Ten years ago, Ghana’s mental health services were severely lacking, accelerated through ‘brain drain’ as trained psychiatrists and mental health nurses left the country to work overseas. A group of UK global health workers was closely involved in a ten-year large-scale innovation aimed at helping to improve mental health services in Ghana at community level. A new generation of mental health workers in Ghana was created adding hundreds of practitioners to the workforce, meaning that thousands of Ghanaians would potentially receive support. The research reported here explored the UK group’s involvement to identify significant lessons learnt. Method An ‘ideological narrative’ was obtained through engaging the research participants in insider practitioner research. They were supported in this process by a university-based researcher, who offered an ‘outsider’ perspective. This novel type of narrative meant participants could not only give account of their own practice and an awareness of their own learning, but also become more aware of the significance of the often unstated, and possibly unconscious, values informing their stories. Results The lessons learnt by the UK global health workers from involvement in this innovation are explored within five themes: Curriculum development as an ongoing process; ‘we are all learning’ and the notion of ‘co-development’; timescales and the importance of culture; the interconnected nature of practice; and education as development. Conclusion This research is intended to help shape individual and group efforts that are involved in global health projects generally through project participants articulating the significant lessons learnt about educational change and the nature of development associated with such projects as ongoing ‘co-development’. It also has the potential to contribute to a wider dialogue with curriculum developers, educators, and others involved in practice innovation, all of which inevitably involve others and are never ended.

This text has emerged from frequent in-depth conversations about theory and practice in teaching and learning among colleagues in Faculties of Dentistry, Medicine, and Education. Our intention is to expand those face-to-face conversations beyond the walls of our university. More specifically, through a conversational hermeneutic approach we endeavor to provide an introduction through accessible teaching approaches and effective learning that might enhance health education and promote student's and educator's experiences. Among topics of our interest, lecturing, which still is pervasive in higher education, has constituted a matter of much debate in the group. Our conversations have not only covered the pros and cons of lecture approaches, and other alternative or complementary teaching strategies, but also, and importantly, theoretical and philosophical perspectives in education. In this article we invite the readers to join us in, we hope, a fruitful conversation about lecturing and Gadamer's dialogical hermeneutics as a means to encourage meaningful conversations within the classroom.

Involvement in sport is common among prospective medical students and may serve as a foundation for the psychological wellbeing of future physicians. This study examined the relationship between medical students’ sport background and their tolerance of ambiguity and uncertainty, an established factor in physician wellbeing and a key component in quality patient care. Sixty-one 3rd year medical students (50% females) at a large Canadian university responded to a web-based survey (62% response rate). The survey included the 29-item TAMSAD (Tolerance of Ambiguity in Medical Students and Doctors) scale and sport background measures (sport type and level of involvement). Analysis of variance and correlational analysis were performed. Analysis of variance indicated a significant mean difference in students’ TAMSAD scores based on sport type. Individual sport participants reported on average higher tolerance of ambiguity and uncertainty than team sport participants. However, in team sport participants, their tolerance of ambiguity and uncertainty tended to increase with an increase in sport involvement (from recreational to competitive). The gained insights are valuable as involvement in dedicated, extracurricular activities such as sport has not been studied in relation to ambiguity and uncertainty tolerance in medical students. The findings have implications for medical education and professional practice. Medical students and physicians could draw on the attributes and skills developed in sport when responding to ambiguity and uncertainty in clinical settings. Those without a sport background could learn and apply some of the strategies athletes use to tackle setbacks and uncertainty in high-stakes situations. Medical school admissions, curriculum designers, and educators could use the knowledge in developing interview questions, designing educational innovations, and selecting instructional strategies for teaching clinical reasoning and decision making. Future research should include qualitative studies to provide in-depth explanations for the relationships observed in this study.

