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This study aimed to evaluate the effectiveness of using a virtual patient (VP) software program in increasing clinical reasoning skills confidence among medical students.

A quasi-experimental design was used to compare the outcomes of students’ confidence levels on clinical reasoning between problem-based learning (PBL) and VP program with 122 pre-clinical Year 2 medical students. History taking, physical examination, clinical investigations and diagnosis was investigated using four PBL cases in the oncology block. Pre- and post-differences in mean confidence scores between the arms were compared, as well as mean difference by type of case and skill category.

A total of 122/156 (78.2%) students participated; n = 55 were from 7 VP groups and n = 67 were from 13 control arm groups. For the primary outcome, the VP arm showed a statistically significant increase in confidence measures among 11/16 (4 cases × 4 skills) categories, compared to 4/16 for the control arm. The proportion of the students who indicated an improved confidence was statistically significant for the cervical cancer case for physical examination (60.0% improved in VP vs 12.5% in control), investigation (60.0% VP vs 18.8% control) and diagnosis (60.0% in VP vs 25.0% in control). Finally, analysis by case showed an increment in overall mean scores from the start to end of the case within the VP arm while the pattern was erratic in the control arm cases.

The study results showed that incorporating the VP into PBL was more effective in increasing students’ clinical reasoning confidence levels compared to the usual PBL. As the study utilized existing PBL cases, it demonstrates how medical schools can incorporate digital VP tools into pre-clinical years before students' transition to learning from actual patients in the clinical years.

Ethnoracial categories and classifications can change over time, sometimes leading to increased social mobility for marginalized groups or nonelites. These ethnoracial changes are often attributed to emulation, where nonelites adopt the elite's social, cultural, and political characteristics and values. In some cases, however, nonelites experience ethnoracial shifts and upward mobility without emulating elites, which events can help explain. I argue that the type of event, whether endogenous or exogenous, affects the ability of elites to enforce their preferred ethnoracial hierarchy because it will determine the strategy – either insulation or absorption – they can pursue to maintain their power. I examine this phenomenon by comparing the cases of Irish social mobility in 17th-century Barbados and Montserrat. Findings suggest that endogenous events allow elites to reinforce their preferred ethnoracial hierarchy through insulation, whereas exogenous events constrain elites to employ absorption, which maintains their power but results in hierarchical shifts. Events are thus critical factors in ethnoracial shifts.

The repercussions of Portugal's colonialism are not widely discussed. The marks of colonialism in the public space are still present in the urban landscape of Portuguese cities. Despite the growing activity of the Black movement's in the country, they are still not being systematically considered in the design of public policies. Moreover, the Portuguese census does not include any data collection on ethnic belonging. Therefore, it is difficult to deepen the knowledge of the Black communities. The Black community has been growing in Porto, the second-largest city in Portugal and it remains highly invisible. Starting from a collaborative project between Portuguese and American professionals, acting in the fields of sociology and socially engaged curatorial and contemporary art practices, an experimental approach was developed to map and cocreate with the Black community in Porto. By using digital tools while collecting, analyzing, and sharing data, and by applying an ethnographic approach and techniques of exploration from documentary photography, the team developed a collaborative project side by side with the community. An exchange between disciplinary knowledge and “various subject positions,” with all participants engaging in an exploration of how to begin decolonizing the city through those tools took place at the project TRAVESSIA. This chapter explores how the Black nonelite is expressing and questioning race and ethnic inequalities in Porto by discussing the results of this collaborative project.

This study aims to capture organizational transformation by delving into the process of business model (BM) reconfiguration in small firms operating within low-tech industries. It seeks to uncover the specific BM components that enabled a traditional less volatile and smaller organizations to adapt and innovate. We offer some recommendations in the form of insights for practitioners and other firms facing similar challenges.

We analyzed the history of a small firm belonging to a low-tech industry. Applying a single case study allowed us to explore organizational transformation in depth over time and identify the essential elements in the process of changing the BM. The analysis was performed using the procedural approach, with narratives, visual maps and temporal staggering.

The small firms went through many changes that resulted in BM reconfiguration at the organizational and industrial levels. The role of partners was relevant in this process, as well as organizational flexibility and more adaptable planning to make the necessary changes over time. The findings demonstrate the dynamism of the BM, with the prioritization of changes in organizational resources and capabilities, in order to adapt to the external environment, over time to create and capture value in a low-technology-intensive sector.

This study contributes a novel perspective to the field of Business Model Innovation (BMI) by highlighting the dynamic nature of BM in the under-explored area of small-scale enterprises of non-technology-intensive sectors. It emphasizes the critical role of serendipity, ambidexterity, pivoting, partnerships, adaptive planning and financial process organization in achieving sustained value creation and capturing value in the evolving external environments.

This paper seeks to illustrate how interventionist education reforms shape dis/trust-building processes and their impact on teacher professionalism in vocational education and training (VET) across national contexts. Using trust as the object of analysis, we discuss the affective mechanisms of becoming a professional in a standards-based neoliberal environment.

Through an analysis of VET teacher narratives in England and Austria, the paper draws attention to the ways in which policy instrumentalism has created a culture of distrust in VET. Drawing upon foundational work on system trust developed by Niklas Luhmann, we illustrate how conditions for trust sit at symbolic thresholds, which set the conditions for professional recognition within VET.

Our analysis revealed that attempts to standardise VET strategy are fuelled by the need for existential security and predictability, leading to tensions in the cultivation of system trust. Conditions for professional recognition across both contexts were based on practices of documentation and subordination, narrowly defining modes of legitimate self-expression in organisations. This constitutes a crisis of trust in VET teacher professionalism, which undermines pedagogical autonomy and integrity.

We seek to highlight the impact that reduced trust in the governance of VET can have on issues associated with teacher motivation, well-being and retention. The consideration of trust is therefore essential both for policy design and implementation in VET organisations.

The application of trust theory offers a distinctive lens through which to understand the impact of accountability, performativity and governance processes upon teacher subjectivity within VET across national contexts.

Sustainable development (SD) is vital in alleviating poverty, hunger and disease (PHD). The purpose of this study is to present a guiding framework with pathways targeting the sustainability challenges concerning PHD based on urban planning and design literature.

A narrative review and content analysis of 27 articles published by 11 journals indexed in Scopus were conducted using bibliometrics analysis.

The study’s findings discuss contemporary normative planning and design ideas and their ability to alleviate PHD. Considering these findings, the authors recommend that urban planning and design implementation processes carefully pursue the United Nations Sustainable Development Goals (SDGs) and Vision 2030 by tracking qualitative metrics that consider social, cultural and spiritual well-being.

The contribution is to propose a conceptual framework for alleviating hunger, poverty and disease through Vision 2030. Practitioners and policymakers can use this framework to assess the impact of their actions. Hunger, poverty and disease research could be guided by this framework to identify and prioritize best practices in cities of the Global South.