The increasing interest in Turkish educational programs has led to the increasing interest in educational migration among the younger Iranian generations. Instructors, as the executive part of educational programs, can also play a key role in satisfying students\' expectations and educational goals. The aim of this study was to identify and compare the Critical Openness (CO), Reflective Skepticism (RS), innovative thinking (IT), external accountability (EA), and internal accountability (IA) for the Iranian and Turkish English as Foreign Language (EFL) instructors through an online survey with Critical Thinking Theory and the 21st century skill consideration lens. To this end, a convenient sample of Iranian (N = 286) and Turkish (N = 281) EFL instructors were invited to take part in the online survey voluntarily. The scales consisted of the Likert scales of Rosenblatt (2017) [1], Semerci (2007) [2], and Sosu (2013) [3], because the conceptual frameworks were also taken from these studies. In the analysis stage, MANOVA was conducted to compare the results of the online survey between Iranian and Turkish EFL instructors in terms of their level of CO, RS, IT, EA, and IA. The analysis of the collected data uncovered that Turkish EFL instructors got higher scores in CO, RS, EA, and IA than Iranian EFL instructors while Iranian EFL instructors received higher scores in the employment of IT. The implications of the results would suggest collaborations between educational policymakers and teacher training course designers.

BACKGROUND: Organizations place strong emphasis on the standardized occupational health and safety procedures to reduce work-related illnesses and workplace accidents. However, standardized procedures are not always followed up in daily work practices. Organizations must cope with the differences between standardized procedures and local adaptation by employees.
METHODS: This ethnographic field study at an industrial workplace in the Netherlands provides insights into employees\' everyday work practices, how these work practices are shaped, and how they relate to local occupational health and safety procedures. Acknowledging safety as a competency embedded in work practices, as introduced by Gherardi and Nicolini (2002), offers a theoretical point of view for looking beyond the dichotomy of standardization and local adaptations.
RESULTS: The results show that a standardized and noncontextualized occupational health and safety management system that focuses on accident-free days and compliance actually leads to ignorance of practical and tacit competences of workers and no learning and improvement of safety procedures can take place. However, our findings also illustrate how employees in their informal everyday work practices reduce the risks produced by the safety system itself.
CONCLUSIONS: Overall, the results indicate that social interactions among employees, leaders, and management within the organization play an important role in workplace safety. The analysis highlights the value of vulnerability and trust in relationships at work to be able to learn and develop safety procedures that align with local demands.
CONCLUSIONS: This study emphasizes the need for participatory approaches in creating safer and healthier workplaces. The cocreation of occupational health and safety (OHS) rules and procedures, however, can only function if they are combined with a responsive leadership style.

IntroductionGlobal health collaborations between individuals from high-resource and low-resource settings are complex and often built on hierarchical structures and power differentials that are difficult to change. There have been many calls and frameworks developed to facilitate more equity within these collaborations, yet little is known about the lived experiences of global health donors and recipients working within such collaborations and how those experiences can facilitate more equitable collaboration. Liberia, a postconflict, post-Ebola country, provides an ideal setting to study lived experiences of global health collaborations.MethodsOur qualitative analysis used key informant interviews representing the perspectives of those working on behalf of the Liberian government, Liberian academics, foreign donors and non-governmental organisations and implementing partners. Thematic analysis guided this analysis to explore topics such as financial control, accountability and decision making.ResultsThe first phase of the analysis mapped the existing patterns of priority setting. Priority-setting power was most strongly held by those with financial control (donors), and implementation plans tended to be built on metrics that aim to meet donor expectations. The second phase of the analysis explored the interplay between underlying factors that we identified in our data associated with driving collaborative inequity: history of prior of engagement, level of transparency and patterns of accountability.ConclusionsOur findings highlight that global health collaborations in Liberia are structured to hinder equitable partnerships. The power structure tied to financial ownership offers little space for recipients to have an equitable role in collaborations, which maintains dependence on external aid and ensures that weak systems remain weak. While our study is limited to Liberia, we anticipate that these dynamics are common elsewhere and reinforce the importance of intentional efforts to ensure equitable decision making and power structures in similar settings worldwide.

To examine the understanding of the ethical dilemmas associated with Big Data and artificial intelligence (AI) among Jordanian medical students, physicians in training, and senior practitioners.
We implemented a literature-validated questionnaire to examine the knowledge, attitudes, and practices of the target population during the period between April and August 2023. Themes of ethical debate included privacy breaches, consent, ownership, augmented biases, epistemology, and accountability. Participants\' responses were showcased using descriptive statistics and compared between groups using t-test or ANOVA.
We included 466 participants. The greater majority of respondents were interns and residents (50.2%), followed by medical students (38.0%). Most participants were affiliated with university institutions (62.4%). In terms of privacy, participants acknowledged that Big Data and AI were susceptible to privacy breaches (39.3%); however, 59.0% found such breaches justifiable under certain conditions. For ethical debacles involving informed consent, 41.6% and 44.6% were aware that obtaining informed consent posed an ethical limitation in Big Data and AI applications and denounced the concept of \"broad consent\", respectively. In terms of ownership, 49.6% acknowledged that data cannot be owned yet accepted that institutions could hold a quasi-control of such data (59.0%). Less than 50% of participants were aware of Big Data and AI\'s abilities to augment or create new biases in healthcare. Furthermore, participants agreed that researchers, institutions, and legislative bodies were responsible for ensuring the ethical implementation of Big Data and AI. Finally, while demonstrating limited experience with using such technology, participants generally had positive views of the role of Big Data and AI in complementing healthcare.
Jordanian medical students, physicians in training and senior practitioners have limited awareness of the ethical risks associated with Big Data and AI. Institutions are responsible for raising awareness, especially with the upsurge of such technology.