Background Studies have shown that specific instructor feedback on student performance enhances student learning. Supervised practice opportunities such as pro-bono clinics during didactic portions of the curriculum allow faculty supervisors to provide specific comments on skill, decision-making, communication, efficiency, safety of practice and clinical reasoning. Use of learning management systems can facilitate the feedback process by providing simple and easy accessible repository of information for both students and faculty supervisors. Objective The purpose of the study is to organize and analyze the faculty comments on selected assessment activities to generate trends that can additionally inform the faculty on student performance. Method Pairs of students provided pro-bono physical therapy sessions for six weeks as part of a patient/client management class in neurological physical therapy. Faculty supervisor provided comments on students’ performance contemporaneously using a predetermined grading rubric for each pro-bono session using the Learning Management System (LMS) of the course. The comments were coded and reviewed to generate trends related to student performance. Results There were a total of 18 pairs of students who performed 108 physical therapy sessions on 18 volunteer participants over a six-week period. There were 830 comments from the six faculty supervisors, averaging 38 comments per supervisor and eight comments per student pair. There was an equal number of comments on areas of strength as there were on areas of improvement. The number of comments decreased as the sessions progressed. Over a third of the students received a comment that required improvement on safety during session 1. In terms of clinical reasoning strategy, majority of comments were about procedural reasoning. Conclusion Review of faculty supervisor comments appear to add value to the overall course assessment and student learning. Having the faculty provide more written comments will further deepen the value of the feedback provided to the students. There is a need to provide more comments that guide the students to self-assess their performance, rather than providing a direct comment. Continued close monitoring and feedback by the faculty supervisors may have resulted in better student performance as reflected in the decline of the number of comments related to needed improvement in performance as the sessions progressed. Faculty also needed to provide more comments related to interactive, collaborative and ethical reasoning.

Introduction Clinical reasoning (CR) is a core clinical skill that has been directly linked with patient outcomes. Therefore, developing sound clinical reasoning skills in students should be a concern for physical therapy (PT) professional education programs. Purpose To develop an understanding of PT student perceptions of CR and how they best learn it to inform future educational practice and research needs. Method A systematic review of the literature was conducted using the databases PubMed, CINAHL, ERIC, and Cochrane database of systematic reviews to develop an understanding of how students perceive CR throughout their professional education programs and how they best learn it. Results Fifteen articles met inclusion criteria. Three major themes were identified from the systematic review. First, student perceptions of CR changes throughout their professional education programs from therapist-centric to client-centered. Second, students prefer educational experiences that mirror anticipated real-world experiences like case-method teaching. Lastly, educational experiences designed to enhance CR capability enhances student professional formation and identity. Discussion Recent calls for reform across all levels of physical therapy education has been made. In part, these reform efforts emphasize the need for PT education programs to provide learner-centered education through practice-based learning experiences and developing adaptive learners. The results of the systematic review support these aims. More research is needed regarding the impact of educational experiences on student CR skill development as well as more valid and reliable tools for assessing CR capability in PT students.

Purpose Grit and resilience are considered non-cognitive traits associated with motivation, attitude and temperament rather than intellect and have been increasingly recognized as important skills to identify and develop in medical professionals. The purpose of this study was to investigate grit scores as well as the relationship of grit and other factors to academic success in Doctor of Physical Therapy (DPT) Students. Method Forty-four 2nd year DPT students from the US, were surveyed utilizing the 12-Item Grit Scale prior to the start of semester 4, composed of an 8-week didactic module followed by an 8-week clinical internship. Cognitive traits including Pre-admission Grade Point Average, Graduate Readiness Exam scores, age, as well as descriptive statistics were extracted from admission data. Cumulative GPA and semester GPA from the 8-week didactic portion of the semester were gathered post semester completion. Results The mean grit score for 2nd year DPT students was 3.74 (SD ± .48). Moderate correlation between grit score and cumulative GPA, r = .501, P = .001 was found. A multiple regression analysis found grit score and age as predictors of cumulative GPA, explaining 41.4% of the variance. Discussion Among 2nd year DPT students at a teaching and learning institution in the southeast United States, grit and age appear to be associated with DPT program cumulative GPA scores. Non-cognitive factors such as grit and age may assist in predicting academic success among entry-level DPT students. Grit has not been examined previously as a non-cognitive trait contributing to academic success among entry-level DPT students but may serve as a helpful addition for admission profile to assist in predicting academic success.

