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Background Clinical reasoning is a fundamental skill in healthcare education, crucial for diagnosing and managing patient care effectively. Traditional pedagogical techniques often fall short in fully engaging students or simulating real-life medical decision-making complexities. Gamification, which applies game-design elements in educational settings, has emerged as a promising strategy to enhance learning outcomes by making the educational process more interactive and engaging. This scoping review aims to comprehensively map the existing literature on gamification techniques used to enhance clinical reasoning education, identifying trends, gaps, and opportunities for future research. Methods The review followed the Joanna Briggs Institute (JBI) methodology and the Arksey and O’Malley framework for scoping reviews. A systematic search of Medline, Scopus, and Web of science, complemented by hand-searching reference lists. Studies published between 2014 and 2023, focusing on gamification applied to clinical reasoning education for healthcare professionals and trainees, were eligible for inclusion. Two independent reviewers screened and selected studies, and data were extracted using a pre-defined tool. Findings were synthesized using both quantitative summaries and qualitative thematic analysis. Results Fifty-three studies met the inclusion criteria, representing research from 20 countries, with the United States contributing the largest proportion (28.3%), followed by Germany (9.4%) and France (7.6%). The majority of studies were cross-sectional (28.3%) or pilot studies (22.6%). Gamification was most frequently applied in university and academic settings (37.7%), followed by clinical and hospital-based training (18.9%), and digital platforms and simulations (17.0%). Medicine (28.3%) and nursing (22.6%) were the most targeted disciplines, with pharmacy (13.2%) following. Serious games were the most common gamification technique (45.3%), with additional strategies including escape rooms (11.3%), board and card games (7.5%), and branching case-based games (5.7%). Most studies (88.7%) referenced at least one theoretical framework, predominantly game-based learning theories (34.0%), followed by constructivist learning (13.2%) and experiential learning theories (13.2%). However, cognitive theories, directly relevant to clinical reasoning, were referenced in only 11.3% of studies, highlighting a theoretical gap. Conclusions Gamification offers diverse and flexible strategies for enhancing clinical reasoning education across healthcare disciplines and settings. However, significant gaps remain, including limited longitudinal evidence, inconsistent use of validated reasoning assessments, underutilization of cognitive reasoning theories, and a lack of standardized design and reporting frameworks. Moreover, research predominantly focuses on medicine and nursing, with limited attention to interprofessional reasoning and underrepresented fields such as dentistry, rehabilitation, and allied health. Future research should prioritize theoretically informed gamification design, apply robust reasoning outcome measures, and explore emerging technologies such as AI-enhanced adaptive gamification and immersive virtual reality simulations to support clinical reasoning development. Addressing these gaps will ensure that gamification evolves from a promising innovation into a rigorously evidence-based strategy for enhancing clinical reasoning competence in healthcare education.

IntroductionAs the field of radiation oncology continues to evolve with rapidly advancing technologies, the need for innovative educational methods is critical. Extended reality (XR) technologies—including virtual reality, augmented reality and mixed reality—have emerged as transformative tools in medical education. While the potential of XR in healthcare education is recognised, there is a lack of comprehensive exploration specifically in the context of radiation oncology education. This scoping review aims to map the existing literature on XR technologies in radiation oncology training and education, identify barriers to their adoption and highlight opportunities for broader integration into curricula.MethodsThis scoping review will follow the Arksey and O'Malley framework with enhancements by Levac et al and will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search will be conducted across databases, including MEDLINE, Scopus and Web of Science, to identify relevant studies on the use of XR technologies in radiation oncology education. Studies will be selected based on predetermined inclusion criteria using the population, concept, context framework. Data extraction will focus on the types of XR technologies used, educational settings, learning outcomes, barriers to adoption and methodologies for evaluating XR effectiveness. The results will be synthesised through descriptive statistics and qualitative thematic analysis. A consultation phase will engage experts to refine findings and ensure the practical relevance of the review.Ethics and disseminationThis protocol does not require ethics approval at the current stage as it involves a scoping review of publicly available literature. Ethics approval will be obtained prior to initiating the consultation phase involving experts. Written informed consent will be obtained from all individual participants included in the study. The study will be conducted in accordance with relevant guidelines and regulations and was approved by the Chang Gung Medical Foundation Institutional Review Board on 13 May 2025 (ref.: 202500731B0). The findings of this review will be disseminated through peer-reviewed publications, conference presentations and tailored executive summaries aimed at educators, policymakers and stakeholders in radiation oncology education.

