Reimagining Undergraduate Critical Care Medical Education: A Path for the Next Decade.

Foundational training in critical care medicine is an integral part of both undergraduate and graduate medical education. Yet, many medical school graduates enter residency underprepared to care for critically ill patients because of a lack of ubiquity of undergraduate critical care education and the heterogeneity of existing didactic and clinical experiences. This Perspective explores the importance of undergraduate critical care education, the current national and international landscape, innovative educational strategies and exemplar curricula, and recent advances in assessment that may better reflect learner-centered educational outcomes. As broad curricular reforms push medical education toward a more innovative, interactive, and collaborative future, now is the time to rethink and reimagine undergraduate critical care education.

An Evaluation of the First Clinical Posting in Psychiatry of the Competency-Based Medical Education (CBME) Curriculum for Undergraduate Medical Students in India.

Background: The new competency-based medical education (CBME) curriculum presents an opportunity to address the many deficiencies in undergraduate (UG) psychiatry education in India. There are no published reports of such evaluations of psychiatry teaching programs based on the new CBME curriculum. Methods: We performed a cross-sectional evaluation of the first clinical posting in psychiatry of the new CBME curriculum using the following metrics: clinical skills, knowledge, attitudes towards psychiatry, self-efficacy in performing the specific learning objectives (SLOs), and satisfaction with specific teaching-learning and assessment methods implemented. Results: The mean knowledge score after the posting was significantly higher compared to the mean knowledge score at baseline (7.79 vs 5.45, p<0.001). The mean clinical skills score after the posting was 13.77 (0-20 range). Improvement was noted in the mean scores on all three sub-scales of the attitudes toward psychiatry scale. However, the improvement in scores was statistically significant only on the 'Stigma of Psychiatry' sub-scale. The mean scores on the items of the self-efficacy scale were between 63.41 and 77.73 (0-100 range). The mean scores on all items of the satisfaction scale were between 4 (somewhat satisfied) and 5 (very satisfied). Conclusion: We have described an evaluation of the first clinical posting in psychiatry of the new CBME curriculum. The posting was effective in imparting knowledge and clinical skills and potentially bringing about favorable changes in the attitudes toward psychiatry among UG medical students. The students also perceived confidence in performing the SLOs and were satisfied with the teaching-learning methods and assessment methods implemented.

Preparedness for practice, competency and skill development and learning in rural and remote clinical placements: A scoping review of the perspective and experience of health students.

When considering health professionals' requirements and responsibilities, competence is a complex concept that extends beyond knowledge to encompass understanding, application, technical skills, problem-solving, and clinical judgment. Rural clinical placements provide a rich learning environment for students to improve their competencies, self-esteem, and preparedness for practice (PFP). This scoping review aimed to identify pre-registration health students' perspectives on rural placement regarding competency and skill development, and enablers and barriers to learning. The methodology outlined by the Joanna Briggs Institute was followed. Out of 1186 records (366 duplicates), 821 were screened by title and abstract, 59 underwent full-text screening and 18 studies were included. Over half the studies included medicine students (n = 11). Reported competencies predominantly focused on self-assessed confidence regarding clinical skills. The reported barriers and enablers to learning highlighted the complexity of the placement experience and the importance of interpersonal factors, learner engagement and the supervisor's role. The review identified a gap in the literature pertaining to student perspectives of competencies and skills not assessed or experienced as well as a lack of standardised measures for PFP. The identified enablers and barriers provide suggestions for rural placement design and emphasise the importance of the student learning experience. Future research could include multiple health disciplines and specific methodologies to identify health students' perspectives regarding the development of competency, relatedness and autonomy, that is how to support health students to think, feel and act like health professionals.

Implementation of competency-based education for quality midwifery programmes in Africa: a scoping review.

