Journal of Advances in Medical Education & Professionalism

Abstract Introduction: The unfolding case study is an innovative teaching strategy that structures patient scenarios over time to enhance learner engagement and improve outcomes. However, its effectiveness in nursing education classroom settings worldwide remains underexplored. This review aimed to synthesize evidence on the impact of unfolding case-study learning on nursing students’ knowledge, critical thinking, and self-efficacy.
Methods: A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses- Scoping Reviews (PRISMA-ScR) guidelines. Searches covered CINAHL (EBSCOhost), Cochrane Library (Wiley), Embase (Elsevier), ERIC (IES), MEDLINE (via PubMed), Scopus (Elsevier), and Web of Science Core Collection (Clarivate) for English-language studies published from January 2012 to September 2025. Study appraisal used the Mixed Methods Appraisal Tool (MMAT, 2018) and NHMRC levels of evidence for quantitative designs.
Results: The initial search identified 550 studies, of which 19 were included after rigorous screening. Findings indicated that unfolding case studies positively influenced knowledge acquisition by promoting active learning, enhancing integration of theory into practice, strengthening collaborative learning and communication, and improving long-term knowledge retention and recall. Evidence also supported improvements in critical thinking skills and self-efficacy among nursing students.
Conclusion: Integrating unfolding case-based learning into undergraduate nursing education offers substantial advantages in developing essential skills, particularly knowledge acquisition, critical thinking, and self-efficacy.

Abstract Introduction: Virtual reality (VR) technologies are interactive multimedia environments that serve as popular educational tools for teaching various groups. This study aimed to explore the applications of VR in the education of different medical science groups, including medicine, medical residents, dentistry, nursing, pharmacy, etc., in a systematic review format. This technology provides unique opportunities for learners to immerse themselves in experiences, leading to increased understanding and practical skills in the field of medical sciences. Therefore, this study was conducted in 2023 to examine the applications and challenges of VR in medical science education through a systematic review.
Methods: This study systematically extracts published articles through keyword searches from 1970 until March 14, 2023, in Web of Science, Scopus, Science Direct, Cochran Library, PubMed,
ProQuest and IEEE. To evaluate the methodological quality of the included studies, we used the STROBE checklist. All stages were carried out by two researchers, and the final selected articles were summarized in tables.
Results: This review included 26 studies from an initial pool of 22,160 identified articles. The analysis revealed six key themes regarding the use of these technologies: their impact on learning outcomes, increased student motivation, enhanced self-confidence, improved teamwork, their role as tools for curriculum integration, and associated challenges. Collectively, the reviewed studies suggest that such technologies contribute positively to learning satisfaction, academic performance, public speaking confidence, and collaborative skills. Additionally, they serve as effective supplementary tools in educational settings. Nevertheless, several studies reported potential side effects, including dizziness, nausea, and eye strain.
Conclusion: This study showed that the use of technologies like VR improved learning, motivation, and teamwork, but there were challenges in their implementation. It is recommended that these
technologies should be integrated into the curriculum and training workshops should be held for their effective use. Additionally, policymakers should provide financial resources and national
guidelines to support the expansion of these technologies.

Abstract Introduction: Design thinking is vital in medical education for addressing complex healthcare challenges, but interdisciplinary collaboration opportunities remain limited. This study evaluates student-reported 1) exposure to design-thinking methods, and 2) access to healthcare-specific design opportunities (courses, projects, mentors, and networks) at Brown University, the Rhode Island School of Design (RISD), and the Warren Alpert Medical School (AMS). It also assesses a student-driven organization that fosters skill development, interdisciplinary collaboration, and project-based learning.
Methods: A survey was developed with multidisciplinary student and faculty review for face and content validity. Using a cross-sectional convenience sample from a cross-institutional listserv, 77 students completed the 25-question survey covering demographics, prior experiences, interests, and perceived access to healthcare design opportunities. Responses used checkbox and Likert scale formats. We used descriptive statistics and between-group comparisons (project participants vs nonparticipants) via t-tests on Likert means (α=0.05).
Results: The survey yielded 77 responses. Respondents represented Brown (61%), AMS (18%), and RISD (14%), with 6% enrolled in joint Brown-RISD programs. Institutional disparities were noted from self-reported aptitudes: RISD students excelled in design (100%), and AMS in research (79%). Brown students reported the greatest access to academic opportunities in healthcare design (68%). Common challenges included limited professional networks (average 2.4/5). Participants sought collaborations and skills from other institutions. Most respondents (94%) desired project-based opportunities, highlighting demand for practical applications. Design x Health project participants reported significantly higher self-perceived access to opportunities and understanding of design processes compared to non-participants.
Conclusions: This study highlights the potential of student-driven organizations in addressing limited opportunities and networking needed to incorporate design in health solutions. By improving access to networks and integrating healthcare design into curricular and extracurricular offerings, such initiatives prepare students to tackle healthcare challenges.

Abstract Introduction: Empathy is a key element in the doctor-patient relationship. Despite its recognized importance for both patient and physician. Several studies have reported a decline in empathy
during medical training. However, few studies have been carried out in this regard in the Arab world, particularly in Morocco. This study aimed to assess the level of empathy in Moroccan medical students and to identify the factors associated with its variation.
Methods: A cross-sectional study was carried out among medical students at various Moroccan medical faculties. Data were collected using a questionnaire that included socio-demographic
data on the students and their parents, clinical and academic data and satisfaction with the relationship with parents, and the validated version of the 10 items Perceived Stress Scale (PSS 10)
for stress assessment. Empathy was assessed using the Jefferson Scale of Empathy– student version (JSE-S) in its Arabic version validated in Morocco. Data were analyzed using descriptive
statistics, bivariate analysis and multivariable linear regression to determine the factors associated with empathy. The significance level was considered 0.05. All statistical analyses were performed
using SPSS Version 26.
Results: A total of 565 students were enrolled. The mean JSE-S score was 106.15±13.65, with a significant drop observed during the third cycle (the 6th and 7th year) (p=0.002). Female students
scored higher than males (p=0.003). Higher satisfaction with parental relationships was positively associated with empathy (p=0.02), while chronic disease was linked to lower scores (p=0.048).
Conclusion: Empathy in Moroccan medical students appears to decline during medical training, which may affect future physician–patient interactions. These findings underscore the importance of implementing educational interventions and curricula designed to foster empathy, ultimately improving communication, patient satisfaction, and quality of care in clinical practice.

Abstract Introduction: Anatomy, histology, biochemistry, and physiology are essential for clinical practice. Task-based learning (TBL) offers an innovative, active learning strategy that aligns with these foundational subjects. Meanwhile, the use of computer-aided data acquisition (data acquisition; DAQ) systems like PowerLab has significantly transformed physiology education through simulation-based experimentation. This study aimed to evaluate the effectiveness of combining TBL and PowerLab in enhancing undergraduate medical students’ understanding of physiology.
Methods: This quasi-experimental study included 180 undergraduate medical students from the Faculty of Medicine and Health Sciences at Unismuh. Participants were selected using convenience sampling. A survey consisting of 12 validated Likert-scale questions (Cronbach’s alpha=0.84)
was conducted to gather students’ insights into how PowerLab can be utilized to perform and educate physiology experiments. A task-based module was used in this study, implemented over five sessions, each lasting 120 minutes, and covering topics such as cardiovascular, respiratory, and neuromuscular physiology. Students’ cognitive abilities were measured using a pre-post-test consisting of 25 validated multiple-choice questions, a practicum exam, and the final mark of the biomedical course. Data were analyzed using SPSS version 26.0 and Microsoft Excel. Frequency and summary statistics were analyzed using descriptive statistics.
Results: During experiments with PowerLab, 74.4% of the students demonstrated a good to excellent understanding of physiological concepts. The pre-post-test scores elicited a statistically significant median increase compared to the pre-test score (p<0.001). There was also a statistically
significant correlation (Spearman’s rho=0.82, p<0.001) between the practicum exam results and average test scores (Spearman’s rho=0.54, p<0.001) with the final marks in the biomedical course. However, 30 students (16.7%) showed decreased scores, indicating variability in response to the intervention, requiring further exploration. Additionally, students reported discrepancies between satisfaction (67% excellent) and perceived comprehension (40% average), suggesting gaps between enjoyment and conceptual understanding.
Conclusion: Integrating PowerLab technology with task-based modules enhances understanding and performance in physiology education. These strategies create an engaging, hands-on learning environment that fosters critical thinking and prepares students for clinical practice applications.
However, further studies are needed to investigate the reasons behind variability in students’ responses, especially those whose scores decreased, and to address observed discrepancies between students’ satisfaction and actual comprehension of the physiological concepts.

Abstract Introduction: Enhancing the clinical competency of novice nurses remains a critical concern in nursing management. This study aimed to determine the effects of a supportive-educational
and a supportive-only intervention on the competency levels of novice nurses.
Methods: We conducted a quasi-experimental study with three parallel groups in three teaching hospitals in Mashhad, Iran. A total of 97 novice nurses participated and were allocated into three groups based on their hospital assignments. The first intervention group received a four-week supportive-educational program tailored for novice nurses. The second intervention group participated in a supportive-only program targeting nurse managers, and the control group completed the routine hospital orientation. Competency was measured using the Creighton
Competency Evaluation Instrument (C-CEI) at baseline and two months later by head nurses. Data were analyzed with Stata 17 at a 0.05 significance level.
Results: After adjusting for pre-intervention scores, the supportive-educational intervention group showed a statistically significant improvement in competency scores compared to the control group (β=10.86, p=0.006, 95% CI: 5.28, 16.44). The supportive-only program also demonstrated a significant statistical effect on nurse competency (β=5.20, p=0.049, 95% CI:0.01, 10.39). However, the improvement was less pronounced than that observed in the supportive-educational intervention group.
Conclusion: Both supportive-educational and supportive-only programs improved the novice nurses’ clinical competency, with the supportive-educational intervention producing more
pronounced effects. These findings suggest that both programs can be implemented in clinical settings to enhance novice nurses’ clinical competency, with the choice tailored to resources, staff
capacity, and institutional needs.

Abstract Introduction: Understanding and clarifying key concepts such as “knowledge sharing” is essential for advancing interprofessional collaboration and education in healthcare. This study aimed to
analyze the concept of knowledge sharing in multidisciplinary surgical teams.
Methods: This is a qualitative study performed using Schwartz-Barcott and Kim’s (2000) hybrid model of concept analysis, implemented in three stages: 1) theoretical, 2) fieldwork, and 3)
final analysis. In the theoretical phase, a comprehensive literature review was analyzed through inductive content analysis. Along the fieldwork phase, semi-structured interviews were conducted
with surgical team members and analyzed deductively following Elo and Kyngäs’ approach. In the final phase, the findings from both stages were integrated to present a comprehensive definition
of knowledge sharing.
Results: The final analysis phase indicated five main categories of attributes: 1) diversity of shared knowledge, 2) interactive, voluntary and multi-directional exchange, 3) purposeful process, 4) varied sharing levels, and 5) diverse sharing methods. Further, two main categories of antecedents were identified: 1) individual and knowledge factors, and 2) organizational factors. Ultimately, the analysis highlighted two main categories of consequences: 1) individual, team and therapeutic consequences, and 2) organizational consequences.
Conclusion: In the present study, knowledge sharing was defined as an interactive, purposeful, and voluntary process occurring at various interpersonal and organizational levels (vertical and horizontal) through professional behaviors. It involves reciprocal (occasionally unilateral) exchange of tacit/explicit knowledge via formal, informal, and web-based channels. Since the core characteristics of knowledge sharing have remained largely consistent between the theoretical and fieldwork phases, this definition can be applied to other clinical environments.

Abstract Introduction: Physician advertising is an important topic in the medical field. It is an important tool for attracting new patients, increasing awareness of medical services, and promoting the brand of physicians and medical centers. Therefore, this study investigated the surgeons’ attitudes toward physician advertising.
Methods: This cross-sectional descriptive-analytical study was conducted on 136 surgeons selected from four teaching hospitals and two private hospitals in Tehran using convenience sampling. A researcher-made questionnaire was used to measure the surgeons’ attitudes towards physician advertising. The survey included scales validated by a group of experts, and questionnaire validation methods were performed using a 5-point Likert scale. Data were analyzed using SPSS 18 software. Descriptive statistics were used to summarize the data, and inferential statistical tests, including chi-square, Fisher’s exact test, and independent t-tests, were used to examine the associations.
Results: The mean age of the study physicians was 36.99±0.9 years. Regarding the physicians’ perceptions of advertising, 89% fully concurred that physician advertising enhanced their revenue.
Conversely, 76.5% of physicians contended that advertising did not foster increased competition or enhance services. Most participants (84.6%) entirely refuted the assertion that advertising undermined the reputation of physicians. Furthermore, 86% expressed complete dissent about the prohibition of advertising by physicians. Seventy-five percent of surgeons said that paying the media to invite physicians to educational seminars was the most improper way for doctors to advertise. Conversely, 88.2 percent of them said that posting instructional information on their
virtual profiles was the best approach. Statistical testing demonstrated that the judgment of the positive attitude toward physician advertising strongly correlated with age (p=0.002). The status of physician advertising in the community was deemed entirely proper for those under 30 years old, whereas it was deemed wholly inappropriate for those aged 30 to 45 and above.
Conclusion: The results of this study showed that physicians’ attitudes towards advertisements by physicians in society were evaluated favorably in terms of ethical aspects and the dignity of the medical profession.

Abstract The care of sick people is a moral issue. In a highly technological era, it risks becoming a matter of repairing unhealthy bodies by means of evidence-based strategies, neglecting the human component. To teach these issues has become a challenge and ignoring it has important consequences. Andrew Jameton described moral distress in medicine in 1984 as the negative
feelings that arise when one feels compelled to act against what one considers morally correct. It is usually due to external or organizational circumstances, but in the case of health careers
students, residents or young professionals, it is hierarchies that often impose themselves as a relevant factor, affecting the moral decisions the students would make if the case that such
hierarchies did not exist. The issue is complex, because longterm consequences have been described, which have to do with exhaustion, disenchantment with the chosen profession, low
job satisfaction and therefore demotivation, depersonalization and moral scars. The latter is a topic currently on the rise in the literature, probably motivated by post COVID-19 era. This text will emphasize the need to address moral distress in medical education, and will try to show some strategies to address it.

Abstract Various teaching methods are used in medical education. While Card games are effective for education, supported by educational theory, and generally well accepted by learners, there is no evidence available regarding its use in the nursing field.