Policy suggestions for improving nursing education in a low- and middle-income country: A modified Delphi study.

BACKGROUND: Health policy critically influences a national healthcare system and nurse's roles, working conditions, and professional development opportunities, especially in low- and middle-income countries. PURPOSE: To explore and prioritize the major challenges and solution, and establish policy directions for improving nursing education in the Kyrgyz Republic. METHODS: The key stakeholders of nursing practice, education, policymaking, and regulation were involved in this modified Delphi study. Following two rounds of exploring priority issues and potential strategies, the participants of the final round assembled for consensual discussions on the establishment of policy directions. DISCUSSION: Innovations in nursing education systems, building educational capacity, and ensuring educational outcomes were suggested and agreed upon for the sequential improvement of nursing education. Timely enactment of these policies will enable the Kyrgyz Republic to mitigate nursing shortages, improve the quality of healthcare services, and enhance overall public health outcomes. CONCLUSION: The policy suggestions derived from this study, including the improvement of nursing education quality and the assurance of nurses' competencies, have great potential for improving quality healthcare practice and sustaining an effective healthcare system.

Transforming Perceptions: The Impact of a Formal Parental Leave Policy on Surgical Trainees.

OBJECTIVE: Surgical trainees who welcome a new child during residency often face challenges related to appropriate parental leave. To address this, we instituted a comprehensive family medical leave policy within our training program and assessed resident perceptions before and after the policy's introduction. We hypothesized that this new formal policy would enhance feelings of support amongst all (not just childbearing) trainees. DESIGN: A web-based survey to gauge resident perceptions on parental leave was distributed to all residents at a single academic general surgery residency at 2 intervals: prior to policy implementation and 1 year after policy implementation. SETTING: The study was conducted at a single institution, academic general surgery residency program. PARTICIPANTS: All general surgery residents at the institution were included (n = 95). RESULTS: About 40 out of 95 (42%) residents participated in the initial survey and 25 of 95 (26%) completed the subsequent survey. There was a significant improvement in resident reported satisfaction with the policy from pre to post: 15% pre to 68% post, p < 0.001, report the policy frequently supported trainees' needs, 20% pre to 88% post, p < 0.001, perceived the policy as fair. Most residents (90.0% pre and 80.0% post) perceived pregnancy as a risk during surgical training. There were no differences in perception of the new policy between residents who were parents and residents who were not parents. CONCLUSIONS: The introduction of a comprehensive family medical leave policy improved all surgical trainees' (including nonparents) perception of policy effectiveness and policy fairness. This is counter to the published perception that parental leave creates a burden on fellow trainees. However, pregnancy remains a stressor for the individual new parent. Surgical programs can develop supportive formal family medical leave policies; it is important to address the inherent systemic and cultural barriers surrounding childrearing during surgical training.

Blind spots in medical education - International perspectives.

BACKGROUND: All individuals and groups have blind spots that can create problems if unaddressed. The goal of this study was to examine blind spots in medical education from international perspectives. METHODS: From December 2022 to March 2023, we distributed an electronic survey through international networks of medical students, postgraduate trainees, and medical educators. Respondents named blind spots affecting their medical education system and then rated nine blind spot domains from a study of U.S. medical education along five-point Likert-type scales (1 = much less attention needed; 5 = much more attention needed). We tested for differences between blind spot ratings by respondent groups. We also analyzed the blind spots that respondents identified to determine those not previously described and performed content analysis on open-ended responses about blind spot domains. RESULTS: There were 356 respondents from 88 countries, including 127 (44%) educators, 80 (28%) medical students, and 33 (11%) postgraduate trainees. At least 80% of respondents rated each blind spot domain as needing 'more' or 'much more' attention; the highest was 88% for 'Patient perspectives and voices that are not heard, valued, or understood.' In analyses by gender, role in medical education, World Bank country income level, and region, a mean difference of 0.5 was seen in only five of the possible 279 statistical comparisons. Of 885 blind spots documented, new blind spot areas related to issues that crossed national boundaries (e.g. international standards) and the sufficiency of resources to support medical education. Comments about the nine blind spot domains illustrated that cultural, health system, and governmental elements influenced how blind spots are manifested across different settings. DISCUSSION: There may be general agreement throughout the world about blind spots in medical education that deserve more attention. This could establish a basis for coordinated international effort to allocate resources and tailor interventions that advance medical education.