IntroductionIn the rapidly evolving field of medical education, gamification has emerged as a promising strategy to enhance clinical reasoning skills among healthcare professionals. By incorporating game-like elements into the learning environment, gamification strives to enhance engagement, motivation and knowledge retention. Given the importance of clinical reasoning in medical decision-making and patient care, this scoping review protocol aims to systematically explore developments, implementations and outcomes of gamification in clinical reasoning education.Methods and analysisThe scoping review will follow the Arksey and O'Malley methodological framework, enhanced by guidelines from the Joanna Briggs Institute. We will search four major databases: OVID Medline, Scopus and Web of Science using key terms such as “gamification,” “clinical reasoning,” and “medical education”. Studies will be selected based on the participants, concepts and contexts (PCC) framework, focusing on literature published in English. Two independent reviewers will screen studies and extract data on gamification elements used in clinical reasoning education. Any disagreement between the reviewers will be resolved by consulting a third person. We will provide a narrative synthesis of the findings, highlighting the variety of gamified strategies and their effects on clinical reasoning skills. This review will also map out gaps in the current literature and provide direction for future research.Ethics and disseminationThe scoping review, which aggregates and synthesises publicly available studies, does not require ethics approval due to its nature as a compilation of existing research. The reporting of findings will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist, promoting both thoroughness and transparency in our analysis. Our dissemination plan encompasses publication in a peer-reviewed journal and presentations at academic conferences focused on medical education. This strategy is designed to engage educators, curriculum designers and policymakers within the sector, ensuring our insights reach those who can apply them most effectively.

Background Clinical reasoning is a critical skill for healthcare professionals, vital for making accurate diagnoses and effective treatment decisions. This study focuses on enhancing collaborative clinical reasoning (CCR) among multidisciplinary healthcare teams in a neurosurgery intensive care unit (NICU) in Taiwan. The study utilizes video-reflexive ethnography (VRE) to examine the factors influencing CCR, the cognitive processes involved, and the efficacy of VRE in promoting CCR. Methods The study employed a qualitative research design, utilizing VRE. Participants included 17 healthcare professionals from a NICU, comprising attending physicians, residents, nurses, and respiratory therapists. Data collection involved video recordings of daily ward rounds, field observations, and reflexive interviews where participants reviewed video clips of their interactions. Thematic analysis was conducted on the transcripts of video recordings and interview. Results Thematic analysis revealed seven key themes in CCR: information sharing, active verbal and behavioral information gathering, information processing and recall, modification and discussion, short-term indications, and management plans and goals. Information sharing was fundamental, with team members frequently exchanging patient data to ensure a common understanding. Active information gathering, both verbal and behavioral, was crucial for obtaining real-time patient insights. Cognitive processing involved synthesizing data to form initial hypotheses, while modification and discussion highlighted the iterative nature of CCR. Conclusions This study underscores the importance of effective communication, active information gathering, and iterative discussions in enhancing CCR. VRE proved to be a valuable tool for promoting self-awareness and continuous improvement among healthcare teams. The findings suggest that education programs should focus on developing teamwork and communication skills, and interventions should aim to optimize information flow and foster a culture of open communication. By enhancing CCR, healthcare teams can improve patient outcomes and ensure safer healthcare delivery. Clinical trial number Not required, as this is not a clinical trial and does not involve any healthcare interventions with human participants.

