Bilge Delibalta

Aims: Clinical decision-making is a fundamental component of safe and effective nursing practice. Simulation-based learning (SBL) has emerged as an innovative educational strategy to support students’ clinical reasoning, professional development, and preparedness for practice. However, relatively little is known about how nursing students perceive simulation-based clinical decision-making experiences in relation to their professional identity, professional responsibility, and confidence. This study aimed to explore final-year nursing students’ experiences of a simulation-based clinical decision-making module (CDMM), with particular attention to their perceptions of professional identity, professional responsibility, and confidence in clinical decision-making.Methods: A qualitative descriptive study was conducted with twelve final-year nursing students from a state university in Turkiye. Participants completed a two-day simulation-based CDMM in March 2023 and subsequently participated in semi-structured individual interviews. Data were analysed using Braun and Clarke’s six-phase thematic analysis.Results: Four interrelated themes were identified: (1) transitioning towards the professional nursing role, (2) assuming responsibility for clinical decision-making, (3) developing confidence in clinical decision-making, and (4) recognising the value of SBL.Conclusion: Participants perceived the CDMM as a meaningful learning experience that supported their transition towards the professional nursing role, increased their awareness of professional responsibility, enhanced their confidence in responding to similar clinical situations, and highlighted the educational value of SBL. These findings suggest that structured simulation-based clinical decision-making experiences may help bridge the gap between theoretical knowledge and clinical practice in undergraduate nursing education.

Background: In the complex context of Intensive Care Units (ICUs), healthcare professionals coordinate care under considerable time pressure, uncertainty, and emotional strain. Effective interprofessional communication is essential for safe, high-quality patient care and is influenced by the communication attitudes of team members. This study aimed to explore the communication attitudes of healthcare professionals working in ICUs.Methods: This qualitative study involved 40 healthcare professionals, including resident physicians, nurses, and anaesthesia technicians. Data were collected in March 2023 through brief individual scenario-based simulation encounters followed by profession-specific focus group interviews. Focus group interview data and observation notes from the simulation sessions were analysed using inductive thematic analysis.Results: Six themes were identified: hierarchical structure, duties and responsibilities, role of the patient, team dynamics, coping mechanisms, and limitations of ICU simulation. Communication attitudes were strongly shaped by authority gradients, role ambiguity, and local team norms, often constraining open dialogue and collaborative decision-making. Participants also described emotional strain and a tendency to manage communication challenges through avoidance or hierarchical escalation rather than direct engagement.Conclusion: Communication in ICUs is shaped not only by individual skills but also by attitudes embedded within organisational structures, professional relationships, and workplace cultures. By foregrounding communication attitudes rather than behaviours alone, this study provides insight into how communication practices are learned, reinforced, and negotiated in critical care settings. Context-sensitive communication education, particularly in-situ simulation that reflects authentic team configurations, may support more reflective interprofessional learning and contribute to safer, more collaborative ICU practice.

A “communicator” is one of the competencies identified by a competent physician. As a nontechnical skill, effective communication needs to be d

Simulated participants (SPs) play an important role in health professions education through their involvement in teaching, assessment, and feedback. However, much of the existing literature has tended to emphasise their functional and pedagogical roles, with relatively less attention paid to how SPs develop and negotiate their professional identities. In this review, we focus on examining the processes associated with SP identity formation, drawing attention to the ways social interaction, role enactment, and theoretical perspectives intersect in simulation-based education. A critical review methodology was employed to synthesise and interpret the existing literature. Searches were conducted in PubMed, PsycINFO (Ovid), Web of Science, and Scopus using predefined keywords related to simulated participants and identity. Studies published in English or Turkish and mentioning SP identity were included. After screening the abstracts and full-texts, ten studies were identified for thematic content analysis. Three broad themes were identified. 1) The needs of simulated participants, 2) SP-related theories, and 3) The characteristics of SPs’ identities. SP identity formation is a process that is shaped through ongoing social interaction, contextual influences, and participation in simulation communities. Bringing together communities of practice and positioning theory provides a way of thinking about how SP identities are formed and how they may be better supported within simulation-based education. Recognition of SPs as identity-bearing professionals may inform ethical simulation practices, enhance SP well-being, and strengthen the overall quality of health professions education.

The quality of the clinical learning environment plays a critical role in shaping medical students’ educational outcomes. The Undergraduate Clinical

Introduction: Understanding how physicians interpret their societal and institutional contexts remains crucial for addressing the complexities of professional identity. This study explores professional identity formation (PIF) in clinical medical education through learners’ narratives and the perspectives of their role models. Methods: Using a multi-center qualitative narrative design, data were collected from clinical-year medical students across accredited state and private medical faculties representing diverse geographical regions. Reflective narrative writing and in-depth interviews were analyzed through a staged contextual qualitative approach. Results: Findings indicate that PIF is shaped through the dynamic interplay between clinical environments, societal and systemic structures, role modelling, and learners’ reflective engagement. Narratives framed professional identity not only in terms of technical competence but also through relational, ethical, and humanistic dimensions. Contextual analysis revealed that tensions between service demands and educational engagement, hierarchy and learner agency, and technical efficiency and humanistic care significantly influenced identity development. Reflection and narrative meaning-making emerged as mediating processes through which learners interpreted and internalized these experiences. Discussion: Drawing on a socio-cultural paradigm informed by activity theory, the study proposes a conceptual framework positioning PIF as a relational and contextually mediated construction shaped by both planned and implicit learning processes. The findings underscore the need for medical education programs to intentionally integrate reflective, narrative, and context-sensitive approaches to support sustainable professional identity development.

Implementing simulation-based education in medical curricula presents distinct challenges, especially for educators newly assuming leadership roles. This study aimed to explore the lived experiences of medical educators who are simulation center leaders to understand the nature of the challenges they encountered and to offer strategic insights for other leaders navigating similar transitions. A qualitative, phenomenological research design was employed. Data were collected from 4 simulation leaders through semi-structured interviews, reflective writings, and institutional documents. Interpretative phenomenological analysis was used to explore how participants made sense of their experiences. An external qualitative expert contributed to the coding and analysis process to ensure trustworthiness. Three major themes emerged: First, the role of the medical educator as a leader: participants reported shifting from being content experts to reflective leaders, emphasizing strategic vision, emotional intelligence, and educational theory. Second, team spirit: the presence of a dedicated team and shared moral purpose supported resilience and collaboration. Communication strategies and informal advocacy strengthened engagement. Third, understanding the challenges: faculty resistance, institutional inertia, and limited resources were viewed through an empathetic lens. Participants addressed resistance via faculty development, research collaboration, and ongoing feedback mechanisms. Finally, institutional support and leadership alignment: administrative support was pivotal in legitimizing efforts and sustaining initiatives. Leadership continuity, policy alignment, and access to decision-making platforms shaped the success of simulation integration. Leadership in health professions education, particularly in simulation-based implementation, requires more than subject expertise; it demands emotional resilience, strategic communication, and relationship-building. Findings suggest that simulation-based change requires not only technical knowledge but also adaptive leadership grounded in context and collaboration. Leaders navigated resistance not as defiance, but as a sign of systemic gaps in understanding and preparation. The study emphasizes the importance of aligning simulation efforts with institutional structures and culture to achieve lasting transformation in medical education.

BACKGROUND Measurement invariance analysis is a critical step in evaluating the structural validity of measurement instruments, ensuring that a scale measures its intended constructs equally across different subgroups. Such analyses are essential before making subgroup comparisons. This study investigated the measurement invariance of the Self-Regulated Learning Perception Scale (SRLPS), a tool designed to assess self-regulated learning levels among medical students. The SRLPS consists of 4 categories: motivation and action to learning, planning and goal setting, strategies for learning and assessment, and lack of self-directedness. MATERIAL AND METHODS A cross-sectional study was conducted involving 878 medical students spanning the first to final years. Multigroup confirmatory factor analysis (MG-CFA) was employed to assess measurement invariance across genders and years of medical education, categorized as preclinical and clinical years. Invariance was evaluated by comparing model fit indices across successive stages of invariance testing. RESULTS The findings demonstrated that the SRLPS achieved full measurement invariance in both sexes, confirming its suitability for valid comparisons between male and female medical students, with ΔCFI ≤0.01. For year of medical education, configural invariance was established, indicating that the 4-factor structure of the SRLPS is consistent across preclinical and clinical students. However, only partial metric invariance was achieved, suggesting that factor loadings for some items differ between preclinical and clinical groups. CONCLUSIONS The measurement invariance should be evaluated before using a scale for subgroup comparison. The SRLPS can be used to make valid comparisons between male and female medical students, but cannot be used for comparison between preclinical and clinical year students.