Seeing with greater clarity: Stakeholder ratings of blind spots in U.S. medical education.

BACKGROUND: Although medical education is affected by numerous blind spots, there is limited evidence to determine which blind spots to prioritize. METHODS: In summer 2022, we surveyed stakeholders from U.S. medical education who had identified 9 domains and 72 subdomains of blind spots. Respondents used 4-point Likert-type scales to rate the extent and magnitude of problems caused for each domain and subdomain. Respondents also provided comments for which we did content analysis. RESULTS: A total of 23/27 (85%) stakeholders responded. The majority of respondents rated each blind spot domain as moderate-major in both extent and problems they cause. Patient perspectives and voices that are not heard, valued, or understood was the domain with the most stakeholders rating extent (n = 20, 87%) and problems caused (n = 23, 100%) as moderate or major. Admitting and selecting learners likely to practice in settings of highest need was the subdomain with the most stakeholders rating extent (n = 21, 91%) and problems caused (n = 22, 96%) as moderate or major. Respondents' comments suggested blind spots may depend on context and persist because of hierarchies and tradition. DISCUSSION: We found blind spots differed in relative importance. These data may inform further research and direct interventions to improve medical education.

Changing the mindsets? Education and the intergenerational spread of tolerance for physical violence against women in Zimbabwe.

We investigate the relationship between childhood exposure to interparental violence and adult tolerance for violent beliefs against women. For individuals who have witnessed parental violence in childhood, our analysis suggests a 14.3-15.2 percentage point (pp) increase in tolerance, highlighting the transmission of violent beliefs across generations. Leveraging Zimbabwe's 1980 education reform as a natural experiment through a regression discontinuity design, we explore the potential of increased education to disrupt this intergenerational transmission. The reform led to an approximately two-year increase in female education, with a more pronounced impact in rural areas. This educational boost is associated with an estimated 4.1-7.9 pp reduction in tolerance for violence, especially among those who witnessed parental violence in childhood. We identify four primary mechanisms contributing to this reduction in tolerance: enhanced access to information, increased help-seeking behaviours, improved labour market outcomes, and higher educational levels among partners. Our findings underscore the effectiveness of educational policies in reducing tolerance for violence against women within low-income contexts such as Zimbabwe, thereby disrupting its intergenerational transmission. Moreover, these results emphasise the potential of education-based interventions in addressing the broader issue of violence against women in low-income countries.

[Interdisciplinary teaching-assisted education reform in "Principal Biology"].

General education in biological courses such as "Principal Biology" is an essential avenue for gaining an understanding of life science and developing an interest in the field. The reform of biological education teaching mode based on interdisciplinary approaches aims to foster cross-disciplinary talents, which is crucial for the rapid development of China's bioeconomy. Teaching method that simply superimposes different subjects is difficult to discover the value of interdisciplinary education. To address this, a novel teaching system and an innovative teaching mode were proposed for "Principal Biology" course by integrating science and engineering subjects, based on the cross-disciplinary feature in Beijing Institute of Technology. The system involves the design of cross-disciplinary course content and the integration of multiple disciplines and knowledge points based on students' majors, taking into account the characteristics of students' physical and mental development. To improve students' scientific literacy and interdisciplinary thinking ability, differentiated and major-driven teaching modes were applied by incorporating the "1+N" mixed and immersive cross-thinking training. The effectiveness of tailored cross-disciplinary teaching was evaluated using "in-teaching" and "post-teaching" data feedback models, which promote the optimization of teaching process and enhance the quality of education in cross-disciplinary biological science.

From the West to the East: an evidence-based educational reform for modern medical students in traditional Chinese medicine learning.