There is a paucity of research on the issue of alcohol provocation in the medical field. While studies have been performed concerning alcohol abuse among students, no studies have concentrated on alcohol provocation among medical professionals. Therefore, it is essential to look at the underlying factors that may influence alcohol use by medical professionals. A qualitative study using focus groups was conducted to construct themes depicting medical professionals’ experiences of alcohol provocation. Physicians (n = 32) and residents (n = 29) were recruited from a large teaching hospital in Taiwan. The volunteers included both subjects and instigators of alcohol provocation (individuals being pressured to drink and those who exert such pressure on others). A questionnaire on their alcohol use was used to quantitatively assess the prevalence of alcohol consumption and inebriation. The participants were then interviewed separately in groups. All interview data were recorded, transcribed and analysed thematically. A notable prevalence of recent alcohol consumption was observed in both the physicians (n = 18, 56%) and residents (n = 17, 59%). Three prominent themes were identified and summarized: (1) Social drinking in the Taiwanese medical profession (2) Workplace hierarchy and changes in drinking culture, and (3) Influence on the medical profession. The behaviour of alcohol provocation among these medical professionals was revealed with its underlying factors of specific cultural norms, workplace hierarchy and social expectations. An understanding of alcohol provocation helps increase the awareness of adverse consequences associated with alcohol provocation, encourage medical professionals to avoid inappropriate drinking behaviors, and reduce the risk of compromising medical professionalism.

Vancomycin-resistant Clostridium innocuum was recently identified as an etiologic agent for antibiotic-associated diarrhea in humans. We conducted a case-control study involving 152 C. innocuum-infected patients during 2014-2019 in Taiwan, using 304 cases of Clostridioides difficile infection (CDI) matched by diagnosis year, age (+2 years), and sex as controls. The baseline characteristics were similar between the 2 groups. C. innocuum-infected patients experienced more extraintestinal clostridial infection and gastrointestinal tract-related complications than did patients with CDI. The 30-day mortality rate among C. innocuum-infected patients was 14.5%, and the overall rate was 23.0%. Chronic kidney disease, solid tumor, intensive care unit admission, and shock status were 4 independent risk factors for death. C. innocuum identified from clinical specimens should be recognized as a pathogen requiring treatment, and because of its intrinsic vancomycin resistance, precise identification is necessary to guide appropriate and timely antimicrobial therapy.

The mechanical characteristics and mechanisms of rock failure involve complex rock mass mechanics problems involving parameters such as energy concentration, storage, dissipation, and release. Therefore, it is important to select appropriate monitoring technologies to carry out relevant research. Fortunately, infrared thermal imaging monitoring technology has obvious advantages in the experimental study of rock failure processes and energy dissipation and release characteristics under load damage. Therefore, it is necessary to establish the theoretical relationship between the strain energy and infrared radiation information of sandstone and to reveal its fracture energy dissipation and disaster mechanism. In this study, an MTS electro-hydraulic servo press was used to carry out uniaxial loading experiments on sandstone. The characteristics of dissipated energy, elastic energy, and infrared radiation during the damage process of sandstone were studied using infrared thermal imaging technology. The results show that (1) the transition of sandstone loading from one stable state to another occurs in the form of an abrupt change. This sudden change is characterized by the simultaneous occurrence of elastic energy release, dissipative energy surging, and infrared radiation count (IRC) surging, and it has the characteristics of a short duration and large amplitude variation. (2) With the increase in the elastic energy variation, the surge in the IRC of sandstone samples presents three different development stages, namely fluctuation (stage Ⅰ), steady rise (stage Ⅱ), and rapid rise (stage Ⅲ). (3) The more obvious the surge in the IRC, the greater the degree of local damage of the sandstone and the greater the range of the corresponding elastic energy change (or dissipation energy change). (4) A method of sandstone microcrack location and propagation pattern recognition based on infrared thermal imaging technology is proposed. This method can dynamically generate the distribution nephograph of tension-shear microcracks of the bearing rock and accurately evaluate the real-time process of rock damage evolution. Finally, this study can provide a theoretical basis for rock stability, safety monitoring, and early warning.

