There has been a call for nursing programs to shift to Competency-based education (CBE). Competency-based education has numerous benefits in nursing education. A curriculum that includes both concepts and competencies helps students and stakeholders understand what new nurse graduates will be able to do with the knowledge they construct throughout the program. Competency-based education is student-centered, flexible, and dependent on students actively engaging in their learning. A small faculty team developed a new direct-entry MSN program, based on essential components of CBE. This article describes the process of incorporating CBE into the development of the program, as well as challenges and barriers to fully implementing CBE into the curriculum.

BACKGROUND: Resident performance on the Plastic Surgery In-Service Examination (PSITE) is used as a predictor of success on the American Board of Plastic Surgery Written Examination, as well as resident progression and fellowship applications. However, information specifically addressing strategies on optimal PSITE preparation is lacking in the plastic surgery literature when compared to general surgery. For this reason, we aim to understand if the topic is well-studied and denote effective study strategies and curricular interventions in both fields that can help residents and programs optimize PSITE performance.
METHODS: A literature search including studies from 2012 to 2022 was conducted following PRISMA guidelines in PubMed and EMBASE to identify articles on strategies to improve in-service exam scores for general surgery and plastic surgery. Only studies that reported measurable outcomes in raw score, percentile score, or percent correct were included.
RESULTS: Qualitative analysis of 30 articles revealed 2 categories of interventions: individual study habits and institutional curricular interventions. In general surgery literature, 27 articles examined interventions positively impacting resident ABSITE scores, with 21 studies classified as institutional curricular interventions and 6 articles addressing individual study habits. Themes associated with improved ABSITE performance included mandatory remediation programs, dedicated study time, and problem-based learning interventions. In contrast, only 3 articles in plastic surgery literature discussed interventions associated with improved PSITE scores, all falling under curricular interventions.
CONCLUSIONS: Unfortunately, the plastic surgery literature lacks concrete evidence on how residents can improve performance. Future research in plastic surgery should replicate successful strategies from general surgery and further investigate optimal preparation strategies for the PSITE. Such endeavors can contribute to improving resident performance and advancing plastic surgery education and patient care.

BACKGROUND: Virtual patients (VPs) are widely used in health professions education. When they are well integrated into curricula, they are considered to be more effective than loosely coupled add-ons. However, it is unclear what constitutes their successful integration. The aim of this study was to identify and synthesise the themes found in the literature that stakeholders perceive as important for successful implementation of VPs in curricula.
METHODS: We searched five databases from 2000 to September 25, 2023. We included qualitative, quantitative, mixed-methods and descriptive case studies that defined, identified, explored, or evaluated a set of factors that, in the perception of students, teachers, course directors and researchers, were crucial for VP implementation. We excluded effectiveness studies that did not consider implementation characteristics, and studies that focused on VP design factors. We included English-language full-text reports and excluded conference abstracts, short opinion papers and editorials. Synthesis of results was performed using the framework synthesis method with Kern\'s six-step model as the initial framework. We appraised the quality of the studies using the QuADS tool.
RESULTS: Our search yielded a total of 4808 items, from which 21 studies met the inclusion criteria. We identified 14 themes that formed an integration framework. The themes were: goal in the curriculum; phase of the curriculum when to implement VPs; effective use of resources; VP alignment with curricular learning objectives; prioritisation of use; relation to other learning modalities; learning activities around VPs; time allocation; group setting; presence mode; VPs orientation for students and faculty; technical infrastructure; quality assurance, maintenance, and sustainability; assessment of VP learning outcomes and learning analytics. We investigated the occurrence of themes across studies to demonstrate the relevance of the framework. The quality of the studies did not influence the coverage of the themes.
CONCLUSIONS: The resulting framework can be used to structure plans and discussions around implementation of VPs in curricula. It has already been used to organise the curriculum implementation guidelines of a European project. We expect it will direct further research to deepen our knowledge on individual integration themes.