UNASSIGNED: Ecological momentary assessment (EMA) is an increasingly used tool for data collection in behavioral research, including smoking cessation studies. As previous addiction research suggests, EMA has the potential to elicit cue reactivity by triggering craving and increasing behavioral awareness. However, there has been limited evaluation of its potential influence on behavior.
UNASSIGNED: By examining the perspectives of research participants enrolled in a tobacco treatment intervention trial, this qualitative analysis aims to understand the potential impact that EMA use may have had on smoking behaviors that may not have otherwise been captured through other study measures.
UNASSIGNED: We performed a qualitative analysis of in-depth interviews with participants enrolled in a pilot randomized controlled trial of a tobacco treatment intervention that used SMS text messaging to collect EMA data on smoking behaviors. In the pilot randomized controlled trial, combustible cigarette and e-cigarette use and smoking-related cravings were measured as part of an EMA protocol, in which SMS text messaging served as a smoking diary. SMS text messaging was intended for data collection only and not designed to serve as part of the intervention. After a baseline assessment, participants were asked to record daily nicotine use for 12 weeks by responding to text message prompts that they received 4 times per day. Participants were prompted to share their experiences with the EMA text messaging component of the trial but were not directly asked about the influence of EMA on their behaviors. Transcripts were coded according to the principles of the framework for applied research. The codes were then examined, summarized, and grouped into themes based on the principles of grounded theory.
UNASSIGNED: Interviews were analyzed for 26 participants. The themes developed from the analysis suggested the potential for EMA, in the form of an SMS text messaging smoking diary, to influence participants\' smoking behaviors. The perceived impacts of EMA text messaging on smoking behaviors were polarized; some participants emphasized the positive impacts of text messages on their efforts to reduce smoking, while others stressed the ways that text messaging negatively impacted their smoking reduction efforts. These contrasting experiences were captured by themes reflecting the positive impacts on smoking behaviors, including increased awareness of smoking behaviors and a sense of accountability, and the negative impacts on emotions and smoking behaviors, including provoking a sense of guilt and triggering smoking behaviors.
UNASSIGNED: The collection of EMA smoking behavior data via SMS text messaging may influence the behaviors and perceptions of participants in tobacco treatment interventions. More research is needed to determine the magnitude of impact and mechanisms, to account for the potential effects of EMA. A broader discussion of the unintended effects introduced by EMA use is warranted among the research community.

BACKGROUND: Social accountability (SA) within medical education signifies a commitment to address critical regional, societal, and national issues through educational, research, and service activities. In resource-limited regions, marginalized communities face barriers to accessing quality healthcare, and the concept of SA is often poorly understood by students. This study aims to investigate the perspectives, awareness, and comprehension of Syrian medical students regarding the concepts and principles of SA.
METHODS: This cross-sectional online study was conducted in Syria from June 1st to July 25th, 2023, to assess the perspectives on SA among medical students enrolled in pre-clinical and clinical phases from the 3rd to the 6th year, encompassing both stream I and stream II. The questionnaire included three parts: consent and introduction, socio-demographic data, and a 12-item survey assessing social accountability. Data were analyzed using Statistical Package for the Social Sciences software version 24 (SPSS 24).
RESULTS: A total of 1312 medical students (62.3% females vs. 37.7% males) participated in our analysis. Less than half of the participants (45.7%) reported that their institution had a limited social mission statement regarding the communities they serve. However, only 39.6% reported that their curriculum partially reflected the needs of the population they serve. A mere 7.5% and 6.8% of respondents indicated that their school had excellent community partners and stakeholders shaping their institution, and they learned significantly about other cultures and social circumstances in the medical context through their curriculum. About 24.1% reported that their institution required them to engage in a substantial amount of community-based learning, and 37.4% believed that their class reflected a good representation of socio-demographic characteristics of the reference population. A significant portion of the participants (44.3%) stated that their school did not encourage them to pursue generalist specialties, and 12.7% felt that their institution did not have a positive impact on the community. Among the included participants, 45.8% had some level of SA status, while 37.7% indicated good SA status. Age, gender, and the phase of study were the only sociodemographic characteristics statistically associated with SA status (p-value < 0.05). The association between the 12 items determining SA and the year of study was statistically significant for seven items (p-value < 0.05). However, adjusted logistic regression revealed no significant correlation between predicting SA status and sociodemographic factors (p-value > 0.05).
CONCLUSIONS: This study underscores the significant influence of clinical experience and gender on Syrian medical students\' perceptions of SA. To enhance these perceptions, medical institutions should tailor support services for different stages of training and target initiatives to engage male students.

