Perspectives of medicine, human biology, and nursing undergraduates on transversal skills learning: a mixed-methods study

RESEARCH Open Access © The Au ho (s) 2025. Open Access This a icle is licensed unde a C ea i e Commons A ibu ion-NonComme cial-NoDe i a i es 4.0 In e na ional License, which pe mi s any non-comme cial use, sha ing, dis ibu ion and ep oduc ion in any medium o o ma , as long as you gi e app op ia e c edi o he o iginal au ho (s) and he sou ce, p o ide a link o he C ea i e Commons licence, and indica e i you modi ied he licensed ma e ial. You do no ha e pe mission unde his licence o sha e adap ed ma e ial de i ed om his a icle o pa s o i . The images o o he hi d pa y ma e ial in his a icle a e included in he a icle’s C ea i e Commons licence, unless indica ed o he wise in a c edi line o he ma e ial. I ma e ial is no included in he a icle’s C ea i e Commons licence and you in ended use is no pe mi ed by s a u o y egula ion o exceeds he pe mi ed use, you will need o ob ain pe mission di ec ly om he copy igh holde . To iew a copy o his licence, isi h p : / / c e a i e c o m m o n s . o g / l i c e n s e s / b y - n c - n d / 4 . 0 /. Fon ana-Rosa e al. BMC Medical Educa ion (2025) 25:162 h ps://doi.o g/10.1186/s12909-025-06749-z BMC Medical Educa ion *Co espondence: Luis González-de Paz [email p o ec ed] Full lis o au ho in o ma ion is a ailable a he end o he a icle Abs ac Backg ound In heal h sciences p ac ice, in e pe sonal skills, c i ical hinking, and lea ning- o-lea n a e c ucial ans e sal skills. E ec i e eaching necessi a es he unde s anding o unde g adua es’ iews. This s udy explo ed unde g adua e expe iences in human biology, medicine, and nu sing deg ees in lea ning ans e sal skills. Me hods An explo a o y sequen ial mixed me hod design wi h quali a i e da a collec ion and a subsequen online su ey s udy. Th ee ocus g oups we e conduc ed wi h hi d- and ou h-yea unde g adua es, and da a we e analyzed wi h hema ic analysis. The online su ey a ge ed unde g adua e s uden s om all academic yea s o add ess inconclusi e de ails. Analysis en ailed desc ip i e s a is ics, and associa ions di e ences in esponses by deg ees we e analyzed using chi-squa e es s o Fishe ’s Exac Tes . Resul s Thi een unde g adua es pa icipa ed in ocus g oups and 159 in he online su ey. Th ee hema ic a eas eme ged: he aining ecei ed and i s pe cei ed ele ance, he e alua ion, and he lea ning me hods. Unde g adua es exp essed ha ans e sal skills we e necessa y o sel -pe sonal g ow h and p o essional de elopmen ; howe e 50.7% epo ed no ecei ing speci ic aining. Human biology and medicine unde g adua es epo ed less aining in c i ical hinking compa ed o nu sing (29.03% and 32.7% s. 76%, p < 0.001) and in in e pe sonal and ela ional skills (16.1% and 16.3% s. 57%, p < 0.001). Subjec i i y is an issue compa ed o adi ional es ing, wi h 39.6% o unde g adua es epo ing knowing he assessmen me hods o ans e sal skills and 56% us ing he p epa a ion o eaching s a . >80% o undeg adua e s uden s wan ed mo e pa icipa o y me hodologies — om class oom me hodology o p oblem-based assessmen s and simula ion, while plena y lec u es and gami ica ion we e less p e e ed. Conclusion Heal h sciences unde g adua es ad oca ed o e ec i ely in eg a ing ans e sal skills in hei p og ams. Nu sing unde g adua es showed highe sa is ac ion and exp essed ha ing expe ienced mo e ans e sal skills lea ning han human biology and medicine unde g adua es. Unde g adua es equi ed educa o s o ecei e mo e suppo and aining in adop ing me hodologies ha acili a e ans e sal skill acquisi ion h ough changes in he assessmen me