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In the field of health care, knowledge and clinical reasoning are key with regard to quality and confidence in decision making. The development of knowledge and clinical reasoning is influenced not only by students' intrinsic factors but also by extrinsic factors such as satisfaction with taught content, pedagogic resources and pedagogic methods, and the nature of the objectives and challenges proposed. Nowadays, professors play the role of learning facilitators rather than simple \"lecturers\" and face students as active learners who are capable of attributing individual meanings to their personal goals, challenges, and experiences to build their own knowledge over time. Innovations in health simulation technologies have led to clinical virtual simulation. Clinical virtual simulation is the recreation of reality depicted on a computer screen and involves real people operating simulated systems. It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings. Clinical virtual simulation can provide a pedagogical strategy and can act as a facilitator of knowledge retention, clinical reasoning, improved satisfaction with learning, and finally, improved self-efficacy. However, little is known about its effectiveness with regard to satisfaction, self-efficacy, knowledge retention, and clinical reasoning. This study aimed to evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students. A randomized controlled trial with a pretest and 2 posttests was carried out with Portuguese nursing students (N=42). The participants, split into 2 groups, had a lesson with the same objectives and timing. The experimental group (n=21) used a case-based learning approach, with clinical virtual simulator as a resource, whereas the control group (n=21) used the same case-based learning approach, with recourse to a low-fidelity simulator and a realistic environment. The classes were conducted by the usual course lecturers. We assessed knowledge and clinical reasoning before the intervention, after the intervention, and 2 months later, with a true or false and multiple-choice knowledge test. The students' levels of learning satisfaction and self-efficacy were assessed with a Likert scale after the intervention. The experimental group made more significant improvements in knowledge after the intervention (P=.001; d=1.13) and 2 months later (P=.02; d=0.75), and it also showed higher levels of learning satisfaction (P<.001; d=1.33). We did not find statistical differences in self-efficacy perceptions (P=.9; d=0.054). The introduction of clinical virtual simulation in nursing education has the potential to improve knowledge retention and clinical reasoning in an initial stage and over time, and it increases the satisfaction with the learning experience among nursing students.

Objective To quantify the accuracy and reproducibility of pathologists’ diagnoses of melanocytic skin lesions.Design Observer accuracy and reproducibility study.Setting 10 US states.Participants Skin biopsy cases (n=240), grouped into sets of 36 or 48. Pathologists from 10 US states were randomized to independently interpret the same set on two occasions (phases 1 and 2), at least eight months apart.Main outcome measures Pathologists’ interpretations were condensed into five classes: I (eg, nevus or mild atypia); II (eg, moderate atypia); III (eg, severe atypia or melanoma in situ); IV (eg, pathologic stage T1a (pT1a) early invasive melanoma); and V (eg, ≥pT1b invasive melanoma). Reproducibility was assessed by intraobserver and interobserver concordance rates, and accuracy by concordance with three reference diagnoses.Results In phase 1, 187 pathologists completed 8976 independent case interpretations resulting in an average of 10 (SD 4) different diagnostic terms applied to each case. Among pathologists interpreting the same cases in both phases, when pathologists diagnosed a case as class I or class V during phase 1, they gave the same diagnosis in phase 2 for the majority of cases (class I 76.7%; class V 82.6%). However, the intraobserver reproducibility was lower for cases interpreted as class II (35.2%), class III (59.5%), and class IV (63.2%). Average interobserver concordance rates were lower, but with similar trends. Accuracy using a consensus diagnosis of experienced pathologists as reference varied by class: I, 92% (95% confidence interval 90% to 94%); II, 25% (22% to 28%); III, 40% (37% to 44%); IV, 43% (39% to 46%); and V, 72% (69% to 75%). It is estimated that at a population level, 82.8% (81.0% to 84.5%) of melanocytic skin biopsy diagnoses would have their diagnosis verified if reviewed by a consensus reference panel of experienced pathologists, with 8.0% (6.2% to 9.9%) of cases overinterpreted by the initial pathologist and 9.2% (8.8% to 9.6%) underinterpreted.Conclusion Diagnoses spanning moderately dysplastic nevi to early stage invasive melanoma were neither reproducible nor accurate in this large study of pathologists in the USA. Efforts to improve clinical practice should include using a standardized classification system, acknowledging uncertainty in pathology reports, and developing tools such as molecular markers to support pathologists’ visual assessments.

\"Have you ever looked at a heavy volume on neuropsychology and wondered what it would actually be like to become a professional clinician, working every day with neurological patients in a busy hospital while simultaneously learning your craft? This book tells the story of that journey. a The Notebook of a New Clinical Neuropsychologist vividly details the experience of starting work in clinical neuropsychology, exploring early-career learning and development through an intimate, case-based approach. Topics include the learning of basic clinical skills and knowledge, counter-transference, the clinician's emotional experiences, ethical and moral dilemmas, and the development of clinical reasoning. The book is structured around individual studies from the author's early caseload, with each vignette containing the relevant neuropathology, clinical presentation, history, neuropsychological test finding and other clinical data. Chapters are also organized around key neuropathological conditions, including traumatic brain injury, stroke, and brain infections, which provide a broader context for the narrative focus of the book. A few academic books explore the personal, intellectual and ethical dilemmas that face a new clinician working with patients in a neuropsychological setting. Tailored to facilitate experiential learning via case studies, reflective practice and problem based-learning, the book will be of interest to students and professionals working within the broad area of neuropsychology and brain injury services.\"--Publisher description.

