We examine new doctors\' and nurses\' experiences of transitioning from training to practising as health professionals, drawing on the concept of liminality. Liminality is a stage of \'in-betweenness\', involving uncertainty and ambiguity as people leave one social context and reintegrate into a new one. Surprisingly little research has explored new health professionals\' experiences of liminality during role and career transitions, particularly in precarious and resource-constrained settings. Drawing on 146 qualitative interviews and seven focus groups, involving 121 new graduate medical doctors and nurses transitioning through internship training in Kenya, we describe three aspects of liminality. First, liminal professional practice, where interns realise that best practices learned during medical and nursing schools are often impossible to implement in resource constrained health care settings; instead they learn workarounds and practical norms. Second, liminal relational identities, where interns leave behind being students and adopt the identities and responsibilities of qualified professionals within pre-existing professional hierarchies of status and expertise. We explain how these new doctors and graduate nurses negotiate their liminal status, including in relation to more experienced but less qualified professional colleagues. We also discuss how interns cope with liminality due to disappointing and inadequate supervision and role modelling from senior colleagues but then find peer support and their place within their own professions. Finally, we discuss how new doctors and nurses come to terms with the precarity of working in resource constrained health systems, abandon expectations of secure, permanent employment and careers, and accept the realities of liminal professional careers. We explain how all three forms of liminality influence professionals\' developing practices, identities, and careers. We call for further studies with a specific liminality lens to explore this critical period in health workers\' careers, to inform policy and practice responding to global transformations in healthcare professions and practice.

OBJECTIVE: The aim of the study was to review the 2010 Australian nurse teacher professional practice standards (\'the Standards\') to see if they were still relevant to current nursing educator practice in any practice setting, such as academia or clinical settings.
BACKGROUND: It has been over 10 years since \'the Standards have been reviewed. Nurse education practice has met many challenges in the past decade, so it is timely to evaluate whether the Standards are still relevant to nursing educators today.
METHODS: A modified Delphi technique was used for this study.
METHODS: Delphi surveys were used to obtain consensus on the relevance of the Standards\' statements to any nursing educator. Links to two electronic surveys were sent to an expert panel of nursing educator leaders. Also, two online focus groups of nursing educators from any practice setting or level of experience were held. Results from the first survey and focus groups led to word changes and additional statements, which were included in the second Delphi survey.
RESULTS: Forty participants responded to the first survey and 38 to the second. Fifteen nursing educators attended the focus groups. There was ≥85 % agreement on all statements in the first survey. with similar high agreement responses in the second survey. Changes in the Standards included language used around culture, inclusion of \'sustainability of the program\' and \'demonstrates knowledge and expertise in teaching and educational practice\'.
CONCLUSIONS: The Australian nurse teacher professional practice standards remain highly relevant to nursing educators across all practice settings. In response to feedback from nursing educators some changes to language and additional standard statements were included in the revised standards.

UNASSIGNED: Parent child interaction (PCI) is positively associated with deaf children\'s language development. However, there are no known, deaf-specific tools to observe how a parent interacts with their deaf child aged 0-3 years. Without a framework for professionals to use with families, it is unknown how professionals assess PCI, what they assess, why they assess, and how the assessment results relate to case management.
UNASSIGNED: Eighteen hearing and deaf professionals, who work with deaf and hard of hearing infants aged 0-3 years and their families, attended online focus groups. The aim of the study was to gain insight into the professional assessment of PCI. Data were analyzed using thematic analysis.
UNASSIGNED: Six themes were generated from the dataset. Professionals discussed how central parents were in the support offered to families in the home, the importance of knowing and understanding the individual family, and accounting for and supporting parental wellbeing. Descriptions on how to administer a best practice PCI assessment included which parent behaviors to assess and how to make adaptations for different populations. Professionals shared how the assessment and review process could be used to inform and upskill parents through video reflection and goal setting.
UNASSIGNED: This study provides insight into the mechanisms and motivations for professionals assessing the interactive behaviors of parents who have deaf children aged 0-3. Professionals acknowledged that family life is multi-faceted, and that support is most meaningful to families when professionals worked with these differences and incorporated them into assessment, goal setting, and intervention plans.

