Hsiang-Chin Hsu

Significance/Background: New graduate nurses experience substantial stress during the transition from student to professional practice, which may compromise their well‐being and professional practice capabilities. While resilience has been identified as a protective psychological resource, limited longitudinal research has examined how resilience influences professional performance over time or whether well‐being functions as a mediating mechanism. Understanding these dynamic relationships is critical for informing evidence‐based strategies to support early‐career nurses. Aims: This study aimed to (1) examine temporal changes in resilience, well‐being, and professional practice capabilities during the first 3 months of employment among new graduate nurses; (2) investigate associations among these variables; and (3) test whether well‐being mediates the relationship between resilience and professional practice capabilities. Methods: A three‐month longitudinal study was conducted with 72 newly graduated nurses. Measures of resilience, well‐being, and five domains of professional practice capabilities (patient‐centered care, interdisciplinary teamwork, evidence‐based practice, quality improvement, and technology application) were collected at baseline, 2 weeks, and 3 months. Pearson's r correlations, generalized estimating equations (GEEs), and Monte Carlo simulations were performed to examine temporal associations and indirect effects. Results/Findings: Resilience was significantly associated with well‐being (B = 1.285, p < 0.001) and all domains of professional practice capabilities. Both resilience and well‐being independently predicted patient‐centered care, interdisciplinary teamwork, evidence‐based practice, quality improvement, and technology application. Monte Carlo simulations confirmed that well‐being significantly mediated the relationship between resilience and all five performance domains. Improvements in well‐being and several domains of professional practice capabilities were observed at 3 months. Linking Evidence to Action: Resilience serves as a foundational psychological resource that supports new graduate nurses' professional practice capabilities. Well‐being serves as a key mechanism translating resilience into evidence‐based nursing behaviors. Early‐career interventions that strengthen resilience and promote well‐being may enhance professional practice capabilities and improve workforce retention during the critical transition period.

Technology-enhanced learning is increasingly applied in medical education to support complex cognitive processes, including diagnostic reasoning. Point-of-care ultrasound (POCUS), as a portable and real-time imaging modality, has been widely integrated into clinical training. However, limited research has explored how learners engage with POCUS to construct diagnostic understanding, particularly within international medical education contexts involving students from resource-variable healthcare environments. This study aimed to investigate international medical students' learning experiences with POCUS as a technology-enhanced learning tool. A qualitative study was conducted involving 28 third- and fourth-year international medical students who participated in a structured POCUS learning activity. The intervention combined guided instruction with supervised hands-on practice in cardiac and abdominal ultrasound within an emergency medicine training context. Following the activity, participants completed written reflective narratives. Data were analysed using reflexive thematic analysis to identify recurring patterns in learners' experiences and meaning-making processes. Four major themes were identified. First, POCUS facilitated diagnostic understanding through real-time visualisation of anatomical structures and physiological processes. Second, integration of ultrasound within problem-based clinical scenarios supported the development of diagnostic reasoning. Third, collaborative learning and instructor scaffolding enhanced engagement and knowledge construction. Fourth, participants recognised the limitations of POCUS and highlighted the importance of reflective practice and continued skill development. These findings demonstrate that learners actively integrate visual, experiential, and contextual information when engaging with POCUS. POCUS functions as an effective technology-enhanced learning tool that supports diagnostic reasoning by linking visualisation with contextualised and reflective learning processes. The findings extend current understanding of technology-enhanced medical education by demonstrating how domain-specific technologies facilitate meaning-making and cognitive integration in diverse and cross-cultural learning environments. These insights have implications for the design of ultrasound-based curricula in emergency medicine education.

Background: The purpose of this study was to examine functional movement patterns and physical functions, including strength, flexibility, balance, and agility in emergency medical technicians (EMTs), and to compare physical function outcomes between EMTs with different levels of functional movement performance. We hypothesized that EMTs with poorer functional movement patterns would perform worse in physical function tests than those with better patterns. Methods: This cross-sectional study recruited 91 EMTs from the Bureau of Fire in Tainan, Taiwan. Functional movement patterns were assessed using the Functional Movement Screen (FMS™). Muscle strength and flexibility of the upper and lower extremities and core stability were assessed using a hand-held dynamometer and clinical tests. The dynamic balance ability of each leg was assessed using the Y-balance test, and agility was assessed using the agility T-test. Results: The average FMS™ score for all EMTs was 14.1, and 44 participants (48%) were classified as the higher-scoring group (FMS™ score higher than 14), and 47 (52%) were the lower-scoring group (FMS™ score 14 or less). The lower-scoring group exhibited significantly poorer fundamental movement patterns, reduced lower-body flexibility (sit-and-reach and straight-leg raise), and lower Y-balance test scores compared to the higher-scoring group. No differences were observed in upper and lower extremity muscle strength, core stability, shoulder mobility, or agility. Conclusion: The current results indicate that EMTs exhibit impaired functional movement patterns, with those with lower FMS™ scores demonstrating reduced lower body flexibility and dynamic balance compared with those with higher scores. These findings highlight the importance of movement-focused assessment and support the need for intervention strategies targeting movement quality, flexibility, and balance to promote occupational health in EMTs.

Background: Nurse burnout has a negative impact on nurse retention, well-being, and the quality of patient care. The differences in healthcare systems and cultures also lead to the differences in perceptions of nurses burnout. The aim of this study was to evaluate the validity and reliability of the nurse burnout scale, a context-specific instrument for Taiwanese nurses. Methods: This methodological study was conducted in three medical centers across Taiwan using secondary data from a National Science Council project. The Taiwan Nurse Burnout Scale (TNBS) was developed through literature review, qualitative interviews, expert validation, and pilot testing. Psychometric evaluation included exploratory and confirmatory factor analyses to assess construct validity, and reliability. Data were analyzed using SPSS and JASP to ensure the scale’s validity and reliability for assessing burnout among Taiwanese clinical nurses. Results: The sample size of the final analytic sample was 529 nurses who were recruited in three medical Centers in Taiwan. A nine-factor and 42-item version of the Taiwanese Nurse Burnout Scale (TNBS) did not demonstrate the best fit indices in the confirmatory analysis, which led to the accounting of an alternative structural model. Exploratory factor analysis (EFA) of the revised scale resulted in a five-factor, 19-item solution that explained 73.2 per cent. of the total variance. A following confirmatory factor analysis (CFA) indicated acceptable fit, where the standardized loadings ranged between.58 to.95, average variance extracted (AVE) ranged between 0.58 and.85, the composite reliability was between.85 and. 94 and the Cronbach’s α 0.92 of the entire scale, thus validating the construct validity and reliability of the instrument. Conclusions: The five-dimensional, 19-item Taiwan Nurse Burnout Scale (TNBS) is indicated to have a strong psychometric face, thus making it an effective and reliable tool in the evaluation of burnout among Taiwanese clinical nursing groups.

Response to Letter in regards to Evaluating in situ Simulation in Critical Care: Insights from Healthcare Professionals [Letter]

Background: Emergency department (ED) internships are essential for developing core clinical competencies in medical students. This study evaluates the weekly progression of key competencies during a structured three-week ED internship and examines the impact of extending the program from two to three weeks. Additionally, it considers how such training supports students’ readiness for multidisciplinary, team-based healthcare environments. Methods: This retrospective longitudinal study analyzed a total of 2068 workplace-based assessment (WBA) forms collected from June 2018 to May 2020. Each WBA evaluated ten key clinical competencies: learning attitude, history taking, clinical judgment, medical knowledge, prescription, communication, patient education, literature appraisal, oral presentation, and documentation. A subgroup of 133 medical students who completed the full three-week internship with complete WBA records was included in the longitudinal analysis. Generalized Estimating Equations (GEE) modeling assessed performance trends and inter-cohort differences between 2018 and 2019. Results: Significant improvements were observed across all competencies, with the most notable gains in history taking, clinical judgment, communication, prescription, and documentation. Learning attitude scores increased from 4.46 (SD = 0.66) in Week 1 to 4.58 (SD = 0.58) in Week 3. Prescription and documentation improved from 3.85 and 4.17 to 4.06 and 4.32, respectively. GEE analysis confirmed significant performance gains by Week 3 (p = 0.0064). Students in 2019 outperformed those in 2018 (p = 0.0318), suggesting that curriculum refinements enhanced educational outcomes. Conclusion: A structured three-week ED internship significantly enhances medical students’ clinical competencies, particularly in areas fundamental to multidisciplinary care such as communication, clinical judgment, and documentation. The extended duration promotes deeper clinical immersion and fosters skill reinforcement through real-time feedback and collaborative practice. These findings underscore the importance of sustained, structured clinical experiences in preparing students to function effectively within interdisciplinary healthcare teams. Further research should investigate optimal training durations and integrative teaching strategies to support competency-based, team-oriented medical education.

International medical students at I‐Shou University's School of Medicine for International Students (SMIS) receive Taiwan government‐funded scholarships to cultivate skilled and compassionate medical professionals from the Caribbean, Central America, and the Pacific Islands. This study examines the meaningful impact of Caribbean medical students' participation in interviews with the families of silent teachers, a central element of Taiwan's distinctive approach to anatomical education. Through these interviews, students were exposed to the deeply personal narratives of body donors, such as their life stories, motivations for donation, and their values, such as altruism, family devotion, and reverence for life. These interactions offered the students a rare opportunity to bridge the gap between technical medical training and healthcare's emotional, ethical, and cultural dimensions. This study examines reflective practices' impact on Caribbean medical students' development during interactions with Silent Teacher donors. Reflective narratives from 28 culturally diverse students were analyzed using thematic analysis. The experience enhanced the students' understanding of the significance of body donation in Taiwanese society, which contrasts with more anonymous approaches in Western medical education. As a result, international students commented on key professional attributes, including cultural humility, empathy, and a stronger ethical awareness. The family interviews allowed students to engage in the human aspect of medicine, reinforcing the importance of compassionate care and emotional intelligence in their future medical practice. This program is a meaningful model for integrating humanistic and ethical learning into the curriculum, especially for international students, fostering their growth into well‐rounded, culturally aware, and empathetic physicians.