Country-owned, as opposed to donor-driven, is a principle within the development sector that recognizes the centrality of countries\' leadership, systems, and resources in executing programs and achieving sustainable development. In alignment with this notion, the Immunization Agenda 2030 was developed with country ownership as one of four core principles of the ambitious ten-year plan. This means that the success of immunization programs, including those with eradication and elimination goals such as polio, measles, and rubella, and those with broader equity goals to \"leave no one behind\" on immunization, would be largely driven by country systems. In this paper we deconstruct country ownership into five operational principles: commitment, coordination, capacity, community participation, and accountability. Through this lens, we illustrate how two countries, Nepal and Nigeria, have exemplified country ownership in their measles and rubella elimination programs and we infer the ways in which country ownership drives system performance and sustains program efforts.

BACKGROUND: Psychological safety and accountability are frameworks to describe relationships in the workplace. Psychological safety is a shared belief by members of a team that it is safe to take interpersonal risks. Accountability refers to being challenged and expected to meet expectations and goals. Psychological safety and accountability are supported by relational trust. Relational continuity is the educational construct underpinning longitudinal integrated clerkships. The workplace constructs of psychological safety and accountability may offer lenses to understand students\' educational experiences in longitudinal integrated clerkships.
METHODS: We performed a qualitative study of 9 years of longitudinal integrated clerkship graduates from two regionally diverse programs-at Harvard Medical School and the University of North Carolina School of Medicine. We used deductive content analysis to characterize psychological safety and accountability from semi-structured interviews of longitudinal integrated clerkship graduates.
RESULTS: Analysis of 20 graduates\' interview transcripts reached saturation. We identified 109 discrete excerpts describing psychological safety, accountability, or both. Excerpts with high psychological safety described trusting relationships and safe learning spaces. Low psychological safety included fear and frustration and perceptions of stressful learning environments. Excerpts characterizing high accountability involved increased learning and responsibility toward patients. Low accountability included students not feeling challenged. Graduates\' descriptions with both high psychological safety and high accountability characterized optimized learning and performance.
CONCLUSIONS: This study used the workplace-based frameworks of psychological safety and accountability to explore qualitatively longitudinal integrated clerkship graduates\' experiences as students. Graduates described high and low psychological safety and accountability. Graduates\' descriptions of high psychological safety and accountability involved positive learning experiences and responsibility toward patients. The relational lenses of psychological safety and accountability may inform faculty development and future educational research in clinical medical education.

BACKGROUND: Central to Safety-II is promoting resilience of healthcare practices. In the \"Room for Resilience\" research project we focus on the role of horizontal and vertical accountability in healthcare teams and aim to discover how the relation between the two impacts team reflections and discussions. In this article, we report on an explorative study at the start of the project which aimed to assess the structures and dynamics of horizontal and vertical accountability.
METHODS: A qualitative study in six teams in three hospitals in the Netherlands. For the project, each team selected a specific clinical process to work on (e.g. pain assessment). We interviewed healthcare professionals, managers, and quality advisors about these processes, how they are discussed in practice and how teams need to account for them. Additionally, we observed the processes and how teams discuss them in practice. In total, we conducted 35 interviews and 67.5 h of observation. Transcripts and field notes were analyzed using thematic analysis.
RESULTS: Professionals at times varied in what they considered the right approach in the clinical process, with differing views on the importance of certain actions. When processes were discussed, this mostly was done during clinical work, and it often concerned reflections about the care for a specific patient instead of reflecting on the team\'s general approach of the clinical process. Organized reflections on the processes were sparse. How processes were conducted in practice deviated from guidelines, mainly due to staff shortages, a perceived lack of value of a guideline, equipment issues, and collaboration issues. For most processes, accountability to hierarchical layers consisted of quality indicator scores. Professionals were tasked with registering indicator data but did not find this meaningful for their work.
CONCLUSIONS: The observed different perspectives within teams on what good quality care is show the importance of having team reflections about these processes. How vertical accountability was organized at times impacted the conditions for teams to discuss resilient performance. Following these findings, we recommend that reflection on resilient practice and the role of accountability processes is organized on all levels in (and outside) the organization.

This study aimed to examine the relationship between perceived unit practice councils\' functionality and nurses\' accountability in Saudi Arabia.
A descriptive, correlational and cross-sectional design was used.
Convenience sampling of 160 nurses working in multiple sites of a large, tertiary medical centre in Saudi Arabia was performed. Structured self-administered questionnaires were used to measure perceived unit practice council functionality and levels of nurse accountability.
Nurses perceived that unit practice councils had moderate levels of functionality; however, nurses had high levels of accountability. Also, perceived unit practice councils\' functionality had a significant positive relationship with nurses\' accountability (r = 0.49, p < 0.001). More studies are needed to investigate the impact of different shared governance models on nurses\' work environments.