hods and subs an i e ans o ma ion o he p og am cu icula. Pe spec i es o medicine, human biology, and nu sing unde g adua es on ans e sal skills lea ning: a mixed-me hods s udy Na halia Sil aFon ana-Rosa1, LuisGonzález-de Paz2,3,4*, Ana C.Codina-Rod íguez5, Ma íaPé ez-Ria 5 and Ma ía del Ma Ca ió-Llach6 Page 2 o 9Fon ana-Rosa e al. BMC Medical Educa ion (2025) 25:162 Backg ound Highe educa ional au ho i ies and in e na ional bod- ies ha e unde sco ed he impe a i e shi owa d educa- ional s a egies ocused on de eloping T ans e sal Skills (TS) [1]. These skills a e essen ial o handling changes in heal h sciences p ac ice, like he inc easing p e alence o a popula ion ha ing long- e m condi ions o he pub- lic heal h eme gency o COVID-19 (2020–2023), which highligh s he necessi y o equipping heal h sciences p o- essionals wi h skills o manage complex scena ios [2, 3]. Heal hca e p o essionals mus be able o analyze si u- a ions c i ically and c ea i ely, adap and manage la ge amoun s o in o ma ion, engage pa ien s e ec i ely, and demons a e in e pe sonal and emo ional skills [3, 4]. In e pe sonal skills in ol e cogni i e, emo ional, and beha io al a i udes, including empa hy and nego ia- ion, ha acili a es adap i e and p osocial in e ac ions in a ious con ex s [5, 6]. This g oup o skills a e c ucial in os e ing collabo a i e e o s and add essing heal h inequi ies ac oss di e se se ings and ne wo ks [7, 8]. The c i ical hinking skill is he men al p ocess o pe cei - ing, analyzing, syn hesizing, and e alua ing in o ma ion de i ed om obse a ion, expe ience, e lec ion, and easoning [9, 10]. C i ical hinking links o lea ning- o- lea n skills and is a key o gene a ing new ideas, o ganiz- ing one’s lea ning h ough e icien ime and in o ma ion managemen [11]. C i ical hinking and lea ning o lea n a e c ucial o de eloping knowledge o imp o e heal h sciences. Obs acles in in eg a ing TS a e no mino [12, 13] and include eache s’ mo i a ion, esou ces, ecogni ion, sel -e icacy, and s uden - ela ed elemen s like commi - men and e o [14]. E ec i e de elopmen o lea ning ac i i ies aims a os e ing skills ans e , pa icula ly in in e pe sonal, c i ical hinking, and lea ning- o-lea n skills, as i equi es a comp ehensi e unde s anding o s uden cha ac e is ics [15, 16]. In e pe sonal skills, c i i- cal hinking, and lea ning o lea n e ec i ely collec i ely o m a obus ounda ion o achie ing sho and long- e m educa ional goals in heal h sciences [5]. Al hough in eg a ing hese skills in o academic cu icula is a p io - i y, he e’s a gap in desc ibing and unde s anding unde - g adua es’ expe ien ial lea ning jou ney. The e o e, his s udy aimed o explo e unde g adua es expe iences in human biology, medicine, and nu sing deg ees ega ding in e pe sonal, c i ical hinking, and lea ning- o-lea n TS. Ma e ials and me hods Con ex This s udy p esen s he esul s o he i s s age o a Eu o- pean p ojec aiming o in eg a e TS in o heal h and social ca e [17]. The p ojec sough pedagogical ac ions and lea ning ac i i ies o wo k on TS h ough a s uden -cen- e ed cons uc i is pedagogical app oach [18, 19]. Se ing The s udy si e was a acul y o Heal h and Li e Sciences a a majo hospi al in Ba celona [20, 21]. The acul y p o- ides deg ee s udies in human biology, medicine, and nu sing [22]. A he end o 2021, he o al numbe o en olled unde g adua e s uden s was 260 in he human biology deg ee, 240 in he medicine deg ee, and 340 in he nu sing deg ee [23]. Design We adop ed an explo a o y sequen ial mixed-me hod design wi h wo phases [24, 25]. Ini ially, quali a i e da a collec ion wi h ocus g oups was conduc ed, ollowed by an analysis