BACKGROUND: Systems thinking is recommended, but not required, for teaching food and water system sustainability in nutrition and dietetics education.
OBJECTIVE: This study investigated systems thinking and sustainable, resilient, and healthy food and water systems (SRHFWS) in nutrition and dietetics programs. It examined program directors\' practices, values, attitudes, confidence levels, and the relationships between systems thinking, teaching SRHFWS topics, confidence levels, and years of experience as a dietitian and program director.
METHODS: Conducted in September 2022, the study used a descriptive design with a validated 20-item Systems Thinking Scale (STS) and a researcher-designed survey with 1-5 Likert-type scales.
METHODS: The online survey was distributed to 611 Accreditation Council for Education in Nutrition and Dietetics (ACEND) program directors, with a 27% (n=163) response.
METHODS: Descriptive statistics (frequency, mean, standard deviation) were calculated using Excel. Inferential statistics were examined using R. ANOVA was used to compare experience as RDN and experience as a program director to confidence levels in teaching each SRHFWS topic. Linear regression was used determine the relationship between total STS score and demographic and programmatic variables.
RESULTS: Seventy-seven percent of program directors scored high on the STS (mean score 65.2, on a 0-80 scale, SD 8.4), and more than 85% of directors agreed including systems thinking in dietetics was important. However, only 32.1% reported teaching systems thinking. Less than half of program directors agreed systems thinking was adequately addressed in ACEND standards, and nearly 80% of program directors agreed there was room to strengthen systems thinking content. Directors neither agreed nor disagreed there are adequate ACEND standards addressing SRHFWS and reported SRHFWS topics were inconsistently taught. Confidence levels were lowest for teaching economic and environmental topics. Awareness and use of resources developed by the Academy of Nutrition and Dietetics Foundation was low.
CONCLUSIONS: Integration of systems thinking in nutrition and dietetics education presents promising opportunities to address complexity in the field. Applying systems thinking to teach SRHFWS may narrow the disparity between educators\' perceived importance and program coverage. Enhancing program directors\' awareness and utilization of Foundation resources and improved alignment between practice standards and accreditation standards may empower program directors to use systems thinking to teach sustainability-related challenges in nutrition and dietetics.

OBJECTIVE: Children of caregivers with limited health literacy are at risk of poorer health outcomes. Thus, health literacy-informed communication tools are critical to achieving a more equitable health system. However, there is no agreement on the health literacy skills pediatric residents should attain. We used Delphi methodology to establish consensus on health literacy objectives to inform development of a pediatric resident curriculum.
METHODS: Our Delphi panel participated in 3 rounds of anonymous surveys to rank the importance of health literacy objectives in pediatric resident education. Consensus was defined as ≥70% of panelists identifying an objective as essential or 100% agreeing an objective was recommended or essential.
RESULTS: Thirteen pediatric health literacy experts comprised a racially, geographically, and professionally-diverse panel. After 3 survey rounds, 27 of the initial 65 objectives met consensus. All final objectives aligned with Accreditation Council for Graduate Medical Education (ACGME) core competencies.
CONCLUSIONS: A panel of pediatric health literacy experts established consensus on health literacy objectives specific to pediatric resident training. These prioritized objectives align with ACGME core competencies, as well as evidence-based strategies like teach-back, and newer considerations like addressing organizational health literacy. They should inform future health literacy curricula and assessment within pediatric residency programs.

OBJECTIVE: As clinician educator tracks continue to gain popularity in graduate medical education, this report aims to fill a gap in the literature by providing a 14-year update on professional outcomes of participants in a psychiatry residency academic administrator, clinician educator (AACE) track and to compare these outcomes to non-track participants.
METHODS: An anonymous web-based survey querying professional achievements was distributed to all graduates of a psychiatry residency training program from 2009 to 2022. Outcomes of AACE track participants and non-track participants were compared.
RESULTS: Of 228 alumni contacted, 61% responded (n = 140). Eighty-seven percent of track participants responded (n = 74) while 41% of non-track participants responded (n = 45). Of track participants, 63% practice in academic settings with 57% having held administrative leadership roles, 49% educational leadership roles, and 39% national or regional leadership roles. Track graduates were academically engaged with 70% reporting at least one publication, 89% at least one presentation, and 93% attending at least one national meeting. In comparison, 31% of non-track participants practice in academic settings with 44% having held administrative, 29% educational, and 20% national or regional leadership roles. Thirty-nine percent have at least one publication, 75% at least one presentation, and 90% attended at least one national meeting. When compared to non-track participants, track participants were significantly more likely to have an academic affiliation and a higher number of publications and were more likely to hold national or regional leadership roles.
CONCLUSIONS: Track participants demonstrate longitudinal career success as clinician educators and academic administrators more so than non-track participants.

