The study, conducted by Gozde Kugcumen of Istanbul Medipol University and Ilkay Gungor Satilmis of Istanbul University-Cerrahpasa, set out to answer a deceptively simple question: does adding a hands-on simulation session to standard online theoretical instruction actually improve what obstetric nurses and midwives know about preeclampsia care, and how confident do they feel applying that knowledge? The researchers ran the trial between February 2019 and August 2020 at a university hospital in Istanbul, registering it prospectively as a clinical trial to signal methodological transparency from the outset. In a field where educational interventions are often evaluated with before-and-after studies lacking any comparison group, the randomized design alone marks this work as a meaningful contribution.

The technical architecture of the trial reflects careful attention to the realities of clinical staffing. A total of 76 nurses and midwives were enrolled and randomized in equal halves of 38 participants per group, but the final complete-case analysis included 61 participants with full baseline and four-week outcome data—30 in the intervention group and 31 in the control group. Eligibility criteria were deliberately strict: every participant held at least a bachelor’s degree and had accumulated a minimum of six months of experience in obstetrics and delivery services. This ensured that the study measured the incremental value of simulation on top of an already educated and clinically active workforce, rather than compensating for gaps in basic training.

Crucially, both arms of the trial received the same foundation: an online theoretical training module covering the follow-up and care of pregnant women with preeclampsia. One week after completing this shared theoretical component, the intervention group took part in a simulation session built around a standardized patient—an actor trained to portray a consistent clinical scenario, allowing learners to practice history-taking, assessment, communication, and decision-making under realistic conditions. This design choice is methodologically important. Because both groups received identical theoretical content, any difference in outcomes at the four-week mark could be attributed to the simulation experience itself rather than to extra contact time or additional reading material.

The measurement battery was equally comprehensive. Knowledge was assessed with the Preeclampsia Information Assessment Form, a validated instrument probing disease-specific understanding, and with an Objective Structured Clinical Assessment Form designed to capture applied clinical performance. Self-efficacy—the psychological construct describing a person’s belief in their own capacity to execute the behaviors required for a task—was measured with the Self-Efficacy Scale in the Follow-up and Care of Pregnant Women with Preeclampsia, abbreviated as SESPWP. The learners’ experience of the education itself was evaluated with the Educational Practices Questionnaire and the Student Satisfaction and Self-Confidence in Learning Scale, two instruments widely used in simulation research to gauge whether the training environment supported engagement and confidence.

When the four-week posttest data were analyzed, the knowledge results favored simulation. Scores on the Preeclampsia Information Assessment Form were significantly higher in the intervention group than in the control group, with a p-value below 0.05, indicating that the difference was unlikely to be a statistical fluke. In practical terms, nurses and midwives who had rehearsed preeclampsia care with a standardized patient retained measurably more disease-specific knowledge a month later than peers who had received only the online lectures. For educators, this finding supports the long-standing hypothesis that active, experiential learning consolidates cognitive material more durably than passive delivery alone.

The self-efficacy story, however, is more complicated—and the authors were careful not to overstate it. Within the intervention group, SESPWP scores rose significantly from pretest to posttest, with a p-value of 0.015, suggesting that participants genuinely felt more capable of managing preeclampsia care after the simulation. Yet when the researchers adjusted for baseline differences between the groups, the between-group effect on self-efficacy was not statistically significant, and the difference in pre-to-post change between the two arms also failed to reach significance. In plain language: simulation participants gained confidence, but the control group’s confidence also shifted over the study period, and the simulation-specific increment could not be demonstrated with statistical confidence.

The authors themselves acknowledge this subtlety in their conclusions. Adding simulation-based training to shared online theoretical education was associated with higher baseline-adjusted knowledge at four weeks, they report, although the between-group difference in pre-post change was not statistically significant in sensitivity analysis, and no simulation-specific between-group effect on self-efficacy was demonstrated. This kind of transparent reporting is increasingly valued in clinical education research, where enthusiasm for simulation has sometimes outpaced the evidence. The trial’s sensitivity analyses—re-examining the primary findings under alternative statistical assumptions—reveal how fragile some between-group contrasts can be in a sample of 61 complete cases, a reminder that even well-designed trials have limits imposed by their size.