phase. This phase aimed o gain an in-dep h unde s anding o undeg adua es’ opinions, knowledge, pe cep ions, and conce ns abou in e pe sonal skills, c i ical hinking, and lea ning- o-lea n TS. A subsequen quan i a i e phase in ol ed he de elopmen o a su ey design. The quali a i e and quan i a i e esul s we e in e- g a ed based on quali a i e and quan i a i e app oaches. Quali a i e da a collec ion wi h ocus g oups Pa icipan s and sc ip design Pa icipan s in he ocus g oups we e pu posely selec ed om a popula ion o unde g adua es in he 3 d and 4 h yea s o human biology, nu sing, and 5 h-yea medicine. The selec ion was guided by ecommenda ions om he uni e si y’s ins uc ional s a ; he c i e ia included pa - icipan s’ communica ion p o iciency, academic pe o - mance, ac i e engagemen in class oom ac i i ies, and a di e se ep esen a ion o pe spec i es a di e en s ages o hei academic ins uc ion. This sampling s a egy aimed o cap u e comp ehensi ely he ange o insigh s and expe iences ela ed o TS. A comp ehensi e li e a- u e e iew and insigh s om a panel o expe s in heal h and social sciences we e ga he ed o o mula e open- ended ques ions and hemes on TS. The sc ip and open- ended ques ions a e in he online appendix. Focus g oups We planned o conduc a leas h ee ocus g oups o examine unde g adua es iews om he h ee-deg ee p og am sepa a ely (human biology, medicine, and nu sing). The ocus g oups we e conduc ed online and las ed om 90 o 100min. Each g oup had a maximum o six pa icipan s. The ocus g oups we e conduc ed by he esea che s in ol ed in he s udy, who ac ed as Keywo ds Real-wo ld ou comes, C i ical hinking, Highe educa ion, Assessmen , T ans e sal skills Page 3 o 9Fon ana-Rosa e al. BMC Medical Educa ion (2025) 25:162 mode a o s and obse e s. The obse e s assis ed by ak- ing no es and managing he discussion low. A he s a , pa icipan s we e in o med abou hei oles and we e awa e o he obse e s; all conce ns we e answe ed. Pa - icipa ion no ms we e clea ly ou lined o ensu e ac i e pa icipa ion, espec , and con iden iali y. Measu es o ensu e con iden iali y we e emphasized and pa icipan s we e eassu ed ha hei esponses would emain anony- mous and be used exclusi ely o esea ch pu poses [26, 27]. In o ma ion analysis We conduc ed a hema ic analysis o explo e he belie s, pe cep ions, and expe iences o heal h science unde - g adua e s uden s ela ed o ans e sal skills [28]. Fi s , we ansc ibed da a and e iewed he ansc ip s o accu acy. Resea che s ead he ansc ip s mul iple imes o amilia ize hemsel es wi h he da a and gain an in- dep h unde s anding. We hen gene a ed open codes by labelling ex agmen s wi h simila meanings. These codes we e g ouped in o main hemes ha e lec ed unde g adua es’ expe iences wi h ans e sal skills. The hemes we e e iewed and e ined o ep esen he pa - icipan s’ pe spec i es accu a ely. The esea ch eam engaged in discussions o alida e he hemes. Quan i a i e da a collec ion wi h a su ey The esul s o ocus g oup discussions we e analyzed o iden i y a eas whe e he quali a i e da a was inconclusi e o equi ed u he elabo a ion. Based on his, an online su ey was designed, es ima ed o ake i e minu es o comple e, and collec ed in o ma ion on: socio-demo- g aphics (gende , academic deg ee, and yea o s udy); awa eness o TS, using a p ede ined lis o TS based on hei opinions as men ioned in he ocus g oups; aining in TS du ing hei deg ee p og am, and speci ic aining in he h ee in es iga ed TS, bo h a ed om 0 (no ain- ing) o 3 (High amoun o aining); pe cei ed impo ance o TS, assessed h ough wo i ems using a 4-poin Like scale anging om “No impo an ” o “Ve y impo an ”; me