BACKGROUND: This longitudinal study using qualitative methodology aims to investigate the perceptions, and implementation, of evidence-based guidelines into practice among new dental graduates (NDGs) during their transition from university into professional practice, by identifying factors that influence the adoption of evidence-based practice (EBP) in dental practice.
METHODS: The study invited NDGs from one UK dental school (N = 66) and employed longitudinal, multiple qualitative methodologies for data collection, throughout the participants\' Vocational Dental Training (VDT) year. Initial interviews (Interview 1) conducted upon graduation and follow-up interviews (Interview 2) carried out between six and nine months into professional practice were combined with participants longitudinal audio diaries (LADs) recorded between the interviews.
METHODS:
RESULTS: A total of 12 NDGs agreed to participate. For Interview 1, twelve participants were interviewed, seven of whom agreed to participate in Interview 2 and six recorded the LADs. Interview 1 exposed diverse views among NDGs about EBP, acknowledging its significance but facing obstacles in implementation due to time and financial constraints. They intended to use evidence selectively, often aligning with trainers\' or NHS treatment options, while hesitating to fully embrace EBP in a busy dental practice. During VDT, LAD entries showed initial enthusiasm for EBP, but integrating evidence-based guidelines within the NHS system led to pragmatic treatment decisions, balancing gold-standard and cost-effective options. Over time, NDGs became more comfortable with alternative treatments, considering patients\' financial constraints, yet they expressed frustration with external pressures limiting their clinical decision-making autonomy. In Interview 2, after six to nine months in practice, NDGs exhibited mixed attitudes towards EBP. Some actively used dental guidelines like SDCEP, others associated EBP with hi-tech or expensive materials, while others would thought to rely on colleagues\' recommendations. None consistently sought direct evidence for treatment decisions.
CONCLUSIONS: NDGs\' attitudes towards EBP changed and became more negative over their first year in professional practice, leading to challenges in their applying it. It questions the assumption that teaching EBP during undergraduate education ensures its implementation. Further understanding the influences on the development of attitudinal challenges will help to devise effective strategies for fostering lifelong learning and supporting evidence-based practice in dentistry.

OBJECTIVE: To analyze the convergence of nurse\'s autonomy expressed in Brazilian and Portuguese professional practice legislation.
METHODS: Qualitative, social-historical documentary study on the normalization of Brazilian and Portuguese professional standards for nursing practice, materials socialized in the digital collection of the profession\'s organizational and disciplinary entities. Qualitative analysis from the perspective of Eliot Freidson\'s sociology of professions.
RESULTS: Ten standards were analyzed, five from each country, which establish legislation for the nurses\' professional practice. The following categories emerged: autonomy of knowledge and specific competence of the profession, in the ethical limits of the multi-professional relationship and in the disciplining of training for professional practice.
CONCLUSIONS: The professional autonomy under analysis implies providing access to services and to multi-professionality for the availability of health to society.

