The rationale for the work is straightforward. Falls in hospital can lead to fractures, head injuries, prolonged admissions, loss of patient confidence, and substantial additional costs for health systems. Older adults and patients with certain conditions are particularly vulnerable, but any inpatient can be at risk depending on medication, mobility, and environment. Because nurses spend more continuous time with patients than any other professional group, their knowledge of risk factors, their attitudes toward prevention, and their day-to-day preventive practices are central to whether a hospital’s fall-prevention program succeeds or fails. Instruments that measure these three dimensions together, in the language nurses actually use at the bedside, are therefore a practical necessity rather than an academic luxury.

To build the questionnaire, the researchers drew on three complementary sources: a review of the published literature on fall prevention, existing validated fall-prevention instruments, and clinical guidelines for inpatient safety. From this foundation they assembled an initial pool of 33 items distributed across three domains: knowledge of falls and their prevention, attitudes toward fall-prevention practice, and self-reported preventive measures that nurses carry out in their routine work. This combination of sources is standard practice in instrument development, because it ensures that the items reflect both the scientific consensus on what prevents falls and the practical realities of nursing care, rather than the assumptions of a single author or committee.

The validation process then proceeded in carefully staged steps. Content validity was evaluated by a panel of 10 experts, who judged whether each item was relevant, clear, and representative of the domain it was intended to measure. Face validity was assessed by 30 nurses, who reviewed the draft items for readability and comprehensibility from the perspective of the people who would ultimately complete the survey. This two-layered qualitative screening is critical: an item that experts consider technically correct may still confuse respondents, and an item that reads well may still miss an important concept. Only after this refinement did the team move to the statistical phase of validation.

Construct validity, the question of whether the questionnaire actually measures the three theoretical domains it claims to measure, was tested using two complementary forms of factor analysis on independent samples of 200 registered nurses each. Exploratory Factor Analysis on the first sample allowed the underlying structure of the items to emerge from the data without imposing a predetermined model. The results supported the intended three-domain structure, with the knowledge, attitude, and preventive-measure domains explaining 48.7 percent, 61.3 percent, and 68.5 percent of their respective item variance. These percentages indicate that each cluster of items hangs together coherently around a single underlying construct, a fundamental requirement for a questionnaire that will produce interpretable domain scores.

The second sample was reserved for Confirmatory Factor Analysis, a stricter statistical test in which the researchers specify the three-domain model in advance and ask how well the observed data fit it. The final model, trimmed to 20 items, showed a satisfactory fit across all the conventional indices: a chi-square to degrees-of-freedom ratio of 1.46, a Comparative Fit Index of 0.96, a Tucker-Lewis Index of 0.95, a root mean square error of approximation of 0.07, and a standardized root mean square residual of 0.03. Values close to or above 0.95 for the fit indices, an RMSEA below 0.08, and an SRMR below 0.08 are generally regarded as evidence of good model fit, so the KAP-PMF comfortably meets accepted psychometric standards.

Reliability, the consistency with which the questionnaire measures what it measures, was assessed using three statistics. Cronbach’s alpha, the most widely cited measure of internal consistency, ranged from 0.78 to 0.86 across the three domains, above the commonly accepted threshold of 0.70. Composite Reliability, which is less sensitive to the number of items in a scale, ranged from 0.79 to 0.95. Average Variance Extracted, which quantifies how much of the variance in the items is captured by the underlying construct rather than by measurement error, ranged from 0.50 to 0.67, meeting or approaching the conventional benchmark of 0.50. Together these figures indicate that the shortened 20-item instrument retains dependable measurement properties despite the substantial reduction from the original 33 items.

That reduction itself is worth noting. The final instrument comprises just 4 knowledge items, 6 attitude items, and 10 preventive-measure items. Shorter questionnaires impose less burden on busy clinical staff, reduce respondent fatigue, and are more likely to be adopted in routine audits, training evaluations, and hospital quality-improvement programs. In resource-conscious healthcare systems, a validated 20-item tool that can be completed in a few minutes is far more practical than a sprawling survey, and the evidence that the trimmed version still fits the three-domain model and performs reliably suggests the researchers made defensible choices about which items carried the most informational weight.

The study was carried out among registered nurses at Hospital Pakar Universiti Sains Malaysia, a teaching hospital in Kelantan, and was approved by the Universiti Sains Malaysia Human Research Ethics Committee with written informed consent obtained from all respondents. It was funded by the Hospital Pakar USM Research Incentive Grant. The authors describe the evidence as preliminary, which is an appropriate caveat: the validation was conducted in a single institution, and further testing in other Malaysian hospitals, in different nursing specialties, and ideally with longitudinal designs linking questionnaire scores to actual fall rates would strengthen the case for broader use. Cross-cultural adaptation of health instruments is notoriously difficult, and a tool validated in one setting may behave differently where patient populations, staffing patterns, or fall-prevention protocols differ.

Even with those caveats, the significance of the work extends beyond one hospital in Kelantan. Malaysia’s healthcare workforce is multilingual, and much of bedside communication happens in Malay, so a validated Malay instrument removes a subtle but real source of measurement error that arises when nurses answer questions framed in a second language. The KAP-PMF also provides a template for other countries and languages where fall-prevention research has been constrained by the absence of locally validated tools. For hospital administrators, the questionnaire offers a way to identify specific gaps in knowledge or attitude that can be targeted by training, and to evaluate whether educational interventions actually shift nursing practice. For researchers, it adds a psychometrically sound instrument to a field where measurement quality often lags behind clinical ambition. As hospitals worldwide confront aging populations and rising expectations for patient safety, tools like this one, built rigorously and tested statistically, are the quiet infrastructure on which safer care depends.

Subject of Research: Development and psychometric validation of a Malay-language questionnaire assessing nurses' knowledge, attitudes, and preventive practices in hospital fall prevention

Article Title: Development and validation of a Malay questionnaire on nurses’ knowledge, attitudes, and practices in fall prevention in a teaching hospital in Kelantan: a cross-sectional study

Article References: Wahi, N., Ibrahim, M. I., Hairon, S. M., Yusoff, M., Abdullah, S. A., Zainun, R. M., & Ab Aziz, M. Z. (2026). Development and validation of a Malay questionnaire on nurses’ knowledge, attitudes, and practices in fall prevention in a teaching hospital in Kelantan: a cross-sectional study. BMC Nursing. https://doi.org/10.1186/s12912-026-05372-7

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05372-7

Keywords: fall prevention, nursing, questionnaire validation, psychometrics, patient safety, Malaysia, confirmatory factor analysis, exploratory factor analysis, Cronbach's alpha, cross-cultural validation, teaching hospital, nursing research

The study, published as an open-access short communication in Global Surgical Education, the journal of the Association for Surgical Education, was led by Marvin Man Ting Chung of the Department of Orthopaedics and Traumatology at the University of Hong Kong. Between April and July 2023, the team distributed a 28-item online questionnaire to resident and resident-specialist grade doctors in the surgical and orthopedic departments of a single public university teaching hospital. The specialties included general surgery, urology, otolaryngology, paediatric surgery, neurosurgery, cardiothoracic surgery, and orthopaedics. Only doctors with prior experience teaching medical students were invited to participate, and all responses were anonymized with informed consent obtained under ethics approval from the institutional review board.

The response rate was strikingly high: 40 of the 55 eligible doctors completed the survey, or 72.7 percent, a figure that lends considerable weight to the findings. The respondents spanned every training grade from postgraduate year 1 through 6 as well as resident specialists, and their gender and seniority distribution closely mirrored the full target population, which reduces the chance that the sample was demographically skewed. Every single respondent had themselves been taught by residents during medical school, and 65 percent rated that experience as good or very good—a detail that matters, because the authors found that residents who had positive experiences learning from residents were significantly more likely to enjoy teaching themselves.

The quantitative picture of teaching activity was equally revealing. Nearly all respondents, 97.5 percent, had delivered bedside teaching; 82.5 percent had acted as student supervisors when students attached to their teams as assistant interns; 60 percent had led small-group tutorials; and 30 percent had given seminars or lectures. The average annual teaching commitment was 23.9 hours, though the range stretched from zero to 80 hours, indicating highly uneven distribution of educational labor across the department. This volume of unpaid, often unstructured educational work is delivered on top of the demanding clinical and operative obligations of a surgical residency.

The attitudinal data told a story of qualified positivity. A majority of residents, 65 percent, said they enjoyed teaching medical students, and 80 percent believed their students benefited from it. Most strikingly, 75 percent agreed that teaching improved their own knowledge and learning, an endorsement of the old pedagogical maxim that to teach is to learn twice. Nearly half, 47.5 percent, actively wanted to be more involved in teaching, and 60 percent believed that formal training in medical education would advance their professional development. These numbers suggest that the appetite for educational engagement within surgical training is far larger than many program directors might assume.

Yet the structural supports for that appetite were almost entirely absent. Only 25 percent of respondents had ever received formal training in medical education or teaching technique. Just 12.5 percent had protected time carved out from clinical duties for teaching, and a mere 20 percent felt valued by their hospital or university for their teaching contributions. Feedback on teaching quality was similarly scarce, reported by only 25 percent. Perhaps most tellingly, a substantial minority voiced outright skepticism: 37.5 percent viewed teaching as a burden, and 40 percent believed that specialists and university staff, not residents, should shoulder the responsibility for undergraduate teaching.

The statistical associations uncovered in the survey add nuance to these headline figures. Male respondents rated their enjoyment of teaching significantly higher than female respondents, a difference that reached statistical significance, and men were also more likely to want greater involvement in teaching. Senior trainees and resident specialists reported feeling more comfortable and better prepared to teach than junior residents, suggesting that pedagogical confidence accumulates with experience over the course of training. Residents who logged more annual teaching hours were more likely to agree that teaching deepened their own learning, with a moderate positive correlation, implying that the reciprocal intellectual rewards of teaching compound with sustained practice. Age, place of primary medical qualification, possession of a higher degree, and success in passing the professional surgical examination on a single attempt showed no significant association with teaching attitudes.

The authors argue that these findings expose a systemic gap that residency programs cannot afford to ignore. The literature they cite shows that structured residents-as-teachers curricula, including workshops and even globally delivered virtual courses, measurably improve residents’ knowledge, confidence, and feedback skills. Peer observation offers a low-cost alternative that reduces the faculty time required for instruction, and distributing teaching materials electronically has proven feasible in busy surgical programs. On the time problem, the authors point to North American models of protected block teaching time, in which residents are freed from on-call and clinical duties during teaching sessions while colleagues cross-cover their service obligations—support that must, they caution, come from genuinely adjusted workloads rather than simply stretching the training day. They suggest practical, low-friction interventions such as brief case-based micro-teaching on ward rounds and distributing teaching duties across the whole team, including attending surgeons.

Recognition emerges as perhaps the most psychologically potent lever. While faculty surgeons can accumulate teaching awards and educational portfolios that advance their careers, residents perceive few direct professional benefits from excellence in teaching, which may explain why some see it as uncompensated labor competing with the operating room. The authors propose awards, formal evaluations, and career advancement tied to teaching quality as mechanisms to close that gap. Their finding that residents with more teaching hours wanted even more involvement hints that institutional acknowledgment could trigger a virtuous cycle. There is also a workforce pipeline argument: prior research shows that surgical residents who are effective educators strongly influence medical students to pursue surgical careers, and the Hong Kong survey’s finding that early positive exposure to resident teachers predicts later enjoyment of teaching underscores how teaching culture perpetuates itself across generations.

The authors are appropriately candid about the study’s limits. It captures a single academic institution whose local educational culture may not generalize, the modest sample size raises the risk of response bias, and social desirability—amplified in a small departmental cohort where anonymity may not feel complete—may have inflated reported enthusiasm. The questionnaire lacked formal validity testing and had no qualitative component. Future work, they write, should use mixed methods across multiple sites with focus groups and properly validated instruments. Even so, the core message travels well beyond Hong Kong: surgical and orthopedic residents already recognize that teaching sharpens their own clinical reasoning and benefits their students. What they need from institutions is not exhortation but infrastructure—formal pedagogical training, protected time, honest feedback, and tangible recognition—so that the residents-as-teachers model can deliver on its promise for the next generation of doctors.

Subject of Research: Perceptions and experiences of surgical and orthopedic residents teaching medical students in a residency training program

Article Title: “Residents-as-teachers”: a survey on perceptions and experiences of surgical and orthopedic residents in teaching medical students

Article References: Chung, M. M. T., Cheung, B. H. H., Co, M. T. H., & Wong, T. M. (2026). “Residents-as-teachers”: a survey on perceptions and experiences of surgical and orthopedic residents in teaching medical students. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 155. https://doi.org/10.1007/s44186-026-00564-w

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00564-w

Keywords: residents as teachers, medical education, surgical residency, orthopedics, clinical teaching, teaching hospital, undergraduate medical education, survey research, protected teaching time, faculty development, Hong Kong, surgical education

The study was a descriptive qualitative investigation built on a retrospective review of complaint records. The researchers retrieved all patient complaints associated with residents that were registered at a large Dutch teaching hospital over a five-year window, from 2017 through 2021. In total, 602 complaints were linked to residents during that period. Rather than treating each complaint as an isolated incident, the team coded them against a well-established competency framework known as CanMEDS — the Canadian Medical Education Directives for Specialists — which describes the roles a competent physician must play: Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional. This framework is used across many training programmes worldwide, which makes it a natural lens for translating raw complaints into educational targets.

The headline finding is striking for how concentrated it is. The Communicator role accounted for 35 percent of all complaints against residents, with the Medical Expert role close behind at 34 percent and the Professional role contributing 21 percent. In other words, roughly two-thirds of everything patients complained about fell into just two buckets: how information was conveyed, and the clinical care itself. The remaining CanMEDS roles — Collaborator, Leader, Health Advocate and Scholar — made up the residual share. For educators, that distribution is actionable intelligence. It suggests that if training programmes want to reduce complaints, the highest-yield investments lie in communication skills and clinical decision-making, not in the more abstract organizational competencies.

Digging into the Communicator category, the authors highlight problems with correct and complete information as a recurring theme. Patients complained when they felt they had not been properly informed about their diagnosis, treatment plan, procedures or what to expect next. This is a subtle but important distinction from simply being rude or dismissive. A resident can be polite, empathetic and well-intentioned and still leave a patient confused about whether a medication should be taken with food, when a follow-up appointment will happen, or what a surgical complication means for recovery. The complaint data suggest that the completeness and accuracy of information transfer — not just the tone of the conversation — is where many resident-patient interactions break down.

The Medical Expert complaints, the second-largest cluster, relate to the core clinical competencies: diagnostic reasoning, treatment choices and technical performance. That residents attract complaints in this domain is not necessarily alarming — they are, by definition, still learning — but the volume is instructive. It signals that patients perceive gaps in clinical judgement or execution often enough to formalize grievances, and it gives programme directors a concrete signal about where supervision, simulation training and graduated autonomy might need reinforcement. The Professional category, at 21 percent, captures issues of conduct, responsibility and ethical behaviour, including attention to patients’ expectations, which the authors specifically flag as an area deserving more attention in postgraduate curricula.

What makes this study methodologically interesting is the framing of complaints as educational data rather than purely as a quality-assurance or medico-legal artifact. Healthcare complaints analysis tools, including the HCAT referenced in the paper, have been developed to code complaint narratives in a structured way, and pairing such coding with the CanMEDS roles creates a bridge between the patient’s experience and the competency framework that already structures residency training. In principle, a programme director could take an anonymized, aggregated complaint profile for their department and map it directly onto learning objectives, simulation scenarios and workplace-based assessments. A cluster of complaints about incomplete discharge instructions, for example, becomes a targeted communication exercise rather than an abstract exhortation to communicate better.

The context matters too. Residents occupy an awkward position in hospital hierarchies: they perform a substantial proportion of frontline clinical work, yet they are learners with variable experience and incomplete autonomy. Patients interact with them constantly — at the bedside, during rounds, in clinics and on the phone — which means residents are disproportionately the face of the hospital. The authors note that patient complaints against residents are growing, and that despite this trend, research specifically focused on complaints against residents has been lacking. Most complaint analyses pool all clinicians together, which obscures the training-specific signal. By isolating resident-linked complaints, this study gives educators a cleaner read on where the learning needs actually sit.

The implications run in both directions. For patients, a well-designed complaint-to-education pipeline promises a hospital system that learns: the next resident on the ward should be better prepared to explain a procedure fully, manage expectations honestly and follow through on commitments. For residents, the framing matters because complaints can be demoralizing and even career-damaging when handled punitively. Analysed constructively, they become formative feedback — uncomfortable, perhaps, but specific and grounded in real patient experience. The authors argue that good postgraduate medical education programmes can result in fewer complaints, which reframes complaint reduction as an outcome measure for educational quality rather than a disciplinary metric.

There are, of course, limits to what a single-centre retrospective analysis can establish. The data come from one large Dutch teaching hospital, and complaint patterns may differ across countries, cultures, complaint systems and specialties. Complaints also represent a skewed sample of patient experience: they capture the dissatisfied minority who took the trouble to file a formal grievance, not the silent majority, and coding narratives into competency categories inevitably involves interpretive judgement. The study was approved by the Medical Ethical Committee of Zuyderland Hospital, with informed consent waived for the retrospective record review, and it was conducted without external funding. Those are standard safeguards, but they do not erase the inherent constraints of qualitative complaint analysis.

Even so, the core message is likely to travel well beyond the Netherlands. Teaching hospitals everywhere sit on archives of complaint files that are consulted mainly by risk managers and lawyers. This study demonstrates a practical alternative: code them against a shared competency framework, identify the dominant failure modes — here, incomplete information, clinical expertise and professionalism — and route those findings into curriculum design, supervision practices and feedback for trainees. The Communicator role’s top ranking is a particularly portable lesson, because communication failures are consistently among the most common root causes of patient dissatisfaction and litigation worldwide. If the path from complaint to change becomes routine, the 602 grievances in this dataset will have done something no individual complaint could: taught an entire generation of doctors-in-training how to care for patients a little better.

Subject of Research: Analysis of patient complaints against medical residents to improve postgraduate medical education

Article Title: From complaint to change: analysing patient complaints against residents to enhance postgraduate medical education

Article References: van Montfoort, A., van der Baaren, L., van der Baan, N., Sosef, M., & Heyligers, I. (2026). From complaint to change: analysing patient complaints against residents to enhance postgraduate medical education. BMC Medical Education. https://doi.org/10.1186/s12909-026-10450-0

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10450-0

Keywords: patient complaints, residents, postgraduate medical education, CanMEDS, communication skills, medical professionalism, patient safety, teaching hospital, medical education, qualitative analysis, clinical training, healthcare quality