BACKGROUND: Improving the quality of midwifery education to international standards is critical to prepare competent midwives. Despite the recognised impact of competent midwives, little is known concerning the implementation of Competency-Based Education (CBE), especially in Africa, where poor investment in quality midwifery education has been reported. OBJECTIVE: The aim of this study is to scope and synthesize the existing literature on the implementation of CBE for midwifery programmes and its sustainability in Africa. METHODS: The scoping review methodology outlined by Arksey and O'Malley framework was adopted to explore the extent of the literature on the implementation of CBE for midwifery programmes and its sustainability in Africa. This framework directed the scoping review methodology, with reference to PRISMA-ScR guidelines. RESULTS: A total sample of 72 studies were finally included in this scoping review. Reporting of the scoping review findings follows the PRISMA- ScR format. The study showed that of the 54 African countries as per the World Bank classification, after review of the full articles following the eligibility criteria for inclusion, literature on midwifery education programmes only spanned 17 African countries as at the time of this report. Of which, 11 are implementing CBE, 5 are still using Traditionally Based Approaches (TBA) while Problem-Based Learning (PBL) is the main teaching pedagogy used in Botswana. This review revealed that for the successful implementation of CBE, a CBE curriculum implementation process must be strictly observed. Evidence from the literature confirmed that CBE has not been sustained in Africa. There is still a struggle to fully integrate the major components of the competency-based midwifery programme due to inadequate support and an inadequate monitoring system. CONCLUSIONS: It is expedient that CBE implementation should be planned concurrently with its sustainability for it to be effective. Adequate training and support should be continuously provided to faculties, institutions, policy makers, professional bodies, students and other stakeholders for successful implementation and sustainability. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1- https://doi.org/10.2196/47603 .

Learning Styles in Nursing Students: A Cross-Sectional Study / Estilos de aprendizaje en estudiantes de enfermería: Un estudio transversal

Introduction. Learning styles are a versatile tool for the development of new competencies in students. The integration of these preferences in the training of nursing professionals offers an opportunity to improve the quality of clinical care, aligning with the approach of the profession. Objective. To evaluate the preference of learning styles in nursing students in the third year of the nursing degree. Method. A quantitative, cross-sectional cohort study was conducted. The universe consisted of 275 nursing students, the sample 161 calculated with a confidence level of 95% and a margin of error of 5%. The Learning Styles Scale (LSS) was used, which consists of 22 items; the data analysis was performed using the SPSS software version 26 for descriptive statistical analysis that calculated frequency, percentage, mean, standard deviation. Results. The competitive domain, followed by the solitary domain, reached a higher mean of performance, results that are particularly important in nursing, a complex and demanding profession, but do not contribute to teamwork and decision-making in complex situations, skills necessary for the development of the profession. Conclusions. The perceptual domain evaluated reached the lowest mean in terms of the learning styles preferred by students, in relation to the competitive and solitary domains that reached greater preference.

Introducción. Los estilos de aprendizaje constituyen una herramienta versátil para el desarrollo de nuevas competencias en los estudiantes. La integración de estas preferencias en la formación de profesionales de enfermería ofrece una oportunidad para mejorar la calidad del cuidado clínico, alineándose con el enfoque de la profesión. Objetivo. Evaluar la preferencia de los estilos de aprendizaje en estudiantes de enfermería del tercer año de la carrera de enfermería. Método. Se realizó un estudio cuantitativo, de cohorte transversal, el universo estuvo conformado por 275 estudiantes de enfermería, la muestra 161 calculada con un nivel de confianza de 95% y un margen de error de 5%, se utilizó la Escala de Estilos de Aprendizaje (LSS) que consta de 22 ítems; el análisis de los datos se realizó utilizando el software SPSS versión 26 para el análisis estadístico descriptivo que calcularon frecuencia, porcentaje, media, desviación estándar. Resultados. El dominio competitivo, seguido del dominio solitario, alcanzó una media de comportamiento más alto, resultados que tienen particular importancia en la enfermería, profesión compleja y exigente, pero no aportan al trabajo en equipo, y a la toma de decisiones en situaciones complejas, competencias necesarias para el desarrollo de la profesión. Conclusiones. El dominio perceptivo evaluado alcanzó la media más baja en cuanto a los estilos de aprendizaje de preferencia por los estudiantes, en relación con los dominios competitivos y solitarios que alcanzaron mayor preferencia.

Unintended consequences - Risk for bias in competency-based assessment.

As nursing education transitions to competency-based education, careful attention to the assessment methodology must be considered. As nursing education contends with structural implicit bias and supports social justice, any transition to the education delivery model must consider the underserved and marginalized. Multilingual and marginalized students have long had inequitable experiences when taking standardized assessments influenced by the perspectives and values of the dominant culture. Resourced and under-resourced nurse educators must be empowered to access information to inform the competency-based assessment design. This perspective article aims to uncover the risk of bias in competency-based assessment when not properly implemented and to present strategies to reduce bias in competency-based assessment. Considerations for schools/colleges of nursing as they implement competency-based assessment are explored.

