bilingual education peer reviewed articles

Bilingual education for young children: review of the effects and consequences

Affiliation.

• 1 Department of Psychology, York University, Toronto, ON, Canada.
• PMID: 30288137
• PMCID: PMC6168086
• DOI: 10.1080/13670050.2016.1203859

Bilingual education has been an educational option in many countries for over 50 years but it remains controversial, especially in terms of its appropriateness for all children. The present review examines research evaluating the outcomes of bilingual education for language and literacy levels, academic achievement, and suitability for children with special challenges. The focus is on early education and the emphasis is on American contexts. Special attention is paid to factors such as socioeconomic status that are often confounded with the outcomes of bilingual education. The conclusion is that there is no evidence for harmful effects of bilingual education and much evidence for net benefits in many domains.

Keywords: Bilingual education; academic achievement; language proficiency; socioeconomic status; specific language impairment.

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• R01 HD052523/HD/NICHD NIH HHS/United States

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Multicultural education : Journals

• Bilingual research journal "The Bilingual Research Journal is the National Association for Bilingual Education’s premier scholarly, peer-reviewed research publication. Bilingual Research Journal delivers in-depth coverage of education theory and practice, dealing with bilingual education, bilingualism, and language policies in education."
• International journal of multicultural education "International Journal of Multicultural Education (IJME) is a peer-reviewed open-access journal for scholars, practitioners, and students of multicultural education. Committed to promoting educational equity for all, cross-cultural understanding, and global awareness in all levels of education including leadership and policies, IJME publishes (1) reports of empirical research typically in qualitative research orientation (some special issues may publish quantiative studies); (2) literature-based conceptual articles that advance theories and scholarship of multicultural education; and (3) praxis articles that discuss successful multicultural education practices grounded on sound theories."
• Journal for multicultural education
• Journal of diversity in higher education "Journal of Diversity in Higher Education largely publishes empirical research focused on issues related to issues of diversity, equity, and inclusion in post-secondary environments."
• Journal of educational controversy "Welcome to the Journal of Educational Controversy — an interdisciplinary electronic journal of ideas. The purpose of this peer reviewed journal is to provide a national and international forum for examining the dilemmas and controversies that arise in the education of citizens in a pluralistic, democratic society."
• Journal of language, identity, and education The Journal of Language, Identity, and Education is an international forum for original research on the intersections of language, identity, and education in global and local contexts. We are interested in interdisciplinary studies that examine how issues of language impact individual and community identities and intersect with educational practices and policies.
• Journal of multicultural counseling and development "Journal of Multicultural Counseling and Development (JMCD) is concerned with research, theory, and program applications pertinent to multicultural and ethnic minority interests in all areas of counseling and human development."
• Journal of multilingual and multicultural development "The Journal of Multilingual and Multicultural Development is a cross-disciplinary journal for researchers from diverse scholarly and geographical backgrounds. It is concerned with macro-level coverage of topics in the sociology and social psychology of language, and in language and cultural politics, policy, planning and practice."
• Language culture and curriculum " Language, Culture and Curriculum is a well-established journal that seeks to enhance the understanding of the relations between the three dimensions of its title. It welcomes work dealing with a wide range of languages (mother tongues, global English, foreign, minority, immigrant, heritage, or endangered languages) in the context of bilingual and multilingual education and first, second or additional language learning. It focuses on research into cultural content, literacy or intercultural and transnational studies, usually related to curriculum development, organisation or implementation."
• Multicultural education (San Francisco, Calif.) "Provides articles, interviews, promising practices & resources in multicultural education."
• Multicultural learning and teaching "Explores the education of people from diverse multicultural backgrounds in a variety of learning environments, inside and outside the classroom. The journal focuses on the broad implications of multicultural learning and teaching practices around the world, going beyond traditional education journals to offer analysis and practical recommendations of interest to teachers, counseling and community-service providers, school administrators, urban program specialists, education policymakers, and any professionals who grapple with questions of multicultural communication."
• Multicultural perspectives "Promotes the philosophy of social justices, equity and inclusion. It celebrates cultural and ethnic diversity as a national strength that enriches society."
• Multiple voices for ethnically diverse exceptional learners : a publication of the Division for Culturally and Linguistically Diverse Exceptional Learners :Multiple Voices - Disability, Race, and Language Intersections in Special Education is the official, peer-reviewed journal of the Council for Exceptional Children's Division for Culturally and Linguistically Diverse Exceptional Learners (DDEL). Multiple Voices is published twice a year and welcomes original research articles, conceptual or theoretical pieces, and book reviews that explores equitable educations for youth at the intersection of disability, race, ethnicity, and language."
• Race, ethnicity and education "Race Ethnicity and Education is the leading peer-reviewed journal on racism and race inequality in education. The journal provides a focal point for international scholarship, research and debate by publishing original and challenging research that explores the dynamics of race, racism and ethnicity in education policy, theory and practice. "
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5 Million Voices

6 potential brain benefits of bilingual education.

Anya Kamenetz

Part of our ongoing series exploring how the U.S. can educate the nearly 5 million students who are learning English.

Brains, brains, brains. One thing we've learned at NPR Ed is that people are fascinated by brain research. And yet it can be hard to point to places where our education system is really making use of the latest neuroscience findings.

But there is one happy nexus where research is meeting practice: bilingual education. "In the last 20 years or so, there's been a virtual explosion of research on bilingualism," says Judith Kroll, a professor at the University of California, Riverside.

Again and again, researchers have found, "bilingualism is an experience that shapes our brain for a lifetime," in the words of Gigi Luk, an associate professor at Harvard's Graduate School of Education.