BACKGROUND: Mechanically ventilated patients are at risk of developing inspiratory muscle weakness (IMW), which is associated with failure to wean and poor outcomes. Inspiratory muscle training (IMT) is a recommended intervention during and after extubation but has not been widely adopted in Dutch intensive care units (ICUs).
OBJECTIVE: The objective of this study was to explore the potential, barriers, and facilitators for implementing IMT as treatment modality for mechanically ventilated patients.
METHODS: This mixed-method, proof-of-concept study was conducted in a large academic hospital in the Netherlands. An evidence-based protocol for assessing IMW and training was applied to patients ventilated for ≥24 h in the ICU during an 8-month period in 2021. Quantitative data on completed measurements and interventions during and after ICU-stay were collected retrospectively and were analysed descriptively. Qualitative data were collected through semistructured interviews with physiotherapists executing the new protocol. Interview data were transcribed and thematically analysed.
RESULTS: Of the 301 screened patients, 11.6% (n = 35) met the inclusion criteria. Measurements were possible in 94.3% of the participants, and IMW was found in 78.8% of the participants. Ninety-six percent started training in the ICU, and 88.5% continued training after transfer to the ward. Follow-up measurements were achieved in 73.1% of the patients with respiratory muscle weakness. Twelve therapists were interviewed, of whom 41.7% regularly worked in the ICU. When exploring reasons for protocol deviation, three themes emerged: \"professional barriers\", \"external factors\", and \"patient barriers\".
CONCLUSIONS: Implementation of measurements of and interventions for IMW showed to be challenging in this single centre study. Clinicians\' willingness to change their handling was related to beliefs regarding usefulness, effectiveness, and availability of time and material. We recommend that hospitals aiming to implement IMT during or after ventilator weaning consider these professional and organisational barriers for implementation of novel, evidence-based interventions into daily clinical practice.

BACKGROUND: Currently, nursing students face a significant lack of preparedness in efficiently addressing complex issues. The use of challenge-based learning, a student-centred situational learning method that utilizes practice scenarios to solve complex problems, can help alleviate the challenges in nurse education. However, there remains to be more extensive exploration on the application of challenge-based learning in nurse practice education.
OBJECTIVE: This study aims to explore the learning experiences of nursing students in challenge-based learning to gain a deeper understanding of the ways and mechanisms through which challenge-based learning enhances specific learning abilities.
METHODS: This study utilized a hermeneutic phenomenological design, employing semi-structured interviews and thematic analysis.
METHODS: A university in Hunan, China, hosted the nursing skills competition based on the principles of challenge-based learning, targeting senior students from nursing schools in Hunan province.
METHODS: A total of 24 fourth-year students from six colleges, including one male and twenty-three female students.
RESULTS: Two themes and seven sub-themes emerged from the study. Theme 1 Constructing a knowledge system in complex scenarios with sub-themes: Case-based education centred on comprehensive knowledge promotes knowledge linkage; Reverse reasoning promotes knowledge differentiation; Making mistakes helps finding the correct path of knowledge; Traps inspire identification of potential problems. Theme 2 Inquiry in uncertainty with sub-themes: Unexpected changes promote exploration of general principles; Combining knowledge with diverse case scenarios promotes flexible thinking; The uncertainty of knowledge fosters independent thinking.
CONCLUSIONS: The complexity and variability inherent in challenging learning situations promote the construction of students\' knowledge systems and the cultivation of an inquisitive spirit. The identification of these mechanisms contributes to the optimization of instructional environment design, the development of a culture of continuous learning and innovation, and effectively tackling complex issues within an ever-evolving global context.

Addressing the ongoing challenge of rising healthcare spending is crucial for ensuring the health quality of a population. At the core of healthcare systems, health professionals play a vital role in patient care and resource utilization. Despite healthcare cost concerns, health professionals often lack an understanding of health economics for optimal decision making. Accordingly, the aim of this study was to assess the knowledge of health economics among healthcare professionals in the Kingdom of Saudi Arabia. The broader goal was to identify knowledge gaps crucial for developing targeted interventions to maintain quality healthcare within the context of resource constraints. We used cross-sectional data collected from January to June 2023 and employed univariate, bivariate, and multivariable techniques for analysis. Univariate analyses were used to compare respondent proportions in socio-economic and demographic categories, bivariate analysis was used to examine the frequencies of independent variables related to the dependent variable, and a multivariate logistic regression model was used to identify the factors associated with knowledge of health economics among healthcare professionals. A total of 1056 responses were included for analysis. Approximately 35.35% of the sample possessed optimal knowledge of healthcare economics. Additionally, 58.14% of respondents considered health economics knowledge essential in their job practice, 16.95% regularly read articles on health economics, 22.06% engage in economic decision making at work, and 20.17% apply health economics techniques in their decision making. Health economics knowledge varied according to profession status, work experience, perceptions about health economics, and involvement in management tasks and decision-making processes. Generally, knowledge of health economics tended to increase with experience, positive perceptions, and engagement in administrative or management tasks. Nevertheless, knowledge of health economics is largely limited among health professionals in Saudi Arabia. Policymakers should address disparities in knowledge and perceptions of health economics through ongoing training courses and workshops. These interventions will ensure the presence of highly skilled professionals capable of implementing effective healthcare decisions and managing the increasing costs of healthcare.