This study aimed to develop two scales to measure nursing students' clinical emotional intelligence (Clin-EI) and clinical competency (Clin-COM) and evaluate the effects of hybrid simulation on their clinical EI and competency. Hybrid clinical simulation training prepares learners for a complex and demanding clinical environment, facilitates practice readiness and develops a sense of emotional stability. Low emotional intelligence (EI) can compromise patient safety and quality of care. This study applied experimental research design and a randomized controlled trial was conducted. Two hundred and twelve nursing students were randomly selected, dividing them into group A (exposed to traditional clinical training) and group B (exposed to hybrid simulation along with traditional clinical training). Exploratory Factor Analysis results revealed a three-factor model for the Clin-EI tool and a one-factor model for Clin-COM. Internal consistency indicators by factor level of Clin-EI (⍺ = 0.86–0.95) and Clin-COM (⍺ = 0.98) indicate good to excellent. The acquired clinical EI, clinical competency and OSCE performance of group B were higher compared with group A with mean differences of −0.889, −0.887 and −7.08 respectively, p-values were all < .001. The factors effect sizes appeared negatively Clin-EI (-0.830), Clin-COM (-0.757) and OSCE (-0.606). All variables have strong significant correlations (p-values <0.001) within both groups. The combination of traditional clinical teaching and hybrid simulation has positively influenced the acquired EI, clinical competency and OSCE performance of nursing students. Developing a high level of clinical EI and competency ensures safe nursing practice. ●Hybrid simulation is a powerful clinical training strategy to improve EI and competency, ensuring practice readiness.●A combination of traditional clinical teaching and hybrid simulation positively influenced EI and clinical competency.●A high level of EI through hybrid simulation training facilitates clinical competency, ensuring safe nursing practice.

The WhatsApp smartphone app is the most widely used instant messaging app in the world. Recent studies reported the use of WhatsApp for educational purposes, but there is no prospective study comparing WhatsApp's pedagogical effectiveness to that of any other teaching modality. The main objective of this study was to measure the impact of a learning program via WhatsApp on clinical reasoning in medical residents. This prospective, randomized, multicenter study was conducted among first- and second-year anesthesiology residents (offline recruitment) from four university hospitals in France. Residents were randomized in two groups of online teaching (WhatsApp and control). The WhatsApp group benefited from daily delivery of teaching documents on the WhatsApp app and a weekly clinical case supervised by a senior physician. In the control group, residents had access to the same documents via a traditional computer electronic learning (e-learning) platform. Medical reasoning was self-assessed online by a script concordance test (SCT; primary parameter), and medical knowledge was assessed using multiple-choice questions (MCQs). The residents also completed an online satisfaction questionnaire. In this study, 62 residents were randomized (32 to the WhatsApp group and 30 to the control group) and 22 residents in each group answered the online final evaluation. We found a difference between the WhatsApp and control groups for SCTs (60% [SD 9%] vs 68% [SD 11%]; P=.006) but no difference for MCQs (18/30 [SD 4] vs 16/30 [SD 4]; P=.22). Concerning satisfaction, there was a better global satisfaction rate in the WhatsApp group than in the control group (8/10 [interquartile range 8-9] vs 8/10 [interquartile range 8-8]; P=.049). Compared to traditional e-learning, the use of WhatsApp for teaching residents was associated with worse clinical reasoning despite better global appreciation. The use of WhatsApp probably contributes to the dispersion of attention linked to the use of the smartphone. The impact of smartphones on clinical reasoning should be studied further.

This study aims to examine the effect of urinary catheter application training based on the ARCS motivation model on learning motivation, self-efficacy and skill levels of nursing students. Effective clinical skills training in nursing requires motivational and supportive teaching methods. The ARCS model promotes active learning through attention, relevance, confidence and satisfaction. The study employed a randomised controlled pre-test-post-test experimental design. The study was conducted between April and June 2025 with 56 students studying in the nursing department of a university in eastern Turkey and taking the course of basic principles and practices in nursing. The participants were divided into experimental and control groups by a simple randomisation method. Both groups were trained in urinary catheterisation with the traditional method. The students in the experimental group received urinary catheterisation training based on the ARCS motivation model. Data were collected using the \"Introductory Information Form\", \"Motivation Scale for Instructional Material\", \"Academic Self-Efficacy Scale\" and \"Urinary Catheter Application Skill Assessment Form”. The students in the experimental group showed a statistically significant increase in the \"Attention\", \"Relevance\", \"Confidence\", \"Satisfaction\" dimensions and \"Skill Assessment Form\" scores in the post-test (p < 0.05). However, no significant difference was detected in terms of \"Academic Self-Efficacy\" scale scores in both intra- and inter-group comparisons (p > 0.05). The findings of the study revealed that the urinary catheter application training structured based on the ARCS motivation model significantly improved nursing students' learning motivation and psychomotor skills. However, the training did not have a statistically significant effect on students' academic self-efficacy levels.