Pharmacovigilance (PV) plays a critical role in monitoring and evaluating adverse drug reactions (ADRs) to ensure the safety of marketed medical products. This study aimed to assess the quality of ADR reports submitted to the national PV center of Nepal by comparing pre- and post-training periods, and to identify factors associated with ADR reporting quality. A retrospective analysis of ADR reports submitted to the national PV center was conducted over a three year period. Reports from January 2020 to November 2022 were classified as the pre-training phase while reports from December 2022 to April 2023 consitituted the post-training phase. In December 2022, the research team developed and implemented a capacity building plan that included a two-day training program for regional PV center contact persons, consisting of pharmacists and other health care professionals (HCPs) responsible for submitting ADR reorts through the VigiFlow system. The quality of ADR reports was assessed using the validated Adverse Drug Report Quality Algorithm (AQUA-12) tool. Statistical analysis was performed using Microsoft Excel and R. A total of 86 reports were evaluated, 57 from the pre-training phase and 29 from the post-training phase. Overall, 35% (n = 30) of the reports were classified as high quality according to the AQUA-12 criteria. Prior to the training, only 16% (n = 9) met the high quality level whereas this proportion increased to 72% (n = 21) following the training. This improvement in ADR reporting quality was statistically significant (p = 0.000; p < 0.05). The training significantly improved the quality of ADR reports, underscoring the value of continuous quality improvement within PV systems. Targeted programs for health care professionals, particularly pharmacists and regulatory authority personnel, are essential to strengthen ADR reporting quality and enhancing patient safety.

Physician burnout is a global crisis, with Hong Kong doctors reporting a personal burnout rate as high as 72%. Anaesthesiology is considered a high-risk specialty, with high risk of depression and suicide. Time constraints preclude engagement of healthcare professionals with structured psychological interventions despite their known benefits. Web-based positive psychology interventions (PPI) offer an accessible alternative for busy clinicians. This mixed-methods study aimed to evaluate the feasibility and acceptability of culturally adapted, web-based PPIs for anaesthesiologists in Hong Kong, and through exploratory efficacy assessment, to explore whether PPIs that are focused on personal growth vs. workplace application may have an effect on well-being. An explanatory sequential mixed-methods feasibility randomized controlled trial with exploratory efficacy outcomes was employed for this study. Fellows and members of the Hong Kong College of Anaesthesiologists were randomized (1:1:1) to two experimental groups (Exp1 individual-oriented PPI/Exp2 workplace-oriented PPI) or wait-list control. The intervention consisted of an induction workshop followed by 4 web-based modules with bite-sized exercises and WhatsApp peer discussions over 10 weeks. Primary outcomes (PERMA-Profiler, GAD-7, PHQ-9, PSS-10, Copenhagen Burnout Inventory) and secondary outcomes (SCS-SF, WAMI, WGS) were measured at baseline, post-intervention and one-year follow-up. Semi-structured interviews were conducted to explore feasibility and participant perceptions. One hundred two participants were recruited for the study. Quantitative outcomes were interpreted as exploratory given the limited sample size. Linear mixed model analysis did not demonstrate significant, sustained improvements in primary outcomes across time points between groups. However, Exp1 showed a significant reduction in depression and increase in meaningful work immediately post-intervention, although this was not sustained at one-year follow-up. Qualitative analysis identified six themes, affirming that the blended web-based approach was feasible. Participants' intrinsic motivation and the perceived applicability to professional and personal domains were key enablers of PPIs. PPIs facilitated participants' competence in the face of clinical challenges, and enabled relational building in the workplace. Implementation challenges included waning engagement due to busy schedules and concerns regarding psychological safety within WhatsApp group chats. Bite-sized, web-based positive psychology interventions appear feasible and acceptable for time-constrained clinicians such as anaesthesiologists in Hong Kong. In this exploratory feasibility trial, PPIs designed to support the basic psychological needs described in self‑determination theory showed preliminary short‑term benefits for well‑being, but future large-scale efficacy trials should evaluate whether such effects can be sustained through complementary system-level measures, including leadership and organizational initiatives that provide autonomy-supportive environments for healthcare professionals. The study was registered on ClinicalTrials.gov (ClinicalTrials.gov ID: NCT06148454) on November 19, 2023.