Introduction: Generally, Traditional Chinese Medicine (TCM) courses are now given to modern medicine students without proper course scheduling, resulting in poor teaching results. Methods: To analyze the main factors affecting TCM learning, we surveyed the medical students and TCM teachers from Xiangya School of Medicine of Central South University via online questionnaires. The questionnaire comprised two parts, the students' part included the basic information, the subjective cognition in TCM, the attitude toward TCM course arrangements, and the attitude toward curriculum content and the design of TCM. The teachers' part included the basic information, the attitudes and opinions on TCM course arrangements, and suggestions and views on TCM teaching reform. The related data were collected from 187 medical students divided into two groups, namely, clinical medical students and non-clinical medical students. Results: We found a more positive attitude toward TCM [including "Scientific nature of TCM" (P = 0.03) and "Necessity for modern medicine students to learn TCM" (P = 0.037)] in clinical medical students compared with non-clinical medical students, clinical and non-clinical medical students tended to find TCM courses difficult, and the students prefer clinical training to be better than theoretical teaching, while the teachers believe that lecture-based education should have a more significant proportion. Discussion: Hence, to optimize the current TCM teaching, we conducted education reform, including differentiated teaching, hybrid teaching, and selective teaching.

Relationship between quality of professional capacity building for kindergarten teachers and children's language development: the mediating role of kindergarten language education activities quality.

Strengthening the professional capacity building for kindergarten teachers is crucial for improving the quality of kindergarten education and promoting children's development. In order to explore the impact of the quality of professional capacity building for kindergarten teachers and kindergarten language education activities quality on children's language development, a study was conducted. A total of 1,584 children from 90 kindergartens in 5 provinces in China were randomly selected as research participants. Utilizing an independent sample t-test and correlation analysis (with SPSS 26.0 as the tool), the study analyzed the disparities in the professional capacity building for kindergarten teachers of different types, kindergarten language education activities quality, and the children's language developmental levels, as well as the interrelationships among these factors. A multilevel structural equation model (using MPLUS 8.3 as the tool) was employed to analyze the mediating role that the kindergarten language education activities quality plays between the quality of professional capacity building for kindergarten teachers and children's language development levels. The results indicate that children in public kindergartens demonstrate significantly higher language development levels than those in private kindergartens. A positive correlation exists between the quality of professional capacity building for kindergarten teachers, kindergarten language education activities quality and children's language development levels. Furthermore, kindergarten language education activities quality shows partial mediating effects on the relationship between them. These findings highlight the need to enhance the quality of education in private kindergartens, reduce the disparities in language development levels between private and public kindergartens, and reinforce the quality of professional capacity building for kindergarten teachers to provide effective support for children's language development. Ultimately, the study suggests concentrating on the organization and implementation of kindergarten language education activities as a means of evaluating the quality of professional capacity building for kindergarten teachers.

Adjustment to Chinese Culture and Mental Health Issues among Foreign Students on Chinese University Campuses during the COVID-19 Pandemic: A Collaborative Ethnographic Study.

Foreign students in China may have difficulty adjusting to Chinese culture and may experience mental health problems related to acculturation, interpersonal issues, and social communication within the context of campus life. Therefore, this study attempts to apply a collaborative ethnography approach to explore the adjustment to Chinese culture and mental health issues among foreign students on Chinese campuses during the COVID-19 pandemic. We spent 16 months exploring the feelings and perceptions of 82 foreign international undergraduate students at six Chinese higher education institutions regarding their adjustment to Chinese culture and gathered their suggestions about how to address the mental health issues experienced by foreign learners in China. The results show that international students tend to have a limited understanding of Chinese culture and rely on very few channels for information-in particular, the Internet, teachers' lectures, and daily life-which can easily result in mental health problems and thoughts of marginalization.In addition, the results showed that international students' mental health problems are subjectively positively correlated with their own personality, cultural intelligence, and cultural identification ability and objectively related to their cultural distance and all aspects of the educational work of international students. It is suggested that Chinese higher education institutions should strengthen their attention to the mental health of international students in China and promote international students' cross-cultural adaptation abilities and understanding of Chinese culture.