To review the barriers to continuours professional development (CPD) learning activities in radiography in Africa and propose strategies for supporting radiographers on the continent. A literature search was conducted in four databases: ScienceDirect, PubMed/MEDLINE, CINAHL, and Google Scholar with no time limit. This was supplemented with hand searching to avoid missing relevant literature. All research studies conducted in Africa on this subject were included in the review. Data were synthesised and analysed thematically. Seven research studies were found to be relevant and included in this review. Three main themes on barriers to radiographers’ participation in CPD learning activities were identified: attitudinal, physical, and structural barriers. Attitudinal barriers include a lack of self-motivation and a feeling that topics are irrelevant at study days. The identified physical barriers are time constraints, financial constraints and distance to CPD events, and limited resources. Structural barriers identified include a lack of knowledge about learning opportunities, shortage of staff, poor study days notification and communication, and a lack of support. There are several barriers to radiographers’ participation in CPD learning activities identified in this review. Strategies to support radiographers are proposed. It is anticipated that the implementation of the proposed support strategies will alleviate the barriers and allow active engagement of radiographers in continuing education.

Most faculty members are evaluated by their administration, in part, based upon student evaluation results. This study sought to determine the relationship between course evaluation scores and course grades, in order to ensure academic rigor and optimize faculty evaluation practices. Overall course evaluation results were compared to average course grades for six allied health programs, over 3 years (n = 256 observations). There was no overall relationship between evaluation scores and course grades; however, individual differences between programs were seen. Grades achieved in a course did not affect the overall course evaluations. However, since there was a correlation between grades earned and course evaluations for some programs in the School of Allied Health, the importance of utilizing multiple assessment tools to determine the effectiveness of a course must be stressed.

Purpose Language competency has been perceived to be a significant barrier to both learning and interaction in university. However, most studies in this field confine themselves to perceptions of students. This study focused on actual behaviors in small group discussions. It explored whether linguistic differences affect the level of participation between students who conduct discussions in their native Arabic language and those who participate in a second language, being English. Method An experimental study conducted at a Saudi medical school. First-year medical students were assigned randomly to attend two small-group discussions either in Arabic or in English. All sessions were video-recorded for data transcription and analysis. The students' utterances were broken down into propositions and subsequently categorized as either explanatory or descriptive. The number of propositions for each student was counted for each group. Analysis of variance was conducted to test for differences. To examine students’ perception toward conducting small-group discussions either in English or Arabic, students were invited to anonymously fill a questionnaire distributed at the end of the sessions. Results Students who were assigned to sessions conducted in their native language produced significant more descriptive (p  Conclusion Students’ who use their native language in small-group discussions contribute more than those discuss matters using a foreign language. However, more students perceived that using the English language helps them better in understanding basic sciences and ensuring deeper knowledge.

Purpose Warnings are one of the basic methods for giving advice to students, yet there is a dearth of guidance and considerable variation and inconsistency in their content and application. Much of the associated terminology is confusing. To provide clarity, this paper examines the essential ingredients of warnings and their optimal construction and use in higher education, with a focus on students intending a career in one of the health and social care professions. Background Currently warnings are often poorly designed and unclear. One example is giving a student a ‘yellow card warning’ without explaining what errors or omissions have occurred, what action needs to be taken, and what could happen if the warning is ignored. Terminology A range of unhelpful descriptors of warnings are often used, such as ‘formal’, ‘informal’, ‘verbal’, ‘written’, ‘Level 1’, ‘Level 2’, or ‘final’. Any warning needs to provide the student with a written and unambiguous explanation of the meaning and implications of any terms used. Essential ingredients Warnings should be recorded (in writing). They should contain the word ‘warning’; a sufficiently detailed explanation of what the student has done wrong; and identification of any rule, regulation or professional guidance that has been transgressed. Warnings should explain what the student needs to do to ensure that the problem does not recur; what the consequences will be or may be if the problem(s) continue unabated or recur; if relevant, what effect the warning will have on the student and their career; the duration a warning will be kept on the student record, and an explanation of what the student can do if they do not agree with the decision to issue a warning. Conclusion There is an increasing tendency for students to challenge adverse decisions. To respond to such challenges, education providers need to be able to show that they have acted reasonably, including providing the student with appropriate warnings.