hods acili a ing TS acquisi ion, wi h pa icipan s a - ing h ee i ems on a 4-poin Like scale om “Ne e ” o “Always”; and opinions on lea ning and assessmen me h- ods, measu ed by se en i ems a ed on a 4-poin Like scale om “Disag ee/Ne e ” o “Ag ee/Always.” The inal su ey is a ailable in he online appendix. Da a collec ion, pa icipan s, and sampling The su ey was edi ed wi h he Google Educa ion sui e (Google Fo ms®). Eligible pa icipan s we e unde g adu- a e s uden s en olled in human biology, medicine, o nu sing p og ams o all academic yea s. A web link wi h he su ey o m and objec i es o he s udy was sen o all pa icipan s using he academic web o maximize pa icipa ion. Th ee eminde s encou aging pa icipa ion we e sen o wo weeks. We expec ed a leas 150 pa - icipan s, co esponding o 1/3 o he unde g adua es a he acul y, o ensu e ex e nal alidi y and gene aliza ion. Da a collec ion s a ed in No embe 2021 and ended in Decembe 2021. S a is ical analysis The h ee ques ionnai es om human biology, medi- cine, and nu sing we e me ged, he da e o bi h was compu ed o age. All i ems sco ed using a ing and Lik- e scales we e dicho omized in o a lowe ca ego y ( a - ings 0–1) and a highe ca ego y ( a ings 2–3). This was implemen ed o acili a e subsequen s a is ical analyses and ensu e cla i y in he in e p e a ion o he da a. Ca - ego ical a iables we e exp essed as %, equency, and con inuous wi h means and s anda d de ia ion. Resul s we e exp essed as o als and by deg ee. Opinions on which TS and me hodologies p omo ing In e pe sonal skills, c i ical hinking, and lea ning- o-lea n TS we e ep esen ed g aphically. Analysis o i ems o knowledge and sel -unde s anding o TS we e calcula ed o all pa - icipan s, and di e ences in p opo ions ac oss g oups o deg ees we e analyzed wi h chi-squa e es s o Fishe ’s Exac Tes . The le el o s a is ical signi icance was se a α = 0.05. All analyses used he R .4.1.2 s a is ical package [29]. In eg a ion o in o ma ion and epo ing We used join displays o in eg a e in o ma ion and con- s uc a na a i e based on quan i a i e and quali a i e indings [30]. Findings we e desc ibed in a single epo wi h join displays o quan i a i e esul s and quali a i e indings side-by-side. Join displays show empi ical e i- dence while acili a ing he de i a ion o me a-in e ences and new insigh s [31]. E hics The s udy’s p o ocol was au ho ized by a c edi ed e h- ics commi ee. All p ocedu es ollowed he es ablished e hical guidelines. Fo ocus g oups, all pa icipan s p o- ided in o med consen be o e hei in ol emen . Fo he su ey s udy, pa icipa ion was en i ely olun a y and anonymous. Resul s Pa icipan s Thi een unde g adua e s uden s (se en males and six women) pa icipa ed in h ee dis inc ocus g oups, each ep esen ing o a speci ic academic p og am: human biology (n = 5), medicine (n = 4) and nu sing (n = 4). In he su ey s udy, 163 unde g adua e s uden s om all academic yea s accessed he online su ey, and 159 (98%) comple ed i . They had a mean age o 20.4 yea s Page 4 o 9Fon ana-Rosa e al. BMC Medical Educa ion (2025) 25:162 (SD = 3.6), he majo i y (73%) we e emales, and 70% we e s udying in he i s o hi d academic yea . Table1 shows he su ey pa icipan s’ cha ac e is ics. Th ee hema ic ca ego ies eme ged om he quali a- i e s udy: (i) he aining ecei ed and i s pe cei ed el- e ance, (ii) he e alua ion, and (iii) he lea ning me hods. These hema ic a eas guided he o mula ion o he su - ey ques ions. The aining ecei ed and i s pe cei ed ele ance Unde g adua es exp essed in he ocus g oups ha TS we e necessa y o pe sonal sel -pe sonal g ow h, p o es- sional de elopmen , and inding a job. The