Procedural simulators for teaching and learning vasectomy techniques: a scoping review.

Background: Procedural simulators can facilitate teaching and improve learning vasectomy surgical techniques. The objectives of this scoping review were to identify available vasectomy simulators (scrotal models), and to assess their characteristics and potential suitability for optimal transfer of surgical skills of most recommended techniques in clinical practice. Methods: We performed searches up to December 2023 using PubMed and Google search engines to identify existing vasectomy simulators. Articles and Web pages reporting vasectomy simulators were also examined using a snowball strategy. In addition, we asked members of the Vasectomy Network, an international Google discussion group, if they knew any other simulators. Two members of the research team performed the initial evaluations of the physical and functional characteristics of retrieved simulators. All team members made consensus on final evaluations. Results: We retrieved 10 relevant scrotal models through PubMed (n=2), Google (n=4), and the Vasectomy Network (n=4). Three were commercially available simulators produced by Gaumard® in the USA and seven were homemade models. All had limited visual and haptic realism of internal and external structures. Most, however, were suitable for simulating some basic skills of the no-scalpel technique to deliver the vas deferens. Fascial interposition could not be simulated with any model. Commercially available models had no advantage over homemade models. Conclusions: Most vasectomy simulators currently available allow learning some basic surgical skills of the procedure but have limitations for optimal learning of the recommended techniques and skill transfer in clinical practice. There appears to be a need to develop and evaluate new simulators with enhance visual and haptic characteristics for teaching and learning vasectomy techniques.

Innovating to meet AACN essentials in a bachelor of science in nursing program.

Our large, two campus (one urban and one suburban) and two track (RN-BSN and Entry-level BSN) program has revised our BSN curriculum to reflect the new Level One American Association of Colleges of Nursing (AACN) The Essentials: Core Competencies for Professional Nursing Education (AACN, 2021). This article describes the work to revise the curriculum to meet the demands of contemporary nursing education with increased elective choices for Generation Z learners, professional role courses on wellness and resiliency, a course on palliative care and symptom management, increased clinical hours to include virtual simulation and more community and public health experiences, and increased innovative student experiences with our clinical partners. A revised clinical evaluation tool (CET) was also developed to evaluate students in competency-based education and to reflect our new program outcomes.

Elevating competency-based education in baccalaureate nursing: A simulation integration project.

Simulation offers a mechanism for scaffolded learning in a safe environment and affords opportunities for students to integrate nursing knowledge, skills, and behaviors into patient care activities. Faculty applied a structured change model and utilized simulation theory and the AACN Essentials framework for competency-based education to integrate simulation across the pre-licensure curriculum at a large school of nursing. A series of clinical learning activities were implemented including one revised scenario, a computer-based simulation adapted from an existing manikin-based activity, and a multi-patient simulation developed by modifying three textbook publisher simulation resources. Students were provided with opportunities to develop competencies across multiple Essentials domains, and congruence between course and simulation objectives was achieved. The purpose of this article is to describe the processes and outcomes of a faculty-driven effort to advance competency-based education in baccalaureate nursing curricula.

Nurse Practitioner Education: Recommending Theories and Frameworks for Simulation-Based Experiences and Research.

Simulation-based education is an evidence-based strategy to address learning and evaluation of outcomes in the updated American Association of Colleges of Nursing Essentials. Currently, there is a dearth of rigorous research on nurse practitioner education simulation. Studies on the topic often neglect a sound theoretical or conceptual framework beyond the National League of Nursing Jeffries Simulation Theory. This article aims to explore and distinguish the implementation of various theories and frameworks to determine how these elements can be stand-alone or used in combination to explore simulation-based experience competency outcomes. Specific recommendations for simulation research are (a) to include learning theories, (b) level learning and track competency progression using a framework, and (c) use a framework for measuring outcomes. Simulation science for nurse practitioner education can be advanced through united and consistent use of established theories and frameworks. These efforts will inform emerging best practices of simulation-based learning to address competition-based learning initiatives, validity of high-stakes simulation evaluation, and how to credit learners for simulation activities.

Advancing healthcare practice and education via data sharing: demonstrating the utility of open data by training an artificial intelligence model to assess cardiopulmonary resuscitation skills.