BACKGROUND: Ultrasound (US) has become integral to obstetrics and gynecology (Ob/Gyn), necessitating proficient training during residency. Despite its clinical importance, there is a perceived gap in the quality and structure of postgraduate ultrasound education in Germany.
METHODS: A cross-sectional survey was conducted among Ob/Gyn residents in Germany from October 2023 to March 2024, using the LimeSurvey platform. The survey, distributed via email, social media, and physical flyers, garnered 211 participants, with 115 completing all sections. The questionnaire covered demographic details, US training experiences, and the perceived importance of US in clinical practice.
RESULTS: Although US was highly valued by respondents, with an average of 26.1% of their clinical activity devoted to it, there was significant dissatisfaction with the training quality. Key issues included inadequate supervision, the necessity of self-training, and low participation in certification courses. Despite 93.0% awareness of professional US organizations like the German Society for Ultrasound in Medicine (DEGUM), engagement with structured training programs was minimal.
CONCLUSIONS: The study highlights a critical need for standardized US training protocols and curricular reform in Ob/Gyn residencies in Germany. The discrepancy between the recognized importance of US and the quality of training indicates a pressing need for improvements. Addressing these gaps through comprehensive, structured educational reforms could significantly enhance the proficiency and confidence of future Ob/Gyn specialists, ultimately improving patient care.

OBJECTIVE: This study assessed the current state of sleep medicine accreditation and training in Asia by conducting a comprehensive survey across 29 Asian countries and regions facilitated by the Asian Society of Sleep Medicine (ASSM) to identify existing gaps and provide recommendations for future enhancements.
METHODS: The ASSM Education Task Force Committee designed a survey to gather data on accreditation, education, and training standards in sleep medicine, including information on challenges in enhancing education in the field.
RESULTS: With an 86% (25 countries/regions) response rate, the survey showed that sleep medicine is recognized as an independent specialty in just nine countries/regions (36% of the countries/regions surveyed). Ten countries/regions have established sleep medicine training programs, with Japan and Saudi Arabia offering it as a distinct specialty. Significant disparities in training and accreditation standards were identified, with many countries/regions lacking formalized training and practice guidelines. The survey also revealed that most local sleep societies across Asia support the development of an Asian Sleep Medicine Training Curriculum led by the ASSM. However, several barriers significantly impede the establishment and development of sleep medicine training programs, including the scarcity of trained specialists and technologists and the absence of national accreditation for sleep medicine.
CONCLUSIONS: The survey highlights the need for standardized sleep medicine training and accreditation across Asia. Developing an Asian Sleep Medicine Training Curriculum and promoting ASSM accreditation guidelines are key recommendations. Implementing these strategies is essential for advancing sleep medicine as a widely recognized discipline throughout Asia.

A first-year foundational science course grew beyond its scope. Revitalization of the course was driven by second and third-year medical students, who created new learning objectives and edited cases that were well-received by course facilitators and students. The students\' role in the course revitalization is a novel approach.

OBJECTIVE: To explore final-year medical students\' perceptions of sleep education during medical school to inform the development of a sleep curriculum.
METHODS: Year 6 medical students on their final general practice placement in 2020 were invited to complete an online survey including questions regarding sleep education recalled during the medical programme.
RESULTS: Responses were received from 51/71 (72 %) students. Main learning topics recalled by participants were sleep apnoea (83 %), sleep physiology (71 %), and snoring (69 %). Education in other topics was reported by <65 % of students. Priority topics for students were treating common sleep disorders, taking a sleep history, and navigating shift work.
CONCLUSIONS: Whilst the majority of students recalled education on specific topics, many had little awareness of education relating to sleep assessment, insomnia, or shift work. Sleep education in the curriculum needs more emphasis and reinforcement given sleep\'s relevance across many domains of health and morbidity. We propose that an identifiable sleep curriculum is required to ensure medical students have the necessary core education regarding sleep and sleep disorders both for patients and themselves. Further, we believe this is possible to achieve in a short timeframe within the constraints of an existing curriculum and propose some creative solutions.