Psychological safety is essential for effective learning, communication, and professional development in nursing and midwifery education. Environments lacking psychological safety hinder student engagement, reduce confidence, and negatively affect learning outcomes. Despite its importance, the concept remains underexplored in African educational and clinical contexts. This study examined trainee nurses' and midwives' perceptions and experiences of psychological safety and interactive communication in classroom and clinical settings in Ghana. An embedded mixed-methods cross-sectional design guided by Good Reporting of a Mixed-Method Study (GRAMMS) checklist and Edmondson's Psychological Safety Theory was employed. A total of 169 students were recruited using purposive and convenience sampling. Data were collected using a structured questionnaire adapted from Edmondson's psychological safety scale (α = 0.79) with embedded open-ended questions. Quantitative data were analyzed using SPSS version 27, while qualitative data were analyzed using Braun and Clarke's Thematic Analysis. Psychological safety levels were categorized as low (1.0-2.9), moderate (3.0-3.9), and high (≥ 4.0). Students reported moderate psychological safety in classroom settings (mean = 3.42, SD = 0.79) and lower psychological safety in clinical settings (mean = 3.05, SD = 0.86). Approximately 70% felt comfortable asking questions in class, while 49% reported fear of public reprimand during clinical training. Respectful communication, supportive supervision, and peer collaboration enhanced psychological safety, whereas hierarchical relationships, negative feedback practices, and fear of embarrassment hindered it. Psychological safety varies across learning environments, with clinical settings presenting greater challenges. Institutional strategies should prioritize mentorship, supportive supervision, and communication training to improve learning outcomes and professional development.

Physiotherapy (PT) education must foster both clinical competencies and non-technical skills such as communication, empathy, and self-efficacy to prepare students for professional practice. Simulation-Based Learning (SBL) offers a structured and safe environment to develop these skills. While the benefits of SBL have been documented in nursing and medical education, evidence in PT programs, particularly across different academic years, remains limited. This study examined changes in perceived self-efficacy, academic engagement, and empathy following SBL participation, and to explore differences between second-, third-, and fourth-year PT students. A prospective quasi-experimental study was conducted between December 2023 and June 2024 involving second-, third-, and fourth-year undergraduate PT students from a single Spanish university (corresponding to the fourth, sixth, and eighth semesters, respectively). Students participated in SBL sessions designed according to international standards and adapted to their academic level. Outcomes were assessed pre- and post-SBL through validated questionnaires: the Academic Situation-Specific Perceived Self-Efficacy Scale, the Utrecht Work Engagement Scale for Students, and the Jefferson Scale of Empathy. All instruments demonstrated adequate internal consistency in the study sample (Chronbach's α ≥ 0.80). Post-SBL perceptions were further assessed using the Student Satisfaction and Self-Confidence in Learning Questionnaire and the Educational Practices Questionnaire-Spanish Version. Out of 451 eligible students, 409 participated in the baseline assessment and 378 completed post-SBL assessments. Statistically significant improvements were found in self-efficacy (p = 0.001), academic engagement (vigor, absorption, and total score; p = 0.008; p = 0.007, and p = 0.023, respectively), and empathy (compassionate care and total score; p < 0.001, and p = 0.007, respectively) across the full sample. When results were examined by academic year, patterns of change differed, with third- and fourth-year students showing consistent improvements across most dimensions, while second-year students exhibited more variable responses, including small decreases in selected engagement and empathy subscales. Post-SBL evaluations indicated high levels of satisfaction and self-confidence in learning, with large effect sizes observed in the more advanced academic years. Students' perceptions indicated strong endorsement of SBL practices, especially in high expectations and learning diversity. SBL was associated with improvements in key learning-related competencies, particularly among students in more advanced academic years. Differences across cohorts highlight the need to tailor SBL design to students' developmental stage, especially during early exposure. Future studies should incorporate control groups, qualitative data, and follow-up assessments to better understand the sustainability and contextual factors influencing SBL outcomes. NCT06852482 (registered on 28 February 2025).