Health professional education stands to gain substantially from collective efforts toward building video databases of skill performances in both real and simulated settings. An accessible resource of videos that demonstrate an array of performances - both good and bad-provides an opportunity for interdisciplinary research collaborations that can advance our understanding of movement that reflects technical expertise, support educational tool development, and facilitate assessment practices. In this paper we raise important ethical and legal considerations when building and sharing health professions education data. Collective data sharing may produce new knowledge and tools to support healthcare professional education. We demonstrate the utility of a data-sharing culture by providing and leveraging a database of cardio-pulmonary resuscitation (CPR) performances that vary in quality. The CPR skills performance database (collected for the purpose of this research, hosted at UK Data Service's ReShare Repository) contains videos from 40 participants recorded from 6 different angles, allowing for 3D reconstruction for movement analysis. The video footage is accompanied by quality ratings from 2 experts, participants' self-reported confidence and frequency of performing CPR, and the demographics of the participants. From this data, we present an Automatic Clinical Assessment tool for Basic Life Support that uses pose estimation to determine the spatial location of the participant's movements during CPR and a deep learning network that assesses the performance quality.

Evaluation of the BOPPPS model on otolaryngologic education for five-year undergraduates.

BACKGROUND: This study aimed to assess the effectiveness of the BOPPPS model (bridge-in, learning objective, pre-test, participatory learning, post-test, and summary) in otolaryngology education for five-year undergraduate students. METHODS: A non-randomized controlled trial was conducted with 167 five-year undergraduate students from Anhui Medical University, who were allocated to an experimental group and a control group. The experimental group received instruction using the BOPPPS model, while the control group underwent traditional teaching methods. The evaluation of the teaching effectiveness was performed through an anonymous questionnaire based on the course evaluation questionnaire. Students' perspectives and self-evaluations were quantified using a five-point Likert scale. Furthermore, students' comprehension of the course content was measured through a comprehensive final examination at the end of the semester. RESULTS: Students in the experimental group reported significantly higher scores in various competencies compared to the control group: planning work (4.27 ± 0.676 vs. 4.03 ± 0.581, P < 0.05), problem-solving skills (4.31 ± 0.624 vs. 4.03 ± 0.559, P < 0.01), teamwork abilities (4.19 ± 0.704 vs. 3.87 ± 0.758, P < 0.05), and analytical skills (4.31 ± 0.719 vs. 4.05 ± 0.622, P < 0.05). They also reported higher motivation for learning (4.48 ± 0.618 vs. 4.09 ± 0.582, P < 0.01). Additionally, students in the experimental group felt more confident tackling unfamiliar problems (4.21 ± 0.743 vs. 3.95 ± 0.636, P < 0.05), had a clearer understanding of teachers' expectations (4.31 ± 0.552 vs. 4.08 ± 0.555, P < 0.05), and perceived more effort from teachers to understand their difficulties (4.42 ± 0.577 vs. 4.13 ± 0.59, P < 0.01). They emphasized comprehension over memorization (3.65 ± 1.176 vs. 3.18 ± 1.065, P < 0.05) and received more helpful feedback (4.40 ± 0.574 vs. 4.08 ± 0.585, P < 0.01). Lecturers were rated better at explaining concepts (4.42 ± 0.539 vs. 4.08 ± 0.619, P < 0.01) and making subjects interesting (4.50 ± 0.546 vs. 4.08 ± 0.632, P < 0.01). Overall, the experimental group expressed higher course satisfaction (4.56 ± 0.542 vs. 4.34 ± 0.641, P < 0.05). In terms of examination performance, the experimental group scored higher on the final examination (87.7 ± 6.7 vs. 84.0 ± 7.7, P < 0.01) and in noun-interpretation (27.0 ± 1.6 vs. 26.1 ± 2.4, P < 0.01). CONCLUSION: The BOPPPS model emerged as an effective and innovative teaching method, particularly in enhancing students' competencies in otolaryngology education. Based on the findings of this study, educators and institutions were encouraged to consider incorporating the BOPPPS model into their curricula to enhance the learning experiences and outcomes of students.

Accelerated competency-based education in primary care (ACE-PC): a 3-year UC Davis and Kaiser permanente partnership to meet California's primary care physician workforce needs.