Compulsory education reform and child mortality in Peru.

The government of Peru amended its constitution to increase compulsory education from six to 11 years in 1993. This constitutional amendment provides a natural experiment to investigate the impact of maternal education on child mortality. Exploiting differences in the reform exposure by age, I find that mothers who were exposed to the reform were less likely to experience the death of a child. There is also evidence that the reform caused a decline in infant mortality. These results are not driven by the age difference between mothers who were treated by the reform and those who were not treated. Additional analyses reveal that the reform increased age at first birth, decreased desired fertility, reduced smoking, and improved economic opportunities for women. The results demonstrate that compulsory schooling may be a useful policy tool to improve women's education, which can, in turn, enhance the survival of their children.

Impact of "expanding powers and strengthening counties" reform on basic public education services: Empirical evidence from Sichuan, China.

The quality of a country's education system is both an indicator of its present level of development and a predictor of future economic advancement. This study intended to explore the impact of the "expanding power and strengthening counties" reform on the supply of basic public education resources. A combination of qualitative and quantitative methods was used to analyze the panel data of 114 counties in Sichuan Province from 2005 to 2017, including 78 counties with expanded powers. The study found that the "expanded power strong counties (EPSC)" had a significant positive impact on the supply level of funding resources measured by per capita public education expenditure. The time effect of the EPSC on the supply of teacher resources for county public education was manifested as a sharp increase in the supply level in the three years before the reform. The supply level tended to be stable after four years of reform. The economic resources supply level was relatively stable in the first three years and rose sharply after four years. There was a downward trend after the reform for 8 years. The structural effect has shown a more significant incentive effect on the supply of public education resources to strong and weak counties. But compared with the weak counties with lower economic development levels, the strong counties with higher economic development levels have a more noticeable effect of their decentralization reform on improving the supply level of public education resources.

Application of flipped classroom teaching mode in community clinical pharmacist training / 中华医学教育探索杂志

Objective:To explore the application and effect of flipped classroom in community clinical pharmacist training.Methods:Seventeen pharmacists trained in 2017-2018 were used as the control group and received traditional teaching mode. Fourteen pharmacists trained in 2019-2020 were used as the experimental group and received the flipped classroom teaching mode. Finally, the teaching effect was evaluated through the trainees' graduation examination results and satisfaction degree. The SPSS 25.0 was used to conduct the t test and chi-square test. Results:The task performance, prescription audit scores, clinical practice scores, and total scores in the experimental group were significantly higher than those in the control group ( P<0.05). However, there was no significant difference in usual performance between the two groups ( P>0.05). For satisfaction survey, the total score of Likert scale in the experimental group was (20.1±3.4), which was significantly higher than that in the control group (16.9±3.4). However, there was no significant difference in the satisfaction of clinical practice and teachers' level between the two groups ( P>0.05). Conclusion:Flipped classroom can improve the enthusiasm of community clinical pharmacist trainees to participate in learning, increase the level of the trainees' theoretical knowledge and professional practice, and is conducive to the cultivation of high-quality community clinical pharmacists.

Interdisciplinary teaching-assisted education reform in "Principal Biology" / 生物工程学报

General education in biological courses such as "Principal Biology" is an essential avenue for gaining an understanding of life science and developing an interest in the field. The reform of biological education teaching mode based on interdisciplinary approaches aims to foster cross-disciplinary talents, which is crucial for the rapid development of China's bioeconomy. Teaching method that simply superimposes different subjects is difficult to discover the value of interdisciplinary education. To address this, a novel teaching system and an innovative teaching mode were proposed for "Principal Biology" course by integrating science and engineering subjects, based on the cross-disciplinary feature in Beijing Institute of Technology. The system involves the design of cross-disciplinary course content and the integration of multiple disciplines and knowledge points based on students' majors, taking into account the characteristics of students' physical and mental development. To improve students' scientific literacy and interdisciplinary thinking ability, differentiated and major-driven teaching modes were applied by incorporating the "1+N" mixed and immersive cross-thinking training. The effectiveness of tailored cross-disciplinary teaching was evaluated using "in-teaching" and "post-teaching" data feedback models, which promote the optimization of teaching process and enhance the quality of education in cross-disciplinary biological science.