IntroductionThe realm of neurosurgery is currently witnessing a surge in primary research, underscoring the importance of adopting evidence-based approaches. Scoping reviews, as a type of evidence synthesis, offer a broad perspective and have become increasingly vital for managing the ever-expanding body of research in swiftly evolving fields. Recent research has indicated a rising prevalence of scoping reviews in healthcare literature. In this context, the concept of a ‘review of scoping reviews’ has emerged as a means to offer a higher level synthesis of insights. However, the field of neurosurgery appears to lack a comprehensive integration of scoping reviews. Therefore, the objective of this scoping review is to identify and evaluate the extent of scoping reviews within neurosurgery, pinpointing research gaps and methodological issues to enhance evidence-based practices in this dynamic discipline.MethodsThe method framework of Arksey and O’Malley will be used to conduct the scoping review. A thorough literature search will be performed on Medline, Scopus and Web of Science to find eligible studies using the keywords related to neurosurgery, scoping review and its variants. Two reviewers will independently revise all of the full-text articles, extract data and evaluate the study extent. A narrative overview of the findings from included studies will be given.Ethics and disseminationThis review will involve secondary analysis of published literature, and therefore ethics approval is not required. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist will be used to guide translation of findings. Results will be disseminated through peer-reviewed journals and presented in conferences via abstract and presentation.

Collaborative clinical reasoning (CCR) among healthcare professionals is crucial for maximizing clinical outcomes and patient safety. This scoping review explores CCR to address the gap in understanding its definition, structure, and implications. A scoping review was undertaken to examine CCR related studies in healthcare. Medline, PsychInfo, SciVerse Scopus, and Web of Science were searched. Inclusion criteria included full-text articles published between 2011 to 2020. Search terms included cooperative, collaborative, shared, team, collective, reasoning, problem solving, decision making, combined with clinical or medicine or medical, but excluded shared decision making. A total of 24 articles were identified in the review. The review reveals a growing interest in CCR, with 14 articles emphasizing the decision-making process, five using Multidisciplinary Team-Metric for the Observation of Decision Making (MDTs-MODe), three exploring CCR theory, and two focusing on the problem-solving process. Communication, trust, and team dynamics emerge as key influencers in healthcare decision-making. Notably, only two articles provide specific CCR definitions. While decision-making processes dominate CCR studies, a notable gap exists in defining and structuring CCR. Explicit theoretical frameworks, such as those proposed by Blondon et al. and Kiesewetter et al., are crucial for advancing research and understanding CCR dynamics within collaborative teams. This scoping review provides a comprehensive overview of CCR research, revealing a growing interest and diversity in the field. The review emphasizes the need for explicit theoretical frameworks, citing Blondon et al. and Kiesewetter et al. The broader landscape of interprofessional collaboration and clinical reasoning requires exploration.

Endothelial hyperpermeability is pivotal in sepsis-associated multi-organ dysfunction. Increased von Willebrand factor (vWF) plasma levels, stemming from activated platelets and endothelium injury during sepsis, can bind to integrin αvβ3, exacerbating endothelial permeability. Hence, targeting this pathway presents a potential therapeutic avenue for sepsis. Recently, we identified isaridin E (ISE), a marine-derived fungal cyclohexadepsipeptide, as a promising antiplatelet and antithrombotic agent with a low bleeding risk. ISE’s influence on septic mortality and sepsis-induced lung injury in a mouse model of sepsis, induced by caecal ligation and puncture, is investigated in this study. ISE dose-dependently improved survival rates, mitigating lung injury, thrombocytopenia, pulmonary endothelial permeability, and vascular inflammation in the mouse model. ISE markedly curtailed vWF release from activated platelets in septic mice by suppressing vesicle-associated membrane protein 8 and soluble N-ethylmaleide-sensitive factor attachment protein 23 overexpression. Moreover, ISE inhibited healthy human platelet adhesion to cultured lipopolysaccharide (LPS)-stimulated human umbilical vein endothelial cells (HUVECs), thereby significantly decreasing vWF secretion and endothelial hyperpermeability. Using cilengitide, a selective integrin αvβ3 inhibitor, it was found that ISE can improve endothelial hyperpermeability by inhibiting vWF binding to αvβ3. Activation of the integrin αvβ3-FAK/Src pathway likely underlies vWF-induced endothelial dysfunction in sepsis. In conclusion, ISE protects against sepsis by inhibiting endothelial hyperpermeability and platelet-endothelium interactions.