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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 aFon ana-Rosa1, LuisGonzález-de Paz2,3,4*, Ana C.Codina-Rod íguez5, Ma íaPé 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 100min. 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 . Table1 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
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Publishe ’s no e
Sp inge Na u e emains neu al wi h ega d o ju isdic ional claims in
published maps and ins i u ional a ilia ions.