A cross-sectional study on the response abilities of clinical and preventive medical students in public health emergency.

Inconsistent training programs for public health emergency (PHE) have been criticized as a contributing factor in PHE's managerial weak points. In response, to analyze the relevant discrepancies among the medical students in the class of 2021 from Xiangya School of Medicine of Central South University, the present study conducted an online questionnaire survey using convenience sampling. The questionnaire comprised four sections, including the basic information, the subjective cognition in PHE, the rescue knowledge and capabilities of PHE, and the mastery of PHE regulations and psychological intervention abilities. To compare the abovementioned aspects, related data were collected from 235 medical students divided into two groups, namely, clinical medical students (Group A) and preventive medical students (Group B). We found a more positive attitude in PHE (P = 0.014) and a better grasp of the PHE classification (P = 0.027) and the reporting system in group B compared with group A. In addition, even if group B showed the same response capability in communicable diseases as group A, the former had less access to clinical practice, resulting in poorer performance in the noncommunicable diseases during a fire, flood, and traffic accidents (P = 0.002, P = 0.018, P = 0.002). The different emphasis of each training program contributed to the uneven distribution of abilities and cognition. Meanwhile, the lack of an integrated PHE curriculum led to unsystematic expertise. Hence, to optimize the PHE management system, equal attention should be paid to medical students with diverse majors along with a complete integrated PHE curriculum.

Blind spots in medical education: how can we envision new possibilities?

As human beings, we all have blind spots. Most obvious are our visual blind spots, such as where the optic nerve meets the retina and our inability to see behind us. It can be more difficult to acknowledge our other types of blind spots, like unexamined beliefs, assumptions, or biases. While each individual has blind spots, groups can share blind spots that limit change and innovation or even systematically disadvantage certain other groups. In this article, we provide a definition of blind spots in medical education, and offer examples, including unfamiliarity with the evidence and theory informing medical education, lack of evidence supporting well-accepted and influential practices, significant absences in our scholarly literature, and the failure to engage patients in curriculum development and reform. We argue that actively helping each other see blind spots may allow us to avoid pitfalls and take advantage of new opportunities for advancing medical education scholarship and practice. When we expand our collective field of vision, we can also envision more "adjacent possibilities," future states near enough to be considered but not so distant as to be unimaginable. For medical education to attend to its blind spots, there needs to be increased participation among all stakeholders and a commitment to acknowledging blind spots even when that may cause discomfort. Ultimately, the better we can see blind spots and imagine new possibilities, the more we will be able to adapt, innovate, and reform medical education to prepare and sustain a physician workforce that serves society's needs.

Exploring social media technologies for novice EFL school teachers to collaborate and communicate: A case in the Czech Republic.

With an increasing number of international schools, traditional EFL teaching methods may not satisfy students' needs. This study aims to investigate perceptions of social media technologies (e.g., Web 2.0) and willingness to adopt such technologies to collaborate and communicate in multicultural classrooms among novice EFL schoolteachers in the Czech Republic. The participants were 100 novice EFL schoolteachers in Prague and the South Moravian regions of the Czech Republic. The study used a mixed research method consisting of a survey (stage 1) and a semi-structured interview (stage 2). The survey examined the participants' appraisal and concerns of using social media technologies to collaborate and to communicate as well as the level of willingness to use social media technologies. A hierarchical cluster analysis using participants' responses regarding their attitudes and behavioural tendency towards using Web 2.0 social media technologies in language classrooms identified three clusters of teachers. The teachers who were most likely to adopt social Web 2.0 technologies were those who had the highest ratings on both appraisals and concerns regarding the use of social media in language classrooms. The results from the semi-structured interviews were consistent with those from the survey. Together, the results from the two stages demonstrated that most pre-service teachers favoured using Web 2.0 technology for collaboration and communication among colleagues and stakeholders in a broader community, but they displayed contrasting levels of appraisal of and concerns towards using social media technologies. Participants believed that this might be due to their different levels of ICT proficiency, workload, and working environment. The political and practical implications in K-12 education in the Czech context are also discussed.