Physical therapy educators are responsible for ensuring that learners demonstrate sufficient skill acquisition for safe and effective clinical practice, which includes the learners’ ability to execute manual skills in a reliable and accurate manner. This study is the first attempt to assist physical therapy educators in assessing the feasibility of including new manual skills in the educational curriculum by using criteria for assessment of student learning. An example using these criteria is illustrated by a pilot experiment using the Vertical Compression Test (VCT) and Saliba Postural Classification System (SPCS), which are currently taught predominantly at the post-graduate level. Physical therapy students (SPT) were trained in the VCT and SPCS during the first year of the educational curriculum. Six SPTs and two experienced clinicians (PT) participated in the experiment. An SPT and a PT applied the VCT to subjects in their normal resting posture (PPre) and in a corrected posture (PCor). Data collection measured quantity of force, duration of application, subjects' sway, SPT/PT interpretation of test results, and students’ confidence in order to determine feasibility of inclusion. There were no differences in quantified manual compression forces with a significant correlation between SPT and PT. Movements of the center of pressure indicated test subjects stood steadier during VCT performed by PT compared to SPT, but not to a clinically significant degree. Interpretation of VCT and SPCS test results was excluded as a focus of this study due to curricular limitations that influenced the study design. Student feedback indicated satisfaction with the learning experience. The use of the proposed criteria for assessment of student learning confirmed feasibility of inclusion of the VCT in the entry-level physical therapy education curriculum. First-year DPT students demonstrated ability to perform the VCT with appropriate technique after minimal training.

Accurate metacognitive control is an essential component of effective clinical reasoning, as the inability to accurately pass judgment over knowledge has been associated with greater diagnostic error than lack of knowledge or poor memory. As such, it is necessary for educators of students in health sciences to assess metacognition in addition to academic performance. Calibration is a quantitative measurement used to operationalize metacognitive control, as it indicates the relationship between perceived and actual performance. This study explored the relationship between local-level calibration and academic performance in 34 students of health sciences in an authentic, classroom setting. The class was designed to have five quizzes across the 15-week semester. Performance on each of the five quizzes was used to track academic performance of each student over time. Statistically significant correlations are reported between local-level calibration and performance on five quizzes. Local-level calibration scores accounted for 51-81% of the variance in quiz scores throughout the 15-week semester course. This study was able to generalize the previously reported relationship between calibration and academic performance as found in laboratory settings and educational psychology courses to students of the health sciences. These findings translate metacognitive research into the health sciences to further the theoretical framework for research in the area of clinical reasoning.