BACKGROUND: A medical student\'s career choice directly influences the physician workforce shortage and the misdistribution of resources. First, individual and contextual factors related to career choice have been evaluated separately, but their interaction over time is unclear. Second, actual career choice, reasons for this choice, and the influence of national political strategies are currently unknown in Switzerland.
OBJECTIVE: The overall objective of this study is to better understand the process of Swiss medical students\' career choice and to predict this choice. Our specific aims will be to examine the predominately static (ie, sociodemographic and personality traits) and predominately dynamic (ie, learning context perceptions, anxiety state, motivation, and motives for career choice) variables that predict the career choice of Swiss medical school students, as well as their interaction, and to examine the evolution of Swiss medical students\' career choice and their ultimate career path, including an international comparison with French medical students.
METHODS: The Swiss Medical Career Choice study is a national, multi-institution, and longitudinal study in which all medical students at all medical schools in Switzerland are eligible to participate. Data will be collected over 4 years for 4 cohorts of medical students using questionnaires in years 4 and 6. We will perform a follow-up during postgraduate training year 2 for medical graduates between 2018 and 2022. We will compare the different Swiss medical schools and a French medical school (the University of Strasbourg Faculty of Medicine). We will also examine the effect of new medical master\'s programs in terms of career choice and location of practice. For aim 2, in collaboration with the Swiss Institute for Medical Education, we will implement a national career choice tracking system and identify the final career choice of 2 cohorts of medical students who graduated from 4 Swiss medical schools from 2010 to 2012. We will also develop a model to predict their final career choice. Data analysis will be conducted using inferential statistics, and machine learning approaches will be used to refine the predictive model.
RESULTS: This study was funded by the Swiss National Science Foundation in January 2023. Recruitment began in May 2023. Data analysis will begin after the completion of the first cohort data collection.
CONCLUSIONS: Our research will inform national stakeholders and medical schools on the prediction of students\' future career choice and on key aspects of physician workforce planning. We will identify targeted actions that may be implemented during medical school and may ultimately influence career choice and encourage the correct number of physicians in the right specialties to fulfill the needs of currently underserved regions.
UNASSIGNED: DERR1-10.2196/53138.

The precision medicine era has seen increased utilization of artificial intelligence (AI) in the field of genetics. We sought to explore the ways that genetic counselors (GCs) currently use the publicly accessible AI tool Chat Generative Pre-trained Transformer (ChatGPT) in their work.
GCs in North America were surveyed about how ChatGPT is used in different aspects of their work. Descriptive statistics were reported through frequencies and means.
Of 118 GCs who completed the survey, 33.8% (40) reported using ChatGPT in their work; 47.5% (19) use it in clinical practice, 35% (14) use it in education, and 32.5% (13) use it in research. Most GCs (62.7%; 74) felt that it saves time on administrative tasks but the majority (82.2%; 97) felt that a paramount challenge was the risk of obtaining incorrect information. The majority of GCs not using ChatGPT (58.9%; 46) felt it was not necessary for their work.
A considerable number of GCs in the field are using ChatGPT in different ways, but it is primarily helpful with tasks that involve writing. It has potential to streamline workflow issues encountered in clinical genetics, but practitioners need to be informed and uniformly trained about its limitations.