su ey esul s on he uppe igh quad an o he join display 1 con- i med his pe cep ion, wi h impo ance gi en o hese h ee issues being > 80%. S a is ically signi ican di e - ences (p < 0.05) ac oss deg ees (human biology, medicine, and nu sing) we e because o he uni o m opinion o biology unde g adua e s uden s. Pa icipan s in he ocus g oups did no gi e a clea de ini ion o TS. In he su ey, mos unde g adua es (> 80%) epo ed sel -unde s and- ing o TS. The g aph in join display 1 shows ha c i ical hinking, oubleshoo ing, abili y o adap o new si ua- ions, and o ganizing and planning we e conside ed TS (> 78% o all pa icipan s ma ked hese op ions). Table 1 Su ey pa icipan s cha ac e is ics. *: The e we e no unde g adua es, as he deg ee spans ou academic yea s All Human Biology Medicine Nu sing n = 159 n = 31 n = 49 n = 79 Age, mean (SD) 20.4 (3.6) 19.3 (1.6) 20.1 (2.1) 21.1 (4.7) Gende Male 37 (23.3%) 8 (25.8%) 14 (28.6%) 15 (18.9%) Female 116 (72.9%) 22 (71.7%) 33 (67.3%) 61 (77.2%) No bina y 3 (1.9%) 1 (3.2%) 1 (2.0%) 1 (1.3%) NA 3 (1.9%) - 1 (2.0%) 2 (2.5%) Cou se 1s yea 48 (30.2%) 11 (35.5%) 13 (26.5%) 24 (30.4%) 2nd yea 30 (18.9%) 5 (16.1%) 7 (14.2%) 18 (22.8%) 3 d yea 35 (21.9%) 7 (22.6%) 7 (14.2%) 21 (26.6%) 4 d yea 27 (16.9%) 8 (25.8%) 3 (6.1%) 16 (20.2%) 5 h yea 12 (7.5%) -* 12 (24.5%) -* 6 h yea 7 (4.4%) -* 7 (14.3%) -* Join Display 1 In eg a ed esul s on pe cep ion o ans e sal skills aining ecei ed and i s ele ance hema ic a ea Page 5 o 9Fon ana-Rosa e al. BMC Medical Educa ion (2025) 25:162 The le side o join display 1 shows e ba ims exp ess- ing unde g adua es expe iences on he limi ed lea ning o TS, which we e gi en in a ew subjec s wi hou enough dep h; hey men ioned a lack o connec ion be ween he TS and he eaching–lea ning p ocess. Nu sing unde - g adua es s a ed ha hey had some aining a he begin- ning o he deg ee (especially in he i s yea ), which was hen in eg a ed in o o he subjec s—bu no wi h su - icien in ensi y, gi en he eal nu sing p ac ice needs. Human biology undeg adua es s uden s said ha c i ical and c ea i e hinking is no adequa ely encou aged, wi h mo e alue placed on ep oducing he heo y gi en in class. Pe cep ion o aining ecei ed di e ed ac oss deg ees: Only 25.2% o p e-g adua es we e conside ed o ha e ecei ed aining in he lea ning- o-lea n skill, wi h no s a is ical di e ences ac oss deg ee p og ams (p > 0.05). P e-g adua es om human biology and medicine deg ees epo ed less aining in c i ical hinking compa ed o nu sing (29.0% and 32.6% s. 76.0%, p < 0.001) and in e - pe sonal and In e pe sonal skills (16.1% and 16.3% s. 57%, p < 0.001), bu no s a is ical di e ences we e sough on he lea ning- o-lea n skill and he pe cei ed impo - ance in he deg ee in he h ee examined TS (p > 0.05). The e alua ion In he ocus g oups, unde g adau es exp essed ha e al- ua ing TS was mo e subjec i e han assessing mul iple- choice es s and ha me hodologies would equi e clea guidelines. The le side o join display 2 shows e - ba ims wi h sugges ions: nu sing unde g adua es ad o- ca ed o combining di e en assessmen s a egies using app op ia e ub ics; human biology undeg adua es p o- posed ailo ing assessmen s, and medical unde g adua e s uden s ad oca ed o mo e g oup wo k in de e mining he g ades. Unde g adua es ecognized he inhe en di - icul y in e alua ing TS (wi h mo e subjec i e elemen s han g ading mul iple-choice es s). They acknowledged he necessi y o assessmen while ad oca ing o e ised me hodologies wi h explici guidelines. The su ey showed di e ences ac oss unde g adua es’ opinions om he h ee disciplines; mo e han hal o he pa icipan s om he nu sing deg ee conside ed