This study had three main purposes which were (a) to assess the adequacy and desirability of Arabic in health professional instruction by investigating students and teachers’ perspectives and attitudes, (b) to explore aspects of Arabic medical translations which are not meeting expectations, and lastly, (c) to examine whether the level of education is a predictor of attitude. A questionnaire survey of medical and dental students at the undergraduate and postgraduate levels was carried out in 2019 at major universities in Damascus. Faculty members were also invited to participate. 346 respondents in total completed the questionnaires. Data were processed and analysed quantitatively and qualitatively. Attitude theory and Health belief model were employed to analyse and interpret the study findings. Overall attitudes toward Arabic as a language of instruction were relatively negative. Students consistently exhibited a preference for English as the language of instruction. The one-way Welch’s ANOVA test found a significant difference among the main subgroups (undergraduates, postgraduates, faculty). Findings also showed that students and teachers suffer from the inadequacy of Arabic medical translations in quality and quantity. Respondents were generally dissatisfied with the proficiency of medical translators, and the majority agreed that there is a shortage of up-to-date Arabic study materials. Students’ implicitly considered Arabic as a threat to their career advancement. Inadequacy of teaching in Arabic was more evident among postgraduates. Syrian students’ desire to join the international medical community was one of the data implications. This study shed new light on the anomalous Syrian educational system as it provided a theortical framework which could further understanding of the interaction between different concepts that affect attitudes towards the language of instruction. In terms of directions for future research, qualitative field research is recommended to give an idiographic account of students and teachers’ subjective perception of the career threats posed by using Arabic as the medium of instruction in medical education.

Purpose Previous studies have demonstrated that a motivational programme can have positive effects in inspiring secondary school students in pursuing a career in health. However, majority of studies were conducted in the United States and were delivered in the multiple sessions and attendances format. MED-E-SIM is a one-day educational pilot programme designed for Australian secondary school students interested in pursuing a career in healthcare. Method MED-E-SIM's aim is to increase participants' interest and certainty in pursuing the healthcare professions through participation in mannequin-based simulated clinical exercises, procedural workshops using part-task simulation trainers, and active engagement in an ‘ask the expert’ style masterclass hosted by healthcare clinicians. In order to evaluate the impact of MED-E-SIM, 66 senior secondary school students who participated in the programme were invited to complete the post programme evaluation survey. Results We observed increases in both students' self-perceived understanding of health profession and knowledge about Basic Life Support after the participation in MED-E-SIM programme. Furthermore, our study also showed that MED-E-SIM programme participation could help improve participants’ decision in pursuing future career in health (P  Discussion Implementing programmes like MED-E-SIM can be a feasible strategy to help increase awareness and interest of pursuit in health-related career amongst our younger generation.

Purpose To identify the characteristics of the clinical competence of novice therapists at the time of hiring using the Objective Structured Clinical Examination (OSCE). Method Twelve physical therapists and four occupational therapists participated in this study. The OSCE test comprised of attitudinal and technical items was administered at the time of hiring (10 days after the time of hiring). This research adopted three items which are widely used in clinical settings as a range-of-motion test, a muscle-strength test using a hand-held dynamometer, and Stroke Impairment Assessment Set. Each subject’s attitudinal and technical total scores were calculated. To compare the percentages of attitudinal and technical scores to the perfect score, Wilcoxon signed-rank test was used. In addition, a chi-square test and residual analysis were used to determine the bias of the technical subitem score distribution in each test. Results In each test, the percentages of attitudinal total scores to the perfect score were higher than those of technical total scores. For the technical subitems in each test, the participants scored higher on simple tasks than on multiple tasks. Conclusion This study suggests that postgraduate education focusing on technical items, especially multiple tasks, is necessary, because attitudinal items have been sufficiently acquired.

Purpose Journal clubs are frequently used by healthcare educators to support learner’s critical thinking and clinical application. However, there is a lack of evidence to support the effectiveness of this learning tool for both the learner utilizing this tool and those in attendance. Debates have been proven to support critical thinking and communication skills. Method A journal club debate format and rubric were created to promote an engaging format for effective interpretation and application of drug information among fourth year pharmacy students and residents. Sections from relevant articles identified in a literature search were used to create a journal club debate format and rubric. This updated tool was used with pairs of pharmacy students and pharmacy residents. Feedback was obtained from the learners and the pharmacy preceptors in attendance. Results A journal club debate is generally well accepted by both learners and preceptors. Benefits include promotion of critical thinking, interpretation of evidence in the scope of supporting literature, and deeper understanding of the relevant disease state and treatment. Opportunities to improve may be the inclusion of limited visual aids for supporting evidence and the expansion of time for discussion and rebuttals. Conclusion Journal club debates are an engaging learning tool to promote and develop drug information identification, evaluation, and application to clinical practice among pharmacy students and residents.

Purpose Flaws in physicians’ reasoning frequently result in diagnostic errors. The method of deliberate reflection was developed to stimulate physicians to deliberately reflect upon cases, which has shown to improve diagnostic performance in complex cases. In the current randomised controlled trial, we investigated whether deliberate reflection can be taught to general-practice residents. Additionally, we investigated whether engaging in deliberate reflection or studying deliberate-reflection models would be more effective. Methods The study consisted of one learning session and two test sessions. Forty-four general-practice residents were randomly assigned to one of three study conditions in the learning session: (1) control without reflecting (n = 14); (2) engaging in deliberate reflection (n = 11); or (3) studying deliberate-reflection models (n = 19). To assess learning, they diagnosed new cases in both a same-day test and a delayed test one week later. In the delayed test, participants were additionally asked to elaborate on their decisions. We analysed diagnostic accuracy and whether their reasoning contained key elements of deliberate reflection. Results We found no significant differences between the study conditions in diagnostic accuracy on the same-day test, p = .649, or on diagnostic accuracy, p = .747, and reflective reasoning, p = .647, on the delayed test. Discussion Against expectations, deliberate reflection did not increase future reflective reasoning. Future studies are needed to investigate whether residents either did not sufficiently learn the procedure, did not adopt it when diagnosing cases without instructions to reflect, or whether the reflective-reasoning process as itself cannot be taught.

The global burden of pain is considerable; therefore, all health professionals require comprehensive pain education. Pain education is essential and should be embedded in health professional curricula. This paper reports on pain knowledge, attitudes and beliefs changes of osteopathy learners undertaking pain education via three curricula models. Osteopathy learners undertook pain education via three different curricula models and at different time points in the course: Standard (Year 4 & 5), Integrated (Year 2 & 3) or Block (Year 1). Learners completed questionnaires at the start (T1) and end (T2) of the 2018 academic year. Evaluation included demographic information, Neurophysiology of Pain Questionnaire (NPQ) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Matched data was received for 211 learners (40.5% response rate). Pain knowledge increased from T1 to T2 within all curricula models (p < 0.007) and between Block and Standard curricula models (p < 0.01). Differences in biomedical orientation scores for Block and Integrated (p < 0.01) and Block and Standard (p < 0.01) were found between groups, with Block model respondents recording the highest biomedical orientation scores. Differences in behavioural orientation score were found for Block and Standard (p < 0.01) with highest behavioural scores in the Integrated and Standard models. Cronbach's alpha was acceptable for PABS-PT Biomedical orientation score only (α = 0.71). T2 NPQ score was found to have a medium negative correlation with the T2 PABS-PT biomedical orientation score for all models, and with the behavioural orientation score for the integrated curriculum group (r = −0.31, p < 0.03). There were reductions in biomedical beliefs and increases in behavioural orientation scores as pain knowledge increased in each cohort over the 2018 academic year. However, osteopathy learners were also measured at different progress points and some measures have low reliability. Following these learner groups over time will enable further comparisons between these different curricula models.

When assessing clinical competence, health professional educators use assessments of knowledge attainment, skills acquisition, and professional development, which impact on decision-making for student’s training progression. Given the impact of progression-failure, it is critical that the expected standard of performance is derived accurately, fairly, and transparently, and that the rating of student performance is performed within the highest standards achievable. There is ongoing disagreement as to the most appropriate methods to address both standard setting and decision-making. The borderline candidate has been debated extensively in the academic and educational setting, with ongoing disagreement surrounding the concept. In this paper, we discuss further perspectives on the use of the borderline candidate, as part of the process for standard-setting, to give insights into how we can reframe the concept more accurately and apply it more appropriately. Drawing parallels to Kane’s validity framework, we consider the concept of the borderline candidate from four different perspectives: ‘what is’-what are the linguistics and implications behind the phrase ‘borderline candidate’; ‘who is’-who is the borderline candidate; decided ‘by whom’-who is the person making the judgement; and ‘under what circumstances’-the context of the assessment. Finally, we translate the theoretical discussion into pragmatic and practical solutions in standard-setting practice