Whose voice counts? Examining government-donor negotiations in the design of Ethiopia's large-scale education reforms for equitable learning.

Motivation: The Government of Ethiopia has a long-standing commitment to improving the quality of education. In recent years, this has shifted to include a more explicit focus on equity in learning outcomes. In this paper, we examine the education reform design process in the context of Ethiopia's political environment which is widely recognised as a strong developmental state. Purpose: The article examines how federal, regional, and international donor actors negotiate their interests in relation to Ethiopia's national quality education reform programme, the General Education Quality Improvement Programme for Equity (GEQIP-E). Methods and approach: We conducted 81 semi-structured, key informant interviews with federal and regional government officials and international donors who were involved in the design of GEQIP-E. Findings: We find that federal government was able to leverage considerable political influence over high-level priorities and the framing of GEQIP-E. Large donors leveraged financial influence to exclude some specific priorities, while smaller donors were able to draw on social influence and technical expertise to include priorities aligned with their interests. Regional governments-which are responsible for policy implementation-were largely excluded from the reform design process. Policy implications: Our analysis highlights the importance of recognizing and understanding different forms of influence in the dynamic process of negotiating reform between government and donors. It identifies that both government and donor voices counted in the process of negotiations, but in different ways and to varying degrees. Understanding how different actors draw on their relative political, financial, and social influence is vital for ensuring successful implementation and sustainability. Importantly, we identify that voices of local actors are left out.

The medical education systems in China and Thailand: A comparative study.

Background and Aims: Both China and Thailand attach great importance to education and are committed to high educational standards on an international level. Our study is to compare the medical education reforms that have occurred in China and Thailand to further improve the medical education system in China. Methods: Through a search of official documents and prior studies, as well as consultation with Thai students studying in China, we gathered data regarding the evolution of the medical education systems in China and Thailand. The aggregate materials are incorporated into the summary and analysis. Results: Over 200 journals and literature were analyzed retrospectively. Thailand's medical education reforms encompass Western strategies without neglecting domestic cultural factors and priorities, and a standardized and medical education system has been established. Chinese medical education reform has yielded remarkable results, though further improvements remain necessary. Conclusion: Reforms of Thailand's medical education system offer important experiences and lessons for China, that the development of medical education needs to absorb the merits of others and also needs to have its own national characteristics. The key to medical education reform in China lies in the establishment of a system that is dedicated to science, while also serving its primary purpose of training high-level medical talent that can meet the needs of Chinese society.

Educational intervention on cervical and breast cancer screening: Impact on nursing students involved in primary care.

Introduction: Nurses are the foundation of the Indian health system. They play a crucial role in primary care and implementation of community-centered government health initiatives such as cancer screening. The purpose of this manuscript is to share the experience of this educational intervention study and emphasize the need for drastic medical education reforms to include curricula to strengthen knowledge about cancer screening among nursing students. Methods: A one-day workshop on "Cervical and breast cancer screening" was conducted for nursing students pursuing BSc Nursing (Group 1) and General Nursing and Midwifery (GNM) (Group 2) in India. A structured, self-administered questionnaire was administered among consented participants before and after the workshop to assess their knowledge and awareness on the subject at the baseline and the improvement they gained after the workshop. Results: Ninety-one students attempted both pre and post-surveys, of which 56 were from Group 1 and 35 from Group 2. Students demonstrated statistically significant improvements in knowledge on cervical and breast cancer screening after participating in the workshop. Conclusion: Undergraduate nursing education curricula must undergo medical education reform to include education and training for nurses in cancer screening and further motivate their increased participation in preventive cancer screening programs.