ha hei deg ee included assessmen s o TS, ha he each- ing guides o he subjec s iden i ied he indica o s o e al- ua ion o he TS, ha he eaching s a o was ained o each he TS, u he mo e, nu sing unde g adua e s u- den s epo ed ha ing ca ied ou sel and pee -assess- men s du ing he deg ee. They ound a highe alignmen on TS and no on knowledge. The able on he igh side o he join display 2 shows all su ey esul s and opin- ions on he lea ning and assessmen me hods. The lea ning me hods Undeg adua e s uden s ad oca ed using a highe le el o pa icipa o y me hodologies— om class oom me h- odology o assessmen s—p io i izing di e en ia ed ele- men s. They claimed o be close o eache s in class, using me hods and o ms o eaching ha p io i ize acqui ing knowledge mo e c i ically, beyond ole mem- o iza ion o a la ge amoun o con en wi h adi ional lec u es wi h side slides cha ac e ized by mono ony and simplici y. The le side o he join display 3 shows e ba ims om he ocus g oups. Nu sing unde g adua e s uden s a gued ha simula ion and gami ica ion a e necessa y o e ec i e lea ning o TS, and new me hods a e needed o ans e he complexi y o eal clinical cases e ec i ely. Join Display 2 In eg a ed esul s on he assessmen o ans e sal skills hema ic a ea Page 6 o 9Fon ana-Rosa e al. BMC Medical Educa ion (2025) 25:162 Human biology unde g adau es uden s sugges ed using mo e p ac ical cases o apply heo y, as in medical s ud- ies; hey also men ioned needing mo e pa icipa o y spaces. Medicine unde g adau es s uden s ag eed wi h he need o mo e pa icipa o y me hodologies. They added in e nships dese ed mo e alue as hey can de elop many o he TS. Fu he mo e, hey emphasized he need o wo k on TS in semina s, speci ically wi h he PBL me hodology (p oblem-based lea ning). Su ey esul s on he igh side o he join display 3 showed p e e ed me hodologies o lea n In e pe sonal skills, c i ical hinking, and lea ning- o-lea n TS. P ob- lem-based and simula ion we e always in he op h ee, wi h almos > 80% o p e-g adua es, while plena y lec- u es and gami ica ion a e less p e e ed. Discussion Undeg adua es pu suing heal h sciences deg ees ecog- nized TS as indispensable o hei sel -pe sonal g ow h and p ospec i e p o essional de elopmen . The de el- opmen o TS equi es collabo a i e wo k, ins i u ional suppo , and he p o iciency o eaching s a [17]. Unde- g adau es ad oca ed o TS as a p ima y ole a he han supplemen a y in academic p og ams, sugges ing seamless in eg a ion wi h con en ional knowledge lea n- ing. They con ended ha he cu en me hods o assess- ing TS lacked e inemen and u ged he adop ion o mo e e ec i e e alua ion echniques. Unde g adua es exp essed hei unde s anding in hei own wo ds—an essen ial skill in knowledge elici- a ion. Thei pe spec i e s essed a pe cei ed de iciency in p o essional cu icula and aining p og ams, empha- sizing an excessi e ocus on knowledge ansmission. In con as , deg ee p og ams a e c a ed pe wo kplace demands and egula o y s anda ds, wi h clinical com- ponen s as key issues [3]. They no ed ha ins uc ional me hods a e agmen ed and con ined o subjec s. The e o e, indica ing a necessi y o a mo e comp ehen- si e app oach o TS in he highe educa ion amewo k. F agmen a ion pe sis s in heal h sciences p ac ice, whe e in e disciplina i y and a pa ien -cen e ed app oach a e no su icien ly implemen ed in daily ou ines [32]. TS migh empowe unde g adau e s uden s and p o ession- als o manage he complexi y o hei oles, complemen - ing occupa ion-speci ic skills and knowledge [32, 33]. Ou indings highligh a disc epancy be ween he ideal unde g adua e lea ning expe ience, emphasizing seam- less in eg a ion o expe ise and TS, and he cu en Join Display 3 In eg a ed esul s on lea ning ans e sal skills acco ding o he lea ning s a egies hema ic a ea Page 7 o 9Fon ana-Rosa e al. BMC Medical Educa ion (2025) 25:162 eali y, p edominan ly cen e ed on knowledge acquisi- ion. This gap equi es enhancing he implemen a ion and assessmen o TS mo e e ec i ely wi hin he aca- demic cu icula. T adi ional assessmen me hods such as es s and ub ics pe sis in cu en lea ning assessmen s wi hou sys ema ically inco po a ing he assessmen o he TS. Despi e some e o s, such as implemen ing P oblem- Based Lea ning [8, 34], he pe sis en eali y is ha he inal g ade does no adequa ely e lec he ele ance and con ibu ion o he TS. Pe cei ed ba ie s o ade- qua e assessmen s o TS ely on he gene al design o he deg ee’s cu icula. The ex ensi e syllabus and exams o en lead o p io i ize con en ha should be memo- ized, and ansmissi e eaching me hods a e he gen- e al app oach, he e o e lacking eedback when wo king wi h TS. Assessmen is a c i ical ace o cu icula design, c ucial o ensu ing he sa e y and p o iciency o heal hca e p o essionals [35]. As epo ed in ou s udy, one- ime high-s akes assessmen s (e.g., an examina ion) a e con ex -dependen and ail o cap u e he dynamic de elopmen o TS o p o essional p ac ice [32, 33]. The eliance on adi ional, summa i e assessmen s poses challenges in accu a ely gauging s uden compe ence [33, 35]. The Eu opean Highe Educa ion A ea ad oca ed a shi o lea ning-cen e ed educa ion wi h s uden s play- ing a mo e ac i e ole [17]. Howe e , he esul s o ou s udy showed ha despi e he in en ion and egula ions, adi ional e alua ion me hods pe sis , and ans o m- ing he lea ning sys em necessi a es p o ound s uc u al changes. Resul s showed unde g adua es p e e ences o ac i e pa icipa ion and pee in e ac ions p omo ing me hod- ologies (e.g., P oblem-Based Lea ning, discussion, coop- e a ion, o simula ion). Nu sing unde g adua es epo ed highe sel -pe cei ed aining in TS han hei human biology and medicine pee s. This inding may be a ib- u ed o he nu sing cu iculum’s s ong emphasis on ea ly and equen clinical placemen s, which os e he acquisi ion and e inemen o in e pe sonal and commu- nica ion skills [36]. This inding migh e lec ha mos p og ams ha e ocused on a single academic deg ee; he e o e, examining unde g adua e s uden s om mul- iple deg ee p og ams wi hin he same esea ch con ex migh ad ance he unde s anding o TS de elopmen wi hin heal h sciences. TS lea ning me hodologies can be emb aced once unde g adua es ha e acqui ed he sel - egula ed lea ning capaci y; howe e , his is o en no he case, and unde g adua es equi e suppo o ansi- ion om adi ional lea ning based on lec u es [37, 38]. Ano he c i ical issue in p omo ing he eaching o TS is he pedagogical p epa edness o unde g adua es educa- o s, who need suppo and aining o adop hese me h- ods [12]. Unde g adua e s uden s dissa is ac ion wi h he mono ony and simplici y o lec u es may signal a de i- ciency in adap ing Eu opean uni e si y pedagogy o an e a whe e in o ma ion is eadily accessible elsewhe e and whe e s uden s seek ins uc ion cha ac e ized by p ob- lem-sol ing app oaches and a mo e humanis ic eache - s uden ela ionship. S eng hs and limi a ions The s udy was con ined o unde g adua e s uden s exclu- si ely om he nu sing, medicine, and human biology p og ams, e lec ing he uni e si y’s academic p og ams whe e he esea ch was conduc ed. While his p o ided aluable insigh s, including s uden s om o he heal h disciplines, such as physio he apy o psychology, could con ibu e di e se pe spec i es. Second, he ocus g oups we e conduc ed online, which could hampe he dialogue and pa icipa ion. Howe e , all pa icipan s we e ac i e, and he du a ion o he g oups was as expec ed wi h- ou incon enience. Thi d, olun a y pa icipa ion in he su ey may ha e in luenced he esul s; howe e , a man- da o y pa icipa ion sys em is imp ac ical, and he pa ic- ipa ion a e and he alignmen o esul s wi h ocus g oup indings ensu es he s udy’s eliabili y. Conclusion Human biology, medicine and nu sing unde g adu- a e s uden s ad oca ed o an inc eased emphasis on ans e sal skills. Unde g adua es in human biology and medicine exp essed g ea e dissa is ac ion wi h a- di ional, knowledge- ocused ins uc ion han nu sing unde g adua es; all desc ibed hei cu icula as p edomi- nan ly ocused on knowledge acquisi ion, wi h adi ional assessmen me hods pe sis ing and lacking e alua ion o ans e sal skills. In eg a ing ans e sal skills in o highe educa ion goes beyond me e quali y audi s and demands a p ac ical and meaning ul ans o ma ion o a unda- men al change o uni e si ies in he Eu opean Highe Educa ion A ea. Abb e ia ions TS T ans e sal Skills Supplemen a y In o ma ion The online e sion con ains supplemen a y ma e ial a ailable a h p s : / / d o i . o g / 1 0 . 1 1 8 6 / s 1 2 9 0 9 - 0 2 5 - 0 6 7 4 9 - z. Supplemen a y Ma e ial 1 Acknowledgemen s We hank he human biology, medicine, and nu sing s uden s o he Uni e si y Pompeu Fab a and The Hospi al del Ma Nu sing School o hei pa icipa ion and ime in his s udy. We wan o exp ess ou g a i ude o D . Ma a Bene o he ime o plan and design he ini ial p ojec . Page 8 o 9Fon ana-Rosa e al. BMC Medical Educa ion (2025) 25:162 Au ho con ibu ions Na halia Sil a Fon ana-Rosa & Luis González-de Paz: Concep ualiza ion; in es iga ion; o mal analysis; w i ing—o iginal d a ; me hodology; da a cu a ion; supe ision; w i ing— e iew and edi ing. Ana C. Codina-Rod íguez & Ma ía Pé ez-Ria : In es iga ion; o mal analysis; w i ing— e iew. Ma ía del Ma Ca ió-Llach: Me hodology; w i ing— e iew and edi ing; unding acquisi ion. Funding This esea ch was unded by he E asmus + p og am o S a egic Pa ne ships o Highe Educa ion Coope a ion o inno a ion and he exchange o good p ac ices (g an no. KA203-46838294). Da a a ailabili y Fo ms a e a ailable om he co esponding au ho upon easonable eques . Decla a ions E hics app o al and consen o pa icipa e E hical app o al was g an ed h ough he Pompeu Fab a Uni e si y E hical Re iew Boa d o P ojec s (CIREP-UPF). The s udy was ca ied ou in acco dance wi h he Decla a ion o Helsinki. In he quali a i e esea ch, all pa icipan s ga e in o med consen o pa icipa e. Comple ing he anonymous online ques ionnai e was conside ed implici consen in he su ey s udy. Consen o publica ion No applicable. Compe ing in e es s The au ho s decla e no compe ing in e es s. Au ho de ails 1Campus Docen San Joan de Déu, Uni e si a de Vic–Uni e si a Cen al de Ca alunya (UVIC-UCC), San Boi de Llob ega , Spain 2Conso ci d’A enció P imà ia de Salu Ba celona Esque a (CAPSBE), Ba celona, Spain 3P ima y Heal hca e T ans e sal Resea ch G oup, Ins i u d’In es igacions Biomèdiques, Augus Pi i Sunye (IDIBAPS), Ba celona, Spain 4Depa men o Public Heal h, Men al Heal h and Mo he and Child Heal h, Uni e si y o Ba celona, Ba celona, Spain 5Nu sing Depa men , Hospi al del Ma , Pa c de Salu Ma , Ba celona, Spain 6Ins i u e o Educa ional Sciences, Uni e si a Poli ècnica de Ca alunya (UPC), Ba celona, Spain Recei ed: 12 Ap il 2024 / Accep ed: 23 Janua y 2025 Re e ences 1. Eu opean Commission. Eu opean Skills Agenda o sus ainable compe i i e- ness, social ai ness and esilience. 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