Purpose Recent studies have indicated a dramatic increase of depression and burnout levels among medical students. This study aimed to answer the question: how does medical students’ mental health affect their stress, physical health, and academic success? Method A survey was distributed to first- and second-year medical students to gather information on various self-perceived parameters of health, well-being, and academic success. Participants rated their mental health, physical health, and stress on a five-point Likert scale. Grade point averages (GPAs) were used as a measure of academic success. Students were separated into “low” (1–3 of 5) and “high” (4–5 of 5) mental health categories based on self-reported mental health scores on the Likert scale. The two groups were compared on their self-reported physical health, stress, and GPAs. Linear regression analyses were also performed with GPA and mental health as the dependent variables. Results 121 surveys met inclusion criteria. The average physical health was 3.03 in the “low” mental health group (n = 61) and 3.88 in the “high” mental health group (n = 60) (p < .001). The average stress was 3.87 in the “low” mental health group and 3.35 in the “high” mental health group (p < .001). The average GPA was 3.22 in the “low” mental health group and 3.26 in the “high” mental health group (p = .33). Multiple linear regression analysis demonstrated that about 40% of the variation in mental health was explained by the combined effects of physical health and stress (R 2 = .40, p < .001). The cumulative effect of mental health, physical health, and stress on GPA was not significant (R 2 = .017, p = .58). Discussion It appears that better mental health is correlated with a decrease in stress and an increase in physical health but has no substantial impact on GPA. This may warrant future research into the influence of mental health on other aspects of academic and professional success.

To analyze, summarize and deliver a comprehensive understanding of the current knowledge of new graduate nurses’ readiness to practise upon entrance to the workplace. A narrative review conducted to pull together the current knowledge on new graduate nurses’ readiness to practise. The review considered both empirical quantitative and qualitative studies published from 2000 to 2019, which addressed and focused explicitly on undergraduate nursing students and new graduates' readiness or preparedness to practise. Problem-based and reflective learning enhanced students' learning independence and developed their critical thinking and problem-solving skills. Also, effective students' supervision, enough support during clinical experiences, and building a strong collaborative relationship between nursing programs and clinical areas improved students’ learning, academic achievement, and smooth translation of theory to practice. Clinical experiences were the mainstay of nursing preparation as they provided nursing students with the required learning opportunities to practise nursing skills and consolidate the knowledge in real-life settings.

The purpose of the study was to determine and compare the self-perceived versus supervisor-rated technical competence in plain film X-ray image evaluation using seven standard parameters among newly recruited radiographers working in tertiary teaching hospitals in Zambia. This was done to evaluate the value of measuring technical competence as a feedback to curriculum development and review. A parallel convergent mixed-methods study was conducted. Two focus groups with a total of 17 radiography supervisors purposefully selected from teaching hospitals and training institutions across Zambia were held to solicit their views on technical image evaluation capability of the newly graduated radiographers. A descriptive cross-sectional survey involving 31 newly recruited radiographers from five Zambian teaching hospitals was conducted to assess self-perceived competence in plain film x-ray evaluation. We used thematic analysis to analyse qualitative data, whilst analysis for quantitative data, STATA version 13 and Graph pad prism 5 was used. Among the 17 radiography supervisors, 11 rated the technical competence of entry-level radiography graduates as low. Reasons advanced included insufficient clinical training, uncoordinated clinical training, lack of focus on core radiography training, and lack of attention and commitment to work. In the cross-sectional study, the mean score for self-evaluated competence was 76%. The frequency of performing chest X-rays predicted self-rated competence score (p