BackgroundAccess to healthcare is a fundamental human right that is often influenced by social norms and power structures. Implicit biases in society, healthcare, and education contribute to health inequalities. Incorporating equity and social justice into nursing and healthcare education, through norm-critical pedagogy can empower learners to address and promote social justice and health equity in patient care and community health.MethodsThe aim of the study was to describe characteristics and recurring elements of norm-critical literature in published research. This study followed Arksey and O’Malley’s scoping review framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews to report the findings. A search was conducted in across five scientific databases – CINAHL, APA PsycINFO, ERIC, Medline, and Web of Science – limiting results to English language articles. Two authors independently screened, extracted, and analysed the data, guided by selected key concepts based on the population, concept, and context framework. The included articles were condensed according to specific characteristics and analysed thematically.ResultsSixteen articles were included in the review, and all published from 2017 onwards, primarily in nursing journals. Most of these articles employed qualitative methodologies. A thematic analysis generated three themes: ‘Redesigning education toward norm-critical pedagogy’, ‘Redefining one’s positionality as a teacher’, and ‘Transforming education for a norm-conscious sustainable healthcare future’.ConclusionsThis scoping review concludes that the characteristics of norm-critical literature, primarily centred on Western nursing education, has limited applicability in other healthcare educations. The literature describes key challenges in integrating norm-criticism into educational structures, often placing undue responsibility on individual teachers to adopt a norm-critical pedagogy. This review calls for further empirical research on norm-criticism to advance its use as a pedagogical model in nursing and healthcare education.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-026-09400-7.

Social media is a ubiquitous part of the modern world and plays a key role in the dissemination of information. While utilizing social media for educational purposes has been repeatedly demonstrated as feasible, it has been underutilized in medical education and remains a critical opportunity to integrate microlearning and stigma reduction curricula. A cross-sectional survey on social media usage, attitudes, and beliefs was sent to medical and nursing students at two large academic institutions within Philadelphia. Descriptive statistics are reported, and non-parametric tests were utilized for exploratory analyses. Health learners were low consumers of social media, reporting using the majority of social media platforms for under an hour a week each. The most used platforms were Instagram, TikTok, and YouTube. Learners overwhelmingly endorsed that social media can be used to enhance health knowledge (72.4%) and as a valuable learning tool for health profession students (65.5%). The statements with the highest endorsement were that social media can influence how providers view and interact with their patients (85.1%) and that social media can be used as a tool to reduce and address bias (75.9%). While learners were skeptical of the trustworthiness of information on social media, they reported that they were able to determine whether a source was trustworthy (77.0%). Lastly, most health learners reported they would use an evidence-based social media page on a short video-based platform like Instagram or TikTok (57.5%). Although health learners may represent low social media users, they did report that they consumed and engaged with health information on social media and agreed social media could be used to enhance their health knowledge and influence their interactions with patients. This represents an opportunity in medical education to better utilize social media as a modality for microlearning, stigma reduction, and the dissemination of accurate health information from a trusted source.

Medical education has increasingly emphasized social accountability and community-oriented learning to prepare graduates for complex health system challenges. Early Community Exposure (ECE) introduces medical students to real-world community and primary care contexts early in training, with the potential to foster empathy, professionalism, and contextual understanding of health. While ECE has been widely implemented, evidence remains limited regarding its impact on first-year medical students in newly established medical schools located in peripheral regions of Indonesia. This study explored how novice medical students experienced and interpreted their first exposure to community-based learning. This study employed a qualitative exploratory case study design. Participants were first-year medical students who completed the inaugural ECE program at Universitas Borneo Tarakan, a newly established medical school in North Kalimantan, Indonesia. Using purposive and snowball sampling, 15 students participated in in-depth semi-structured interviews conducted between January and March 2025. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically using a hybrid inductive-deductive approach informed by community-based education, experiential learning, and social cognitive theory. Strategies to enhance trustworthiness included member checking, reflexive journaling, and peer debriefing. Seven interrelated themes were identified: (1) meaningful experiences, (2) early learning transformation, (3) bridging theory and practice, (4) professional identity formation, (5) internalization of professional values, (6) adaptation and motivation, and (7) program optimization. Students described ECE as a transformative and humanistic learning experience that enhanced empathy, responsibility, teamwork, and confidence. ECE enabled students to contextualize preclinical knowledge within real community settings while fostering early professional identity formation. Challenges included limited time allocation, scheduling constraints, and accessibility issues for some community participants. Early Community Exposure provided first-year medical students with a pivotal learning experience that integrated cognitive, affective, and professional development from the outset of training. Embedding structured reflection, mentorship, and institutional support may further strengthen the educational impact of ECE, particularly in peripheral and resource-limited settings. These findings highlight the value of early community-based learning in preparing socially accountable physicians.