What the participants thought of the experience adds another layer to the findings. Scores on the Educational Practices Questionnaire and the Student Satisfaction and Self-Confidence in Learning Scale indicated high levels of satisfaction and positive evaluations of the simulation experience across the board. High satisfaction matters for a practical reason: educational interventions only work if clinicians are willing to complete them, and simulation formats that learners find engaging are more likely to be adopted and sustained in busy hospital environments. The consistency between the objective knowledge gains and the subjective learning experience strengthens the case that the standardized-patient session created a genuinely effective educational environment, even if its effects on confidence could not be isolated statistically.

The broader implications reach well beyond a single Istanbul hospital. Preeclampsia affects a meaningful share of pregnancies worldwide and demands rapid, coordinated recognition and management, typically initiated by bedside nurses and midwives before physicians become involved. Educational bodies have increasingly recommended simulation as a core component of obstetric emergency training, yet high-quality randomized evidence in nursing and midwifery populations has been comparatively scarce. This trial, conducted as part of a doctoral thesis in gynecologic nursing and presented orally at the 3rd International and 4th National Women’s Health Nursing Congress in May 2025, contributes precisely the kind of controlled, instrument-based evidence that such recommendations require. Its message is measured but useful: simulation appears to help clinicians retain what they learn about preeclampsia care, learners value the experience highly, and claims about self-efficacy benefits should await larger trials with the statistical power to detect them. For hospitals weighing the cost of standardized-patient programs against the return in clinical preparedness, the study offers a data point worth serious attention—and a clear template for the replication studies the field now needs.

Subject of Research: Effects of simulation-based education on nurses' and midwives' knowledge and self-efficacy in preeclampsia care

Article Title: Effects of simulation-based education on nurses’ and midwives’ knowledge and self-efficacy in preeclampsia care: a randomized controlled trial

Article References: Kugcumen, G., & Satilmis, I. G. (2026). Effects of simulation-based education on nurses’ and midwives’ knowledge and self-efficacy in preeclampsia care: a randomized controlled trial. BMC Nursing. https://doi.org/10.1186/s12912-026-05428-8

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05428-8

Keywords: preeclampsia, simulation-based education, randomized controlled trial, nursing education, midwifery, self-efficacy, standardized patient, clinical training, obstetric care, BMC Nursing, Istanbul, knowledge retention

The study focused on water smart agriculture, a suite of improved crop, soil, and water management practices promoted by Catholic Relief Services through its Raíces and RENACER programs. These initiatives, which phased into the study regions in 2020 and 2021, delivered their training through farmer field schools known locally as escuelas de campo agrícola. The stakes could hardly be higher. Evaluations of the programs showed that while the average farmer in the Dry Corridor was losing 60 to 80 percent of staple crops in recurrent droughts, farmers using the introduced practices lost less than 40 percent of their crops, achieved 70 percent higher yields than control plots, and doubled the national average yield.

The research team, led by Aidé Cuenca Narváez of the University of Notre Dame together with Alixandra Underwood, Festus O. Amadu, and Tracy Kijewski-Correa, examined four distinct practices. Permanent mulching asks farmers to leave crop residue in the field rather than burning it or feeding it to livestock, and to plant nitrogen-rich cover crops interspersed with trees. Responsible nutrient management requires mastery of the four Rs of fertilizer application: the right source, rate, time, and place. Integrated armyworm management prioritizes non-chemical pest interventions, reserving pesticides as a last resort. Visual soil evaluation, the most demanding of the four, trains farmers to diagnose the health of their plots and respond accordingly.

To explain why some of these practices took root in farmers’ memories while others faded, the researchers turned to cognitive load theory, a framework from educational psychology that describes the limits of working memory. The theory divides mental burden into three components: intrinsic load, reflecting the complexity and novelty of the material itself; extraneous load, arising from how information is presented; and germane load, the mental effort devoted to building lasting knowledge. The team added a fourth category of their own, which they call contextual load, to capture the mental bandwidth consumed by poverty and perceived resource scarcity. When these loads exceed working memory capacity, knowledge acquisition collapses.

The researchers scored each practice on complexity, novelty, and the degree of Spanish-language literacy assumed by the training materials. Permanent mulching emerged as the lowest-load practice: it is neither complex nor novel and does not depend on intensive written instruction. Responsible nutrient management imposed a moderate load, since fertilizer use was already widespread and instruction was largely visual. Integrated armyworm management carried a high load because it requires abandoning an entrenched pesticide routine through a bundled set of interventions. Visual soil evaluation ranked highest, demanding diagnostic skills most farmers had never practiced and relying on written Spanish-language materials.

The empirical results were striking. Using a multivariate probit regression on survey data collected in June 2022 from households across twelve communities in the Chiquimula and Baja Verapaz departments, the team found that perceived resource constraint significantly reduced knowledge retention for three of the four practices. The typical resource-constrained farmer was 8 percent less likely to retain knowledge about permanent mulching, 25 percent less likely for integrated armyworm management, and 29 percent less likely for visual soil evaluation. Sixty-nine percent of respondents described themselves as regularly struggling to meet their household’s basic needs, making the constrained group far from a marginal minority.

One practice defied the pattern. Responsible nutrient management was actually associated with positive retention among resource-constrained households, a result the researchers attribute to familiarity. Fertilizer use was already an established habit, and the free fertilizer distributed by the program reinforced it, though most participants credited their farmer field school experience rather than the inputs themselves for trying the practice. Yet that motivation rarely persisted: focus group participants reported lacking the finances to sustain fertilizer purchases once the program ended, which may explain why remittances, a source of alternative income, were positively associated with retention of this practice alone.

Education emerged as a powerful buffer against cognitive overload. The positive effect of schooling strengthened as the cognitive load of the practice rose, from a modest coefficient for permanent mulching to the strongest effect for visual soil evaluation. Land tenure told its own story: farmers who owned their land were significantly more likely to retain knowledge of the practices promising long-term soil improvements, including nutrient management, armyworm management, and soil evaluation. Renters, by contrast, face little incentive to invest in soil they may lose as it improves, since landowners tend to rent productive plots at higher prices or reserve them for family members.

The qualitative data added crucial texture to the numbers. Retention of integrated armyworm management, the lowest overall at 48 percent, fell to just 27 percent among farmers whose crops had not been affected by the pest, underscoring that knowledge endures only when it remains relevant to a farmer’s immediate challenges. Focus groups also revealed that even well-retained practices like permanent mulching faced adoption barriers, as the immediate need to plant edible or marketable crops often prevailed over the slower soil-quality benefits of cover cropping. Language compounded the problem: although training was delivered mainly in Spanish, many communities in Baja Verapaz speak Maya Achi, forcing reliance on informal real-time translation that added yet another layer of cognitive burden. Indigenous women participants particularly valued adapting technical measurements to locally meaningful references such as hand spans or footsteps rather than metric units.

The implications for development practice are concrete. Programs that fail to offset resource constraints, whether by providing inputs like fertilizer or pairing training with complementary support, may never achieve the adoption they seek, because the most constrained farmers cannot spare the mental bandwidth to learn. The authors recommend visual communication through diagrams and pictures, facilitation guides in local languages such as Achi, and harmonizing training with established local practices and measurement methods. They also highlight the pedagogical role of women, who frequently attended the field schools on behalf of their households and then transferred knowledge to male family members working the fields, suggesting that training-the-trainers approaches for female participants could multiply impact. The study’s limitations are acknowledged: retention was measured by open-ended recall rather than demonstrated skill, the sample included only program participants without a comparison group, and the findings emerge from short-term emergency programming rather than sustained extension. Still, the core message is difficult to ignore. Poverty does not merely deprive farmers of seeds, fertilizer, and land; it taxes the very mental machinery needed to learn their way out of vulnerability, and any climate adaptation program that ignores this burden is training against the grain of scarcity itself.

Subject of Research: Effects of resource constraints and cognitive load on retention of water smart agriculture knowledge among smallholder farmers in Guatemala's Dry Corridor

Article Title: Resource constraint effects on water smart agricultural practice retention in Guatemala’s Dry Corridor

Article References: Cuenca Narváez, A., Underwood, A., Amadu, F. O., & Kijewski-Correa, T. (2026). Resource constraint effects on water smart agricultural practice retention in Guatemala’s Dry Corridor. Discover Agriculture, 4(1), Article 274. https://doi.org/10.1007/s44279-026-00752-8

Image Credits: AI Generated

DOI: 10.1007/s44279-026-00752-8

Keywords: water smart agriculture, climate-smart agriculture, farmer field schools, cognitive load theory, Guatemala Dry Corridor, smallholder farmers, agricultural extension, knowledge retention, resource constraints, soil conservation, land tenure, poverty

The research team, led by Songyuan Yao, Rui Liu and Xiju He, took advantage of a natural experiment already unfolding at their institution. Forty first-year medical students, none of whom had prior cadaver-dissection experience, were taught anatomy in two intact classes of twenty students each. One class received pure virtual reality instruction; the other followed a traditional cadaver-based curriculum. Rather than designing a bespoke laboratory study, the researchers integrated data from three routine educational-assessment modules already collected at the medical school, then designated the comparative analysis framework after the fact. That design choice matters for interpretation: because students were assigned by class rather than individually randomized, the study is exploratory and noncausal, a caveat the authors state plainly.

What makes the study unusual is its insistence on measuring performance beyond simple recognition. Most evaluations of virtual reality anatomy teaching stop at multiple-choice quizzes taken minutes after the lesson, a format that flatters digital tools because standardized images on a screen resemble the standardized renderings inside a headset. The Chinese team instead tracked three harder outcomes: the peak force students applied during a standardized task on cadaveric tissue, their diagnostic accuracy on noncanonical computed tomography and magnetic resonance imaging cases that deviated from textbook appearances, and the trajectory of their knowledge scores from thirty minutes to four weeks after instruction.

The haptic gap was the most striking. When students who had learned in virtual reality first touched real cadaveric tissue, they pressed with an average peak force of 8.74 newtons, compared with 4.52 newtons among cadaver-trained classmates. That mean difference of 4.22 newtons carried a 95 percent confidence interval of 2.92 to 5.52 and an effect size of Cohen’s d equal to 2.09, an extraordinarily large value by any educational or psychological standard. In practical terms, students who had never felt the resistance of skin, fascia and muscle handled real tissue nearly twice as forcefully as those who had, suggesting that the absence of realistic touch feedback in the virtual environment left a measurable imprint on motor behavior the moment students encountered the physical world.

Not every comparison favored the cadaver group, however. On a standardized model recognition task, the two groups were statistically indistinguishable: the virtual reality condition averaged 0.91 against 0.87 for the cadaver group, a difference that fell short of significance at p equal to 0.082. Immediate knowledge scores were likewise compatible with no difference between the teaching formats. In other words, for the kind of clean, canonical recognition questions that dominate conventional anatomy exams, a headset did the job just as well as a dissection table. The virtual classroom appears to be a perfectly adequate place to learn the map of the body; the trouble emerges when students must navigate terrain the map never depicted.

That trouble surfaced in two places. First, on noncanonical radiological cases, where anatomy appears in unfamiliar orientations or distorted by pathology, the virtual reality group’s accuracy dropped to 0.52 while the cadaver group achieved 0.71. The mean difference of 0.19, with a 95 percent confidence interval spanning 0.27 down to 0.11, indicates a robust deficit in what cognitive scientists call transfer: the ability to apply knowledge in forms that differ from how it was originally learned. The authors attribute this to what they describe as the representational variability of physical anatomy learning. A cadaver is irreducibly messy, with vessels and nerves varying from body to body, and that messiness forces students to build flexible mental representations. A polished three-dimensional model, by contrast, presents a single idealized anatomy that students may encode rigidly.

The second deficit emerged over time. Thirty minutes after instruction, both groups recalled the material equally well. But at the four-week mark, the virtual reality group’s mean score had fallen to 11.75 while the cadaver group retained a mean of 17.20, a mean difference of 5.45 points with a confidence interval of 8.24 down to 2.66. The statistical interaction between teaching condition and time was significant, reported as F of 2 and 76 equal to 15.38 with p below 0.001 and a partial eta squared of 0.29, meaning nearly a third of the variance in change over time was attributable to the instructional format. The authors suggest this weakening of delayed retrieval may reflect the retrieval demands of physical learning: manipulating a real body, orienting oneself around a table, and searching for structures in variable tissue all create rich, effortful memory-encoding conditions that passive virtual navigation may not replicate.

None of these results should be read as a verdict against virtual reality, and the researchers are careful to say so. The study involved a small sample of forty students, condition was confounded with intact class, and the three focal outcomes were designated for the integrated analysis after the data had been collected, all factors that make the findings exploratory rather than definitive. Ethics approval for the secondary use of anonymized routine assessment data was granted by the Hubei University of Medicine Ethics Review Committee in July 2025, and all participants gave written informed consent. Funding came from a teaching research project at the university’s Yaohu College, which the authors report played no role in the design, analysis or interpretation of the work.

Still, the pattern of results carries a clear message for medical educators weighing the considerable costs of maintaining dissection laboratories against the convenience and scalability of virtual reality. The digital classroom excels at delivering immediate, testable knowledge of anatomical structure, and it does so without the expense, ethical complexity and logistical burden of cadaveric programs. But the study’s evidence points to three specific costs that pure virtual instruction does not currently repay: a near doubling of force applied to real tissue on first contact, a nineteen-percentage-point drop in interpreting noncanonical clinical images, and a progressive loss of retained knowledge over four weeks. Each of these deficits maps onto a capability that matters in clinics and operating rooms, where bodies vary, tissue resists, and knowledge must be summoned months after the lecture.

The authors conclude that virtual reality may be most useful not as a replacement for physical anatomy learning but as a component within a competency-aligned blended curriculum, one that deliberately pairs immersive three-dimensional visualization with the haptic, variable and retrieval-demanding experiences that only real specimens provide. As medical schools worldwide expand their digital offerings, this study offers a concrete template for evaluation: measure not just what students can recognize immediately, but how hard they press, how flexibly they generalize, and how long they remember. By those fuller measures, the virtual body is a powerful teaching aid that has not yet learned to feel, to surprise, or to stick.

Subject of Research: Haptic and cognitive trade-offs of virtual reality versus cadaver-based anatomy education in first-year medical students

Article Title: Haptic and cognitive trade-offs of virtual reality–supported anatomy education: a retrospective multimethod cohort comparison

Article References: Yao, S., Liu, R., & He, X. (2026). Haptic and cognitive trade-offs of virtual reality–supported anatomy education: a retrospective multimethod cohort comparison. BMC Medical Education. https://doi.org/10.1186/s12909-026-10481-7

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10481-7

Keywords: virtual reality, anatomy education, medical education, cadaver-based learning, haptic transfer, knowledge retention, educational technology, cohort study, medical imaging, simulation training, cognitive transfer, Hubei University of Medicine