PROBLEM: Our nation faces an urgent need for more primary care (PC) physicians, yet interest in PC careers is dwindling. Students from underrepresented in medicine (UIM) backgrounds are more likely to choose PC and practice in underserved areas yet their representation has declined. Accelerated PC programs have the potential to address workforce needs, lower educational debt, and diversify the physician workforce to advance health equity. APPROACH: With support from Kaiser Permanente Northern California (KPNC) and the American Medical Association's Accelerating Change in Medical Education initiative, University of California School of Medicine (UC Davis) implemented the Accelerated Competency-based Education in Primary Care (ACE-PC) program - a six-year pathway from medical school to residency for students committed to health equity and careers in family medicine or PC-internal medicine. ACE-PC accepts 6-10 students per year using the same holistic admissions process as the 4-year MD program with an additional panel interview that includes affiliated residency program faculty from UC Davis and KPNC. The undergraduate curriculum features: PC continuity clinic with a single preceptor throughout medical school; a 9-month longitudinal integrated clerkship; supportive PC faculty and culture; markedly reduced student debt with full-tuition scholarships; weekly PC didactics; and clinical rotations in affiliated residency programs with the opportunity to match into specific ACE-PC residency tracks. OUTCOMES: Since 2014, 70 students have matriculated to ACE-PC, 71% from UIM groups, 64% are first-generation college students. Of the graduates, 48% have entered residency in family medicine and 52% in PC-internal medicine. In 2020, the first graduates entered the PC workforce; all are practicing in California, including 66% at federally qualified health centers, key providers of underserved care.

Re-thinking the Concept of Cultural Competency in Nursing Care of Older Adults.

The influx of migrants to Canada has resulted in a shift in the country's demographic landscape. Individuals often interpret and approach health and wellness through the lens of their cultural heritage, which has led to stereotyping behaviors and discriminatory practices, exacerbating the notion of "Othering". Immigrant older adults are likely to experience discrimination in a more dreadful way in the form of societal isolation and marginalization due to the collective systems of power such as ageism, ableism, and racism. This paper results from continuous thought-provoking discussions initiated by the first author (AM) in her doctoral program at the University of Western Ontario for the Philosophy of Nursing Science course, taught and facilitated by the second author (SM). After studying the course materials on "revolutionary science" and reflection on the process of paradigm shift introduced by Thomas Khun and engaging in critical discussions on a range of relevant philosophical concepts such as bio-power, othering, silencing and ignorance, marginalization, oppression, neoliberalism, health equity, and social justice, we have been prompted to rethink the concept of cultural competence in nursing education and healthcare practices, particularly in the context of nursing care of older adults. Therefore, in this paper, we will critique the concept of cultural competency in the context of an anti-racist and anti-oppressive lens and suggest a pivotal response to move towards an inquiry-driven approach based on cultural humility and respect in the nursing care of older adults.

AACN competency-based essentials revisit: Evidence-based validation of entrustable professional activities in Asia.

AIM: This study intended to validate the competency-based approach through an entrustable professional activity in the nursing undergraduate education arena in Taiwan. BACKGROUND: Entrustable professional activity is a recommended strategy to enhance nursing competencies and skills. It has been widely applied to nursing education in Western countries, especially graduate programs. However, its effects in eastern countries and undergraduate programs remain unclear. DESIGN: A quasi-experimental comparison design was used. METHOD: The study is conducted at the Department of Nursing at a university in southern Taiwan. A total of 72 Two-Year Nursing Program students participated in the study. After implementing the designated entrustable professional activity in the Wound Care Nursing course, outcomes were measured using the Competency Inventory of Nursing Students, Learning Satisfaction and Objective Structured Clinical Examinations. These outcomes were then compared with post-test results at the end of the semester. About 90 % of students completed the study with the test group (n=31) receiving extra activity and the comparison group (n=34) receiving usual teaching. Data were analyzed through chi-square, paired t and Student's t-test. RESULTS: The test group demonstrated significantly higher scores in perceived competency and clinical examinations than the comparison group. However, both groups experienced an increase in learning satisfaction without reaching a significant difference. CONCLUSION: Results of the study indicate that competency-based pedagogy, e.g., using entrustable professional activities, should be integrated into nursing curricula to meet the new American Association of Colleges of Nursing standards with compelling evidence.

Analysis of Physiology Theory Question Papers for Competency-Based Medical Education Implementation in Gujarat: A Pilot Study.

Introduction Theory question papers form an important part of assessment in medical education. As per the Competency-Based Medical Education (CBME) guidelines 2019, questions should test higher levels of cognition. This pilot study analyzes 60 question papers from different universities in Gujarat for their construct and content validity. The aim was to analyze the quality of physiology question papers from various medical universities in Gujarat to gain insights into assessment quality and its alignment with the CBME guidelines. The objectives were twofold: to evaluate the "construct validity" and "content validity" of these physiology theory question papers over the past three years according to the CBME standards. Methods An observational study using a cross-sectional records-based approach was carried out, evaluating 60 summative exam question papers in physiology from eight different universities of Gujarat for their construct and content validity. Using Bloom's taxonomy, the learning level of the cognitive domain for the questions asked was assessed. The findings compared and displayed a sample of papers. Results A total of 1842 questions were analyzed from the 60 question papers of eight different universities of the Gujarat state. The study found that the questions asked for different levels of cognition in Bloom's taxonomy, i.e., remember, understand, apply, analyze, evaluate, and create, were 560 (30.40%), 434 (23.26%), 222 (12.05%), 118 (6.41%), 94 (5.10%), and 0.00%, respectively. A total of 414 (22.48%) questions did not have any verb, so they did not fit into any level of Bloom's taxonomy. The majority of questions (1773, 96.25%) were asked from the core competencies, while a small percentage (69, 3.75%) of questions were asked from the non-core competencies of physiology. Conclusion The majority of questions in the summative question papers in physiology were of level "remember" and "understand" as per Bloom's taxonomy. Of the questions, 26% did not have any verb. There is a need to incorporate more questions testing higher levels of cognition and to use blueprints by universities. Faculty training is also necessary to bring about course correction.

Competency development for pharmacy: adopting and adapting the FIP global advanced development framework.

Background: Pharmacy education shifts toward competency-based training to meet healthcare demands. This study aims to develop and validate the Kuwait Advanced Competency Framework (KACF) for pharmacists. The study adopts the FIP Global Advanced Development Framework (GADF) to develop a country-specific framework, emphasizing the importance of aligning with global standards while adapting to local contexts. The developed framework builds upon the Kuwait Foundation Competency Framework to address the need for advanced pharmacy services. Methods: This is a mixed methods study that employed an "adopt and adapt" approach. The KACF was adopted from the FIP GADF and adapted following four phases. Phase one involved checking and validating the Arabic version of the FIP GADF. Phase two employed a series of focus groups to validate accuracy and relevancy of competency statements. Phase three utilized a workshop with different stakeholders as a final step of validation. Phase four involved a national survey to assess the national pharmacy workforce against the framework competencies. Qualitative feedback from focus groups and workshops informed competencies modifications. Quantitative data were analyzed using descriptive and multiple correspondence analyses (MCA). Results: The translation phase verified a bilingual framework that could be utilized by pharmacists in Kuwait. The initial and final validation phases identified 20 behavioral statements (out of 22 in the original document) that are relevant to pharmacy practice in Kuwait. The national survey, comprising 169 respondents, validated the KACF's applicability, revealing variations in career stage progression across competency clusters. Findings highlighted associations between career stages and practice settings, offering insights for tailored workforce development strategies. Conclusion: The KACF emerges as a pivotal tool for advancing pharmacy services in Kuwait, aligning with global trends toward competency-based education. Findings underscored the necessity for context-specific approaches in advancing pharmacy practice, providing a comprehensive understanding of competency progression and readiness for advanced roles.

Reject the "Practice Readiness Myth": Ask if systems are ready for nursing graduates instead.

The nursing profession is engaged in robust national dialogue on how to implement competency-based education. This dialogue often conflates the concept of "competency-based education" with nursing "competence" or "practice readiness." Our aim is to discuss the potential harms of conflating "competency-based education" with "competence" or "practice readiness." This commentary explores the possible risks of issue conflation. Risks include (a) suggesting that nurses who have successfully obtained licensure are not "competent" or "ready to practice," and (b) de-emphasizing the importance of safe and sustainable work environments for new graduate nurses. We discuss the need to separate conversations about "competency-based education" and "practice readiness"; the need to increase the clarity and specificity of discourse surrounding competency-based education; and the need for strategic alignment across academia and practice.