This study aimed to investigate the association between mandatory post-call rest regulation in Türkiye and residency preferences in cardiovascular surgery. This retrospective study was conducted using publicly available data from the official websites of governmental institutions in Türkiye. The primary reference was the ''Regulation on Specialty Training in Medicine and Dentistry'', published in the Official Gazette on September 3, 2022 (Issue No. 31942). The five residency placement periods before and after the enactment of the regulation were categorized as "pre-regulation" and "post-regulation" groups, respectively. Institutions were subgrouped as Ministry of Health hospitals and university medical faculties, while cities were categorized as Istanbul-Ankara-Izmir and other cities. Istanbul-Ankara-Izmir were additionally analyzed as major metropolitan centers with distinct sociodemographic characteristics and advanced healthcare infrastructures. The total number of cardiovascular surgery residency slots and the number of unfilled slots were obtained from the Assessment, Selection and Placement Center (OSYM) reports. The mean unfilled slot rate for total cardiovascular surgery residency positions was 36.16 ± 6.88% in the pre-regulation group and 12.43 ± 10.08% in the post-regulation group (p = 0.002). For Istanbul-Ankara-Izmir was 13.33 ± 8.6% in the pre-regulation period and 5.84 ± 5.06% in the post-regulation period (p = 0.132). For other cities, the rates were 57.1 ± 11.19% and 20.91 ± 18.25%, respectively (p = 0.005). In university medical faculties, the rates were 45.55 ± 9.3% before and 20.41 ± 18.45% after the regulation (p = 0.026). In Ministry of Health hospitals, the respective rates were 22.9 ± 10.05% and 6.43 ± 5.88% (p = 0.013). The post-regulation period was associated with a lower rate of unfilled cardiovascular surgery residency positions compared with the pre-regulation period.

This study aimed to evaluate the effectiveness of a generative artificial intelligence based simulated patient model in improving gynecological history-taking skills among medical students, compared with traditional clinical teaching methods. A prospective randomized controlled trial was conducted involving 40 fourth-year medical students during their gynecology clerkship. Students were randomly assigned to either an AI group (n = 20) or a control group (n = 20). Both groups received identical theoretical instruction on history taking. The control group practiced interviews with instructor-led standardized patients, while the AI group conducted simulated interviews with a large language model configured to behave as a real patient using predefined gynecological cases. Outcomes were assessed using a gynecological history-taking content checklist, Objective Structured Clinical Examination (OSCE) Score, and the Mini-Clinical Evaluation Exercise (Mini-CEX). Statistical analyses were performed using t-tests, chi-square tests, or Mann-Whitney U tests. Baseline characteristics did not differ significantly between the two groups. Students in the AI group achieved a significantly higher history-taking checklist completion rate than those in the control group and missed fewer key history items. The AI group achieved significantly higher total OSCE scores compared to the control group. Mini-CEX results showed that the AI group performed significantly better in medical interviewing skills and organization/efficiency. No significant differences were observed in professionalism, clinical judgment, counseling skills, or overall clinical competence. The use of a generative AI-simulated patient significantly enhanced the information completeness and organizational quality of gynecological history taking among medical students. AI-based simulation appears to be an effective and scalable adjunct to traditional standardized patients, offering educational benefits for reinforcing systematic clinical inquiry. However, these findings are preliminary as a single-center study with a limited sample size. Further large-scale, multi-center research is required to confirm the generalizability of these results across diverse educational settings.