At the same time, one of the hottest trends in public schooling is what's often called dual-language or two-way immersion programs.

How We Teach English Learners: 3 Basic Approaches

Traditional programs for English-language learners, or ELLs, focus on assimilating students into English as quickly as possible. Dual-language classrooms, by contrast, provide instruction across subjects to both English natives and English learners, in both English and in a target language.

The goal is functional bilingualism and biliteracy for all students by middle school.

New York City, North Carolina, Delaware, Utah, Oregon and Washington state are among the places expanding dual-language classrooms.

The trend flies in the face of some of the culture wars of two decades ago, when advocates insisted on "English first" education. Most famously, California passed Proposition 227 in 1998. It was intended to sharply reduce the amount of time that English-language learners spent in bilingual settings.

Proposition 58 , passed by California voters on Nov. 8, largely reversed that decision, paving the way for a huge expansion of bilingual education in the state that has the largest population of English-language learners.

Bilingual Education Returns To California. Now What?

Some of the insistence on English-first was founded in research produced decades ago, in which bilingual students underperformed monolingual English speakers and had lower IQ scores.

Today's scholars, like Ellen Bialystok at York University in Toronto, now say that research was "deeply flawed."

"Earlier research looked at socially disadvantaged groups," agrees Antonella Sorace at the University of Edinburgh, in Scotland. "This has been completely contradicted by recent research" that compares more similar groups to each other.

So what does recent research say about the potential benefits of bilingual education? NPR Ed called up seven researchers in three countries — Sorace, Bialystok, Luk, Kroll, Jennifer Steele, and the team of Wayne Thomas and Virginia Collier — to find out.

It turns out that, in many ways, the real trick to speaking two languages consists in managing not to speak one of those languages at a given moment — which is fundamentally a feat of paying attention.

Saying "Goodbye" to mom and then " Guten tag " to your teacher, or managing to ask for a crayola roja instead of a red crayon, requires skills called "inhibition" and "task switching." These skills are subsets of an ability called executive function.

People who speak two languages often outperform monolinguals on general measures of executive function. "[Bilinguals] can pay focused attention without being distracted and also improve in the ability to switch from one task to another," says Sorace.

Do these same advantages accrue to a child who begins learning a second language in kindergarten instead of as a baby? We don't yet know. Patterns of language learning and language use are complex. But Gigi Luk at Harvard cites at least one brain-imaging study on adolescents that shows similar changes in brain structure when compared with those who are bilingual from birth, even when they didn't begin practicing a second language in earnest before late childhood.

Young children being raised bilingual have to follow social cues to figure out which language to use with which person and in what setting. As a result, says Sorace, bilingual children as young as age 3 have demonstrated a head start on tests of perspective-taking and theory of mind — both of which are fundamental social and emotional skills.

Reading (English)

About 10 percent of students in the Portland, Ore., public schools are assigned by lottery to dual-language classrooms that offer instruction in Spanish, Japanese or Mandarin, alongside English.

Jennifer Steele at American University conducted a four-year, randomized trial and found that these dual-language students outperformed their peers in English-reading skills by a full school year's worth of learning by the end of middle school.

Such a large effect in a study this size is unusual, and Steele is currently conducting a flurry of follow-up studies to tease out the causality: Is this about a special program that attracted families who were more engaged? Or about the dual-language instruction itself?

"If it's just about moving the kids around," Steele says, "that's not as exciting as if it's a way of teaching that makes you smarter."

'Invisible' Children: Raised In The U.S., Now Struggling In Mexico

Steele suspects the latter. Because the effects are found in reading, not in math or science where there were few differences, she suggests that learning two languages makes students more aware of how language works in general, aka "metalinguistic awareness."

The research of Gigi Luk at Harvard offers a slightly different explanation. She has recently done a small study looking at a group of 100 fourth-graders in Massachusetts who had similar reading scores on a standard test, but very different language experiences.

Some were foreign-language dominant and others were English natives. Here's what's interesting. The students who were dominant in a foreign language weren't yet comfortably bilingual; they were just starting to learn English. Therefore, by definition, they had much weaker English vocabularies than the native speakers.

Yet they were just as good at decoding a text.

"This is very surprising," Luk says. "You would expect the reading comprehension performance to mirror vocabulary — it's a cornerstone of comprehension."

How did the foreign-language dominant speakers manage this feat? Well, Luk found, they also scored higher on tests of executive functioning. So, even though they didn't have huge mental dictionaries to draw on, they may have been great puzzle-solvers, taking into account higher-level concepts such as whether a single sentence made sense within an overall story line.

They got to the same results as the monolinguals, by a different path.

School performance and engagement.

Wayne Thomas and Virginia Collier, a husband and wife team of professors emeritus at George Mason University in Virginia, have spent the past 30 years collecting evidence on the benefits of bilingual education.

"Wayne came to our research with skepticism, thinking students ought to get instruction all day in English," says Virginia Collier. "Eight million student records later, we're convinced," Wayne Thomas chimes in.

In studies covering six states and 37 districts, they have found that, compared with students in English-only classrooms or in one-way immersion, dual-language students have somewhat higher test scores and also seem to be happier in school. Attendance is better, behavioral problems fewer, parent involvement higher.

Diversity and integration.

American public school classrooms as a whole are becoming more segregated by race and class. Dual-language programs can be an exception. Because they are composed of native English speakers deliberately placed together with recent immigrants, they tend to be more ethnically and socioeconomically balanced. And there is some evidence that this helps kids of all backgrounds gain comfort with diