Nursing students' experience of a transformative approach to teaching cross cultural clinical decision making.

OBJECTIVES: This study reveals the learning gained by Canadian and Rwandan nursing students from a course to enhance cross cultural clinical decision-making skills using a collaborative approach across two countries. METHODS: A qualitative descriptive study was conducted using thematic analysis. The study included analysis of end of course reflections of 94 students. RESULTS: Students became more open-minded, curious, strengthening teamwork, increasing their critical thinking, and identifying cross-cultural similarities in practice. They challenged their previous beliefs about others. CONCLUSIONS: Students achieved a transformation of previous knowledge and decision-making skills. Results indicate the value of underpinning courses with theories and being open in allowing students to develop their own means to achieve expected learning outcomes. IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE: Creating learning environments designed to stimulate open mindedness and exploration of cultures among students can be achieved through online learning. Providing opportunities for students to learn across other countries about their nursing practices and health systems are critical to understanding how future patients who are immigrants and refugees from other countries differing perspectives to their health care needs.

Impact of a transformative health literacy model for Thai older adults with hypertension.

BACKGROUND: Hypertension is the important risk factor for cause disability and death, particularly if there is a loss of self-care knowledge. Health literacy encompasses the comprehension and awareness of health-related information, which is beneficial for managing the health of older adults with hypertension. Therefore, the objective of this study was to examine the impact of a transformative health literacy model to develop the health literacy levels among Thai senior citizen with hypertension. METHOD: This research employed an experiment. Thirty-six participants engaged in the transformative health literacy model. The instrument is the health literacy in hypertension scale, which had acceptable reliability and validity. RESULTS: The study revealed that the level of health literacy in the post-test and follow-up phases of the experimental group who received the health literacy promotion model was significantly higher than the pre-test level of health literacy at a significance level of 0.05. CONCLUSION: The study outcomes create a new pathway to enhancements of health literacy in Thai older adults with hypertension.

Medical student learning on a distributed training platform in rural district hospitals.

BACKGROUND:  Decentralising medical school training enhances curriculum relevance, exposing students to generalist patient care in diverse contexts. AIM:  The aim of the study was to understand the student experiences of learning during their 7-week Family Medicine rural rotation. SETTING:  Final year medical students who had completed their Family Medicine rotation in November 2022. METHODS:  A qualitative study involving 24 final year students (four semi- structured interviews and four focus group discussions [4 x 5 students]). All interviews were recorded, transcribed verbatim and analysed thematically. RESULTS:  Analysis revealed positive learning experiences and identified the following themes: taking responsibility for learning, the generalist context, teaching and learning in context and managing the learning environment. CONCLUSION:  Active participation in hospital activities, exposure to disorientating dilemmas that challenged assumptions and reflection on these experiences led to transformative learning and knowledge co-construction.Contribution: The study contributes to the discussion and reinforces the advantages of distributed, experiential training, highlighting the positive impact of meaningful participation and transformative learning opportunities.

'Ain't I a Nurse', implementing a digital illustration of resistance when challenging anti-Black racism in nursing education.

Since the COVID-19 pandemic, ongoing reports have highlighted the urgency of addressing anti-Black racism within Canada's healthcare system. The paucity of research within a Canadian context has created growing concerns among Millennials and Generation Zs for healthcare to address growing health disparities and health inequities that are attributed to institutional and structural racism. Recognizing the paradigm shift that has occurred because of the pandemic and the sleuth of racial killings, the nursing classroom has witnessed a change and a need for nursing education to be relevant for the cohort of nursing students who are seeking answers. The scarcity of nursing literature addressing diverse forms of learning demonstrates the need for nursing education to explore new ways of being diverse, inclusive and innovative when teaching intergenerationally. In this paper, the author challenges nurse educators to revisit the student-educator relationship by introducing critical digital pedagogy to dismantle anti-Black racism and promote student-educator engagement for transformative learning to occur. As an educator, the author implements the use of digital illustration as a tool of resistance for students and educators to assess, engage, act and reflect on creating change within nursing education. Using Black feminist thought and culturally responsive learning, the author introduces an arts-based approach through the innovative design of an illustration, titled, 'Ain't I a Nurse. Combining historical stories with contemporary socio-political experiences, the author demonstrates how students and educators can enter a cognitive learning experience where they can connect mentally and emotionally, and in so doing re-envision and recreate a new world that centralizes equity, diversity and inclusivity through critical discourses. Through the illustration anti-Black racism is challenged and anti-Black racism resistance is discovered as an antidote in dismantling anti-Black racism within nursing education.

Medical students' experience and learning outcomes of overseas community involvement project: a qualitative study.

BACKGROUND: Medical students in Singapore engage in short term medical missions, locally known as Overseas Community Involvement Projects (OCIPs). Little is known about the learning outcomes of an OCIP and how this complements their medical education back home. Understanding this can help the medical educators structure the OCIP to optimise its learning value. OBJECTIVES: This study aims to gain an in-depth understanding of the experiences and learning outcomes of the medical students who participated in the OCIP. METHODS: This was a qualitative study involving Singaporean students from one medical school travelling to Nepal. Data was collected from reflective journals, overall group reflections and two focus group discussions. The data was thematically analysed using the Accreditation Council for Graduate Medical (ACGME) core competencies for medical professionals. RESULTS: The data could be classified under various themes within the six domains of the ACGME framework. The study revealed themes of: humanism, socioeconomic and cultural determinants of health under the domain of patient care, application of medical knowledge, investigating and evaluating the needs of a population and feedback to drive improvement under the domain of practice-based learning and improvement, use of non-verbal cues and communicating across language barriers under the domain of interpersonal and communication skills, healthcare systems and delivery, resourcefulness and adaptability, health equity and accessibility under the domain of systems-based practice, ethics, role-modelling, teamwork and leadership skills, interprofessional skills and resilience under the domain of professionalism. Understanding the students' motivations, utilising reflections, and following the patients' journey facilitated attainment of these outcomes. CONCLUSIONS: This OCIP experience translated to learning outcomes aligned with the ACGME framework. There is great potential for the experiential learning from a well-structured OCIP to help with personal and professional development and global health education.

Reimagining faculty development: A paradigm shift from content to transformative learning processes.

BACKGROUND: Faculty development programs in health professional education traditionally emphasise theories, principles, and effective teaching practices. However, the efficacy of these strategies in instigating meaningful changes in instructional practices has come under scrutiny. METHODS: This qualitative research aims to enhance our understanding and support of educators' ongoing learning and growth. Employing a transformative learning lens, the study explored the experiences, professional development practices, and responsibilities of clinical educators who participated in a faculty development course. Utilising Mezirow's transformative learning theory as a framework, this research investigated the transformative journey of educators, analysing reflective pieces from 144 participants. RESULTS: The study findings revealed shifts in pedagogical approaches, ranging from the recognition of a haphazard teaching style to the intentional integration of evidence-based methods and pedagogical philosophies. The thematic analysis identified key stages in the transformative process, illuminating educators' commitment to structured teaching, self-directed learning, and continuous improvement. CONCLUSION: This research has contributed valuable insights into how faculty development programs can stimulate reflective practices and transformative learning in health professional education. The article argues for the centrality of transformative learning processes in faculty development, presenting an intriguing perspective on sustainable and impactful professional growth. Trends across learning experiences are presented, accompanied by practical recommendations. The implications of the research for clinical educators, administrators, and developers of formal faculty professional development programs are also discussed.

Challenging anti-racism in nursing education: A moral and professional call to action.

The call to implement anti-racism pedagogy in nursing education and practice is reverberating globally. Racist ideologies are foundational to systems of health inequity. An antiracist approach is critical to dismantling systemic racism and promoting optimal health outcomes in the quest for health equity. Therefore, employing an anti-racist pedagogy within nursing education that allows students and teachers to reflect on their roles in dismantling racist structures and transforming equity outcomes in practice and society, is a moral undertaking. However, for nursing education to make significant inroads in health equity, it cannot be guided by the same Eurocentric motives and value systems that continue to shape health inequities. We must transcend the boundaries of Eurocentric knowledge construction to intentionally shift how nurses think and practice within systems of inequities. Alongside the pressing and growing call for radical transformation of students and teachers through anti-racist pedagogy, we also provide directions to teaching strategies that support the uptake of anti-racism in nursing curricula and classroom engagement.

Assessing REflective simulation-based e-Training on motivational interviewing among multidisciplinary healthcare practitioners [RESeT-MI]: a mixed methods pilot study.

BACKGROUND: Many health science curricula have integrated behavioral modification techniques in their plans. Motivational Interviewing is one such technique. Educational interventions to promote Motivational Interviewing have had limited success. Integrating simulation-based learning in health science curricula might offer a platform whereby students can train in well controlled environments with increased authenticity, provision of standardized experiences and the capacity for immediate feedback to participants. Using motivational interviewing as an exemplar, the purpose of this study was to assess the impact of a simulation-based reflective e-training program on knowledge, attitudes, and confidence in Motivational Interviewing among healthcare practitioners from diverse healthcare disciplines. A secondary aim was to explore whether self-reflection can promote reflective learning. METHODS: This was a mixed-method study design. Fifteen participants from different health disciplines were included in the quantitative phase of the study, the simulated interview, and the reflective assignments while five participated in the focus group. Pre and post tests were used to examine the effect of training on knowledge, attitudes, and confidence in Motivational Interviewing. Assessment of Motivational Interviewing Treatment Integrity [MITI] scores in a simulation-based scenario was used. A qualitative content analysis of a focus group provided a more in-depth understanding of the participants experiences. Excerpts from reflective assignments were analyzed using Transformative Learning Theory concepts. RESULTS: A Wilcoxon test showed that the training elicited a change in confidence in performing Motivational Interviewing [Z= -2.766, p = 0.006], median scores increased from 29 to 34. A quarter of technical scores and half of the relational scores indicated good competence. Participants reflected content transformation through feelings of empowerment and satisfaction when they were successful in engaging and motivating clients. Process transformation was evident in reflections on how to improve core skills specifically reflective listening. Reflections on Motivational Interviewing spirit related values showed premise transformation, which may indicate attitude changes. CONCLUSION: A simulation-based e-training program on Motivational Interviewing represents an important educational modality for training in the health disciplines. Results of this study provide evidence supporting the integration of reflective simulation-based e-training into the education curricula of health disciplines in MI and beyond.

Attitudes and Confidence in Communication Skills of Fourth-Year Medical Students After Online Small Group Discussion and Peer Role-Play: A Survey Study.

OBJECTIVE: This study investigated the impact of online small group discussions and peer role-play on medical students' attitudes toward and confidence in communication skills. METHODS: The study involved a 3-hour instructional design that integrated small group discussions and role-plays to enhance the communication abilities of fourth-year medical students. The data were obtained from students through a post-activity online survey. Likert scale responses were quantified as percentages. Students' narrative feedback on their learning achievements was subjected to content analysis. Codes and categories were agreed upon by investigators and reviewed by an external auditor. RESULTS: A total of 151 medical students responded to the survey, representing a 47.94% response rate. The majority strongly agreed that good communication skills help physicians obtain reliable information (94.00%) and that practicing questioning skills is essential (92.1%). Content analysis revealed that nearly half (48.34%) considered that the learning activities fostered positive attitudes toward communication. These attitudinal improvements included increased empathy and emotional care (37.75%), recognition of communication as a trainable skill (10.57%), and recognition of the necessity of communication skills for physicians (8.61%). Additionally, most students (75.5%) reported increased confidence in their communication skills. CONCLUSIONS: In alignment with transformative learning theory, online small group discussions combined with peer role-play may potentially enhance the attitudes and confidence of medical students in relation to communication skills.

Emerging Health Care Leaders: Lessons From a Novel Leadership and Community-Building Program.

Background: Although there are guidelines and ideas on how to improve public health education, translating innovative approaches into actual training programs remains challenging. In this article, we provide an overview of some initiatives that tried to put this into action in different parts of the world, and present the Emerging Health Care Leader (EHCL), a novel training program developed in Switzerland. Policy Options and Recommendations: Looking at the experience of the EHCL, we propose policymakers and other interested stakeholders who wish to help reform public health education to support these initiatives not only through funding, but by valuing them through the integration of early career healthcare leaders in projects where their developing expertise can be practically applied. Conclusion: By openly sharing the experiences, strengths, weaknesses, and lessons learned with the EHCL program, we aim to foster a transparent debate on how novel training programs in public health can be organised.

Handle with Care: Transformative Learning as Pedagogy in an Under-Resourced Health Care Context.

Issue: A significant component of health professions education is focussed on students' exposure to the social determinants of health and the challenges that patients within the health care system face. An appropriate way to provide such exposure is through distributed clinical training. This usually entails students training in smaller groups along the continuum of care, away from tertiary academic hospitals. This also means students are away from their existing academic and social support systems. It is evident that knowledge and clinical skills alone are not sufficient to prepare students, they also need to be taught to critically reflect on how their own values and attitudes traverse their knowledge and skills to influence their practice as healthcare professionals. This process of critical reflection should aim to provide a transformative learning experience for students and requires active facilitation. In under-resourced health care contexts where clinicians responsible for student training are facing high patient load, lack of resources, inequitable health care services and high levels of burn-out, the facilitation of student learning may be compromised. Evidence: Clinical learning opportunities that are considered transformative, frequently challenge students' sense of self and sense of belonging. This experience can have detrimental effects if the processes of transformative learning pedagogy are not adequately facilitated. The provision of support staff, lecturers and clinical facilitators on the distributed training platform is challenged by the remote nature of some of the sites and the cost of recruiting and capacitating additional on-site staff. The potential for what has been termed "transformative trauma" and the subsequent halted transformative learning experience, has ethical implications in terms of student wellness and the educational responsibility institutions carry. Implications: The authors suggest considerations in facilitating an ethical transformative learning process. These include making the transformative learning pedagogy explicit to students and clinical facilitators and using the 'brave spaces' framework to help students with individuation and provide them with the tools to understand how emotion influences behavior. Strategies to improve relationship development and communities of support, as well as ideas for faculty development are offered.

A spark of change: developing an innovative gerontological nursing intervention mapping initiative for training and education (IGNITE).

BACKGROUND: With an aging global population and advancements in medical technology, there is an urgent need for innovative gerontological nursing education programs. This study aimed to develop and evaluate the Innovative Gerontological Nursing Intervention Mapping Initiative for Training and Education (IGNITE) program. This program is a digital platform-based postgraduate nursing curriculum that employs the Intervention Mapping Approach (IMA) and Transformative Learning Theory to address the evolving needs of gerontological nursing. METHODS: The IGNITE program's development process encompassed a comprehensive approach, including needs assessment, mapping of course objectives, integration of theory-based methods and strategies, course design, implementation, and rigorous evaluation. The pilot evaluation study involved pre- and post-tests focused on ageism, attitudes towards elder care, knowledge about older adults, transformative behavior change, and program satisfaction. The findings revealed significant improvements across all these dimensions, affirming the effectiveness of the program. RESULTS: The program leveraged experiential learning, critical reflection, and rational discourse to facilitate transformative educational experiences. Notably, pre- and post-test comparisons showed marked improvements in attitudes towards older adult care and dementia care knowledge. Participants expressed high satisfaction with the program, with significant reported changes in transformative behaviors. The study also illuminated the initial negative attitudes of clinical nurses towards older adults and underscored the importance of transformative learning experiences in fostering empathy and understanding. CONCLUSIONS: The IGNITE program lays a foundational framework for developing educational materials that promote transformative learning and self-reflection among healthcare professionals. This approach can lead to innovative nursing practices and personal growth. The application of the IMA and Transformative Learning Theory in gerontological nursing education shows significant promise. Future research should focus on exploring the long-term impacts of such programs and their applicability in diverse healthcare settings.

Transforming self-experienced vulnerability into professional strength: a dialogical narrative analysis of medical students' reflective writing.

Medical students' efforts to learn person-centered thinking and behavior can fall short due to the dissonance between person-centered clinical ideals and the prevailing epistemological stereotypes of medicine, where physicians' life events, relations, and emotions seem irrelevant to their professional competence. This paper explores how reflecting on personal life experiences and considering the relevance for one's future professional practice can inform first-year medical students' initial explorations of professional identities. In this narrative inquiry, we undertook a dialogical narrative analysis of 68 essays in which first-year medical students reflected on how personal experiences from before medical school may influence them as future doctors. Students wrote the texts at the end of a 6-month course involving 20 patient encounters, introduction to person-centered theory, peer group discussions, and reflective writing. The analysis targeted medical students' processes of interweaving and delineating personal and professional identities. The analysis yielded four categories. (1) How medical students told their stories of illness, suffering, and relational struggles in an interplay with context that provided them with new perspectives on their own experiences. Students formed identities with a person-centered orientation to medical work by: (2) recognizing and identifying with patients' vulnerability, (3) experiencing the healing function of sharing stories, and (4) transforming personal experiences into professional strength. Innovative approaches to medical education that encourage and support medical students to revisit, reflect on, and reinterpret their emotionally charged life experiences have the potential to shape professional identities in ways that support person-centered orientations to medical work.

Student midwives' lived experiences of caring for bereaved parents following perinatal loss using actor-based simulation: A phenomenological study.

BACKGROUND: Student midwives frequently encounter bereaved parents in clinical practice; however, the experience of caring for bereaved parents can be a significant source of traumatic stress. Although the use of simulation to teach bereavement care is considered a powerful experiential form of learning, evidence for its effectiveness as a transformative learning strategy is limited. AIM: To explore student midwives' lived experience of caring for bereaved parents experiencing perinatal loss using high-fidelity simulation. DESIGN: Students midwives participated in an actor-based bereavement simulated scenario. Data was collected using semi-structured interviews. Interpretative Phenomenological Analysis was conducted to gain a deep understanding of the meaning of the experience. Mezirow's Transformative Learning Theory was applied as an analytical framework to illustrate how the student midwives made sense of and learned from the experience of caring for bereaved parents experiencing perinatal loss. SETTING: One BSc (Hons), 156-week undergraduate midwifery programme within a university in the Northwest of England. PARTICIPANTS: A purposeful sample of nine first-and second-year student midwives volunteered to participate in the study. FINDINGS: One of the superordinate themes that emerged from the analysis (1) 'trying to console and making things easier' and the related subthemes (1a)'what words can I say', (1b)'my instinct was to console the mum', (1c)'left to sort of pick up the pieces' captured the deep sense of powerlessness and the professional dilemmas experienced as students struggled to emotionally console and communicate the right words to say to the grieving parents. CONCLUSION: The study highlights the vital role of simulation as a defined model of bereavement education that equips students with the necessary knowledge, skills, and confidence to provide compassionate care to bereaved parents experiencing perinatal loss. IMPLICATIONS FOR PRACTICE: The emotional toll of caring for bereaved parents is significant, and higher education institutions should adopt experiential forms of learning using actor-based simulation scenarios to emotionally prepare students to care holistically for parents affected by perinatal loss.

Developing the agroecological niche in Nicaragua: The roles of knowledge flows and intermediaries.

Supporting transitions to sustainable, resilient agri-food systems is important to ensure stable food supply in the face of growing climate extremes. Agroecology, or diversified farming systems based on ecological principles, can contribute to such systems. Based on a qualitative case study of Nicaragua, a forerunner in agroecology, this paper unpacks an ongoing transition to agroecology, focusing on how the transition has been shaped by knowledge flows and intermediary actors. Using a niche development framework based on knowledge processes, we analyze the growth of the agroecological niche in Nicaragua over three phases of niche development. The findings show how knowledge processes' emphases have shifted over time, as have functions enacted by intermediaries. Dedicated, diversified intermediaries have been key in creating momentum for agroecology, as have individual actors moving between niche and regime. Agency in niche development has come from both niche and regime actors. Finally, we find that Nicaragua's transition to agroecology has been ambiguous: While the niche has succeeded in changing the mainstream selection environment to its favor in some arenas, transition dynamics lag in others. Drawing lessons from this ambiguity, we suggest entry points for broader systems change, such as market stimulation, value chain development, phase-out policies, and supportive policy in related arenas. We also point out possible actions for niche actors such as integration of financial and commercial actors into niches and creation of dedicated market-focused intermediaries. Our results provide evidence of an ongoing transition and action points for supporting niche development in (sustainable agri-food) transitions around the globe.

Parameters of learning during clinical nursing study abroad: Focused analysis of phenomenological data using a change-transformative learning theory lens.

AIMS: To explore the nature and extent of learning attained as a result of unaccompanied-by-faculty clinical nursing study abroad experiences and to answer the research question 'what is the nature and extent of learning during study abroad?'. BACKGROUND: Following the Covid-19 restrictions, international placement opportunities for student nurses are now resuming. In light of this, it is an opportune time for nurse educators to reflect and consider the effectiveness of clinical study abroad placements as contexts of learning, especially in relation to attainment of desired learning outcomes such as personal and professional growth and the development of culturally competent global graduates. This is an important area to research as specific understanding in relation to the extent of learning and variations in learning between students is limited. DESIGN: The study was situated within the interpretivist paradigm to elicit experiences of study abroad. Aligned to this, a hermeneutic phenomenological methodology was applied to ensure these experiences emerged from the subjective horizon of student nurses. METHODS: Following ethical approval, two semi-structured interviews per student (post-return and follow-up) were conducted with student nurses who had undertaken a study abroad experience. Phenomenological hermeneutical data analysis for multiple context research was undertaken and a change-transformative learning theory lens was additionally employed to the analysis to differentiate between the extent of and variations in, learning attained. Twenty UK and European student nurses, who were registered onto a study abroad programme prior to the Covid-19 restrictions participated. RESULTS: Variations between participants were identified in relation to the nature and extent of learning. Participants experienced personal and professional growth and they experienced transformation in relation to self as a person, learner and nurse. However, variations existed when considering the attributes of global graduateness and cultural competence development. Whilst participants changed by expanding their knowledge in relation to global and cultural issues, some participants also appear to have concurrently experienced a reinforcement of ethnocentric frames of reference. CONCLUSIONS: Analysis revealed that study abroad offered opportunities for students to experience change and transformation. Whilst students demonstrated learning in both the domains of change and transformation, transformative learning in all identified outcome areas was not guaranteed. Whilst transformative learning was apparent when considering personal and professional growth, less extensive learning was demonstrated when considering development of the attributes of global graduateness and cultural competence. The paper therefore recognises the complex nature of study abroad experiences and recommends continued investigation in this field.

Transformative Learning, Priming, and Simulation Timing: A Randomized Controlled Pilot Study Among Emergency Medicine Residents.

Background Traditionally, learning is thought to occur best when prerequisite cognitive background information is delivered before simulation training. More recent studies have attempted to analyze the transformative nature of simulation by placing simulation before didactics. However, these studies were flawed as they provided background on the subject before the simulation itself. Our study aims to isolate the transformative effect of simulation and answer the question of whether lecture or simulation should come first. Methodology We designed a novel simulation session and accompanying lecture for 18 Emergency Medicine residents in all three years of training regarding a subject they were entirely unfamiliar with, the emergent management of a left ventricular assist device (LVAD). The residents were randomized into two groups. One group had the lecture (8/18) before their simulation, while the other group (10/18) had the simulation first and the lecture afterward, testing the motivational nature. Thereafter, both groups responded to a post-session survey with Likert-style and open-ended comment questions to assess the reaction to the session and a knowledge-based multiple-choice question test. Results Both groups did not score significantly differently on either the immediate post-test or a retention post-test that we administered four weeks later. Three of eight participants reported in open comments that they were much more comfortable with a lecture-first than a simulation-first format. Conclusions Despite controlling for some of the limitations of previous studies, our results including learners' preferences do not support a transformation in the sequence of clinical skills learning. Until other larger studies prove the opposite, we recommend continuing with the lecture followed by the simulation sequence as per existing conceptual simulation learning frameworks.

Transformative learning in clinical reasoning: a meta-synthesis in undergraduate primary care medical education.

Clinical reasoning is a vital medical education skill, yet its nuances in undergraduate primary care settings remain debated. This systematic review explores clinical reasoning teaching and learning intricacies within primary care. We redefine clinical reasoning as dynamically assimilating and prioritising synthesised patient, significant other, or healthcare professional information for diagnoses or non-diagnoses. This focused meta-synthesis applies transformative learning theory to primary care clinical reasoning education. A comprehensive analysis of 29 selected studies encompassing various designs made insights into clinical reasoning learning dimensions visible. Primary care placements in varying duration and settings foster diverse instructional methods like bedside teaching, clinical consultations, simulated clinics, virtual case libraries, and more. This review highlights the interplay between disease-oriented and patient-centred orientations in clinical reasoning learning. Transformative learning theory provides an innovative lens, revealing stages of initiation, persistence, time and space, and competence and confidence in students' clinical reasoning evolution. Clinical teachers guide this transformation, adopting roles as fortifiers, connoisseurs, mediators, and monitors. Patient engagement spans passive to active involvement, co-constructing clinical reasoning. The review underscores theoretical underpinnings' significance in shaping clinical reasoning pedagogy, advocating broader diversity. Intentional student guidance amid primary care complexities is vital. Utilising transformative learning, interventions bridging cognitive boundaries enhance meaningful clinical reasoning learning experiences. This study contributes insights for refining pedagogy, encouraging diverse research, and fostering holistic clinical reasoning development.