy and adopted a qualitative research method. Participants were selected based on their live experience in the teaching field and their willingness to share experiences. A semi-structured interview format was used for data collection. One-on-one, in-person interviews were conducted to allow interviewees to cooperate openly in discussion. Prior to the interviews, consent forms were signed regarding audio recording and later use for research purposes. Notes were also taken on the spot for future reference, and participants were reminded that they could stop the interview at any time. The researcher used thematic analysis as the data analysis technique. A central theme emerged showing a shift in teachers’ perceptions of their professional roles. Most teachers began their careers with a traditional approach emphasizing passive learning, discipline, and content coverage. However, professional training and reflective practices enhanced their facilitation skills, enabling them to see themselves as facilitators rather than passive transmitters of knowledge. This transformation brought dynamic changes in classroom management, where inquiry-based learning, one-to-one dialogue, and student engagement through creative assignments took precedence.

The study focused on investigating the transformative learning experiences of trainee teachers at one of the teacher training institutes of District Peshawar. Transformative learning is more than a simple technique; it is an effective path of self-analysis and professional development that empowers teachers to become inclusive, creative, and considerate. Through transformative learning, teaching becomes a meaningful mission that challenges presumptions and encourages critical thinking. The present study aimed to investigate transformative learning experiences in teacher training through a narrative of teachers and was delimited to a particular group in District Peshawar. The researcher followed the interpretivism philosophy and adopted a qualitative research method. Participants were selected based on their live experience in the teaching field and their willingness to share experiences. A semi-structured interview format was used for data collection. One-on-one, in-person interviews were conducted to allow interviewees to cooperate openly in discussion. Prior to the interviews, consent forms were signed regarding audio recording and later use for research purposes. Notes were also taken on the spot for future reference, and participants were reminded that they could stop the interview at any time. The researcher used thematic analysis as the data analysis technique. A central theme emerged showing a shift in teachers’ perceptions of their professional roles. Most teachers began their careers with a traditional approach emphasizing passive learning, discipline, and content coverage. However, professional training and reflective practices enhanced their facilitation skills, enabling them to see themselves as facilitators rather than passive transmitters of knowledge. This transformation brought dynamic changes in classroom management, where inquiry-based learning, one-to-one dialogue, and student engagement through creative assignments took precedence.

The growing emphasis on competency-based education (CBE) has heightened the need for clearly defined metrics and robust assessment frameworks to evaluate 21st-century competencies. Curriculum analytics (CA) provides a promising avenue for assessing learning outcomes (LOs) and informing continuous improvement in higher education. However, challenges persist in differentiating academic performance from actual LO development and in translating assessment data into meaningful program-level actions. This study examines how CA tools support the direct assessment of LOs and contribute to continuous improvement processes in higher education. Using a two-case study design, we analyzed CA implementation in two universities through interviews, cognitive walkthroughs, and institutional document analysis. Data triangulation identified 18 themes, nine of which reached full consensus among the three researchers. Findings indicate that CA tools effectively support the assessment of LOs aligned with 21st-century competencies by generating actionable insights that guide faculty toward more authentic and reflective teaching practices. The study contributes to the LA field by providing empirical evidence of how CA tools can bridge assessment and pedagogical improvement, offering both theoretical and practical implications for researchers and practitioners.

Diagnosis is a foundational task in clinical medicine, yet its reasoning structure remains under-explained in medical education. This paper presents a five-step model of diagnostic reasoning that analyses the epistemic foundation of diagnosis: namely, the structured process by which clinicians construct coherence under constraint. The model describes diagnosis as a disciplined convergence from presenting data toward an explanatory frame that is internally consistent, pathophysiologically plausible, and resistant to contradiction. Grounded in coherence-based epistemology and abductive inference, the framework clarifies how clinicians move from presentation to working diagnosis through five recursive phases: problem framing, perspective construction, constraint application, stabilisation, and clarification. It integrates, rather than replaces, existing approaches-such as dual-process theory, illness script development, and Bayesian updating-by making their underlying reasoning structure explicit and teachable. The model serves as a scaffold for reasoning transparency, structured feedback, and reflective practice. It provides coherence criteria for assessing diagnostic thought and supports formative instruction across simulation, objective structured clinical examination (OSCE), and bedside contexts. While awaiting empirical validation, the present framework offers a theoretical foundation for studying how diagnostic coherence develops and can be taught. In this account, diagnosis is not defined by classification or probability alone, but by the clinician's capacity to construct and sustain an explanatory model that coheres with evidence and contextual constraints.

Abstract Cultural collaboration can support a more holistic approach to nursing care in managing complex conditions, such as pressure ulcers. This study aimed to evaluate the effects of multiplayer, interactive, and noninteractive virtual patient simulations on knowledge, effectiveness, satisfaction, and self-confidence regarding pressure ulcer management among Portuguese and Turkish nursing students. The quasi-experimental, pre-posttest design study was conducted between March and July 2025; data were obtained from 52 nursing students (Experimental Group: 26; Control Group: 26) in Turkey and Portugal using the "Personal Profile Form," "Pressure Ulcer Prevention Knowledge Assessment Instrument," "Simulation Effectiveness Tool-Modified," "Student Satisfaction and Self-Confidence in Learning Scale," and "Structured Debriefing Questionnaire." Between-group comparisons of "Pressure Ulcer Prevention Knowledge Assessment Instrument" posttest scores revealed significant differences in the "Preventive Measures to Reduce the Duration of Pressure/Shear" subscale and total scores. Within the experimental group, pre-post comparisons revealed significant moderate improvements in the same subscale and total scores. "Simulation Effectiveness Tool-Modified" pre-post comparisons in the experimental group showed significant improvements in "Learning," "Confidence," "Debriefing" subscales, and total scores. "Student Satisfaction and Self-Confidence in Learning" scores improved significantly only in the experimental group. Qualitative data analysis identified themes, including Clinical Competence and Skill Acquisition, Reflective Practice, Communication and Collaborative Practice, Simulation Fidelity and Challenges, Confidence and Clinical Readiness, and Affective Response to Simulation. This study demonstrates that multiplayer, interactive virtual patient simulation is associated with improvements in nursing students' knowledge, perceived simulation effectiveness, and satisfaction in pressure injury management.

Resident doctors in their 3rd year of emergency medicine training in the UK face multiple challenges, leading to very high levels of burnout and exodus from the training programme. The North West School of Emergency Medicine trialled reflective practice (Balint) groups to try and help this. This involves regular small group meetings focusing on case-based reflections on the emotional aspects of practice. We aimed to explore the impact of Balint groups on emergency medicine resident doctors. Qualitative study involving semistructured interviews with resident doctors in their 3rd year of training (ST3) in the UK. Participants included those who had undertaken Balint group sessions, ST3s who did not participate, and Balint group facilitators. Interviews were recorded, transcribed and analysed using reflexive thematic analysis. 12 participants were included between September 2023 and May 2024. They reported Balint groups to be a hugely positive part of their training. Participants developed a psychological toolkit and a supportive community to help manage the emotional and stress-related aspects of emergency medicine. This led to improved job satisfaction, which participants believed would enhance retention. Participants felt their ability to manage the emotional needs and challenges of their patients had improved. The groups were feasible to run but required planning and communication to facilitate release from clinical work. Balint groups for ST3 emergency medicine resident doctors are feasible. Clinicians report benefits for themselves and perceived benefits for their patients. This supports continuing and developing the programme locally and piloting similar programmes in other professional groups and localities.

Background Culture plays a powerful role in shaping teaching, learning, and professional relationships in medical education. Hierarchical norms, communication styles, and expectations of respect influence not only formal curricula but also the hidden curriculum, with significant implications for learner engagement, feedback, and patient care. Aim This reflective, theory-informed narrative compares cultural influences on medical education in West Africa and the United Kingdom, drawing on personal experience and informal peer reflections, and explores how these experiences have shaped the author’s evolving teaching practice. Methods The paper adopts a reflective approach grounded in experiential learning, supported by relevant educational theory and literature. Comparisons are made between undergraduate and postgraduate medical training in West Africa and current practice in the UK, with particular attention to hierarchy, learner–teacher relationships, evaluation, feedback, and the hidden curriculum. Findings In West African medical education, strong cultural emphasis on hierarchy and reverence for seniority creates clear authority structures but may inhibit bidirectional learning, critical questioning, and feedback. These norms contribute to a hidden curriculum that can foster intimidation, teaching by humiliation, and limited learner agency. The UK medical education is characterised by flatter hierarchies, first-name professional relationships, and formalised mechanisms for feedback and evaluation, promoting psychological safety, reflective practice, and patient-centred care. These differences influence learner confidence, engagement, and educational outcomes. Discussion Cultural values deeply shape the hidden curriculum, affecting behaviours, expectations, and professional identity formation. Integrating principles of andragogy and reflective practice offers a framework for bridging cultural differences and enhancing teaching effectiveness across contexts. Conclusion Awareness of cultural influences is essential for effective medical education in increasingly globalised healthcare systems. By critically reflecting on and selectively integrating positive elements from both West African and UK educational cultures, medical educators can foster respectful, inclusive, and learner-centred environments that support professional development, patient safety, and high-quality care.

There are various ways around the world in which pre-service mathematics teachers are trained.   This systematic review explores global approaches to training pre-service secondary mathematics teachers between 2015 and 2025. Guided by complexity theory and following PRISMA protocols, the study analysed 21 peer-reviewed articles from five continents. Thematic analysis identified five recurring areas: gaps in foundational mathematics knowledge, limited digital competencies, insufficient development of 21st-century teaching skills, the influence of teacher beliefs and attitudes, and the need for enhanced programme design. Findings reveal persistent challenges in content mastery, technological integration, and pedagogical preparedness. This research is significant in revealing systemic weaknesses in mathematics teacher education and emphasises the necessity for policy reforms that embed digital literacy, reflective practice, and emotional resilience within pre-service training. Overall, the study highlights the importance of holistic and adaptive teacher education models to equip future mathematics educators for complex, technology-driven classroom environments.

Despite global recognition of the Scholarship of Teaching and Learning (SoTL), its endorsement in national policy, and the availability of dedicated funding, higher education institutions (HEIs) continue to engage with conceptual ambiguity and uneven patterns of SoTL development. In the Global South, this has prompted sustained reflection and sector-wide efforts to strengthen SoTL cultures. This paper reports on a qualitative, external multi-institutional benchmarking study involving SoTL coordinators from selected South African public universities who participated in a two-day reflective workshop to examine SoTL institutional cultures, support mechanisms, and programme goals. The study is framed by John Biggs’ notion of the Reflexive Institution (RI) and Margaret Archer’s Social Realism (SR). A basic search commenced in 2023 with a desktop review of institutional SoTL websites and targeted email enquiries. Insights from this preliminary phase informed the purposive selection of HEIs with well-established SoTL programmes, whose representatives subsequently convened to explore the SoTL cultures within their respective contexts. Findings indicate that the institutionalisation of SoTL in South African HEIs reflects significant variation shaped by differing contexts and resource conditions. These variations, the paper argues, are less signs of conceptual confusion than adaptive responses that foster reflective practice and strengthen faculty agency. However, without a coherent strategy, embedded structures, and sustained resourcing, SoTL risks remaining peripheral to disciplinary research. The paper contributes to sectoral efforts to motivate new theoretical insights and transformative practices that advance SoTL in ways that are both impactful and locally relevant.

The lack of individualized feedback may lead foreign language educators to think about giving feedback using a variety of artificial intelligence powered (AI-powered) tools, increasing access to automated assessment systems. Furthermore, metacognitive scaffolding guides students in planning, reflecting, monitoring, and assessing their language progress which can be adaptive through AI-driven tools like grammarly and write & improve that alter feedback. The purpose of this study is to investigate how AI-enhanced adaptive scaffolding delivered through automated feedback prompts and reflective questions can improve English as a foreign language (EFL) learners’ writing performance and self-regulatory engagement. Along with a self-report questionnaire, the study used a quantitative approach with experimental design. The study sample consisted of 120 EFL students. Participants were enrolled in a 6-week English writing course; they were randomly assigned to two groups: 60 students in the control group receiving conventional teacher feedback and 60 students in the experimental group receiving AI-assisted scaffolding via grammarly and write & improve. Data were collected through a self-report questionnaire on self-regulated learning strategies and writing tasks and analysed using ANCOVA to assess group differences. The findings show that students’ reflective practices, self-regulation, and personalized feedback were all strengthened by AI adaptive scaffolding. They suggest that AI-powered, adaptive, and metacognitively oriented feedback can extend the role of automated feedback from error correction to supporting learners’ strategic engagement with writing tasks. Implications are discussed for integrating AI-driven scaffolding into mainstream EFL pedagogy to enhance both assessment and self-regulated learning.

Purpose Although studies have explored information literacy threshold concepts (ILTC), little attention has been given to faculty strategies for facilitating ILTC transfer to students. This study aims to explore 11 University of Kurdistan faculty members’ understanding of their method of implementing ILTC. Design/methodology/approach The authors followed a qualitative approach for this study and used semi-structured interview for collecting participants’ experiences. The emerged themes about understanding ILTC are in line with its American Library Association proposed framework. Findings Among the six ILTC, Information Creation as a Process emerged as the foremost among the other threshold concepts constituting 29.13 % of the codes. Other threshold concepts, Authority is Constructed and contextual, Information has Value, Searching as Strategic Exploration, Scholarship as Conversation and Research as an Inquiry gained 27.18%, 16.5%, 10.86%, 9.71%, 6.8% of the codes, respectively. Some organizing themes emerged from the codes, including Data Authenticity and Research Aptitude. Their narratives reveal four hidden stages (Familiarization, Guidance and Supervision, Reflective Practice and Authoring) through which they transition their understanding to foster student independence in research. Originality/value This study also extends threshold concept theory by proposing dual-threshold transformation and a post-threshold authorship phase.

This chapter examines how gamification strategies facilitate self-directed learning, intellectual autonomy, and academic growth within AI-mediated postgraduate supervision. Employing a systematic literature review methodology in accordance with PRISMA 2020 standards, the chapter synthesises research that investigates the integration of gamification and artificial intelligence in postgraduate education. Key strategies, including milestone-based progression, collaborative problem-solving, and interactive feedback, are analysed as mechanisms for fostering autonomy and intrinsic motivation among postgraduate students. The review indicates that structured challenges and rewards enhance engagement, reduce over-reliance on AI tools, and support the development of complex research skills. Furthermore, gamification serves as a catalyst for professional growth, with collaborative and reflective practices enhancing critical thinking and resilience. Ethical considerations, such as algorithmic bias, fairness, and the necessity of maintaining human-centred mentorship, are also examined. The chapter concludes that the integration of gamification into AI-mediated supervision frameworks promotes creativity, independence, and intellectual rigour, providing valuable insights for educators and institutions seeking to align technological innovation with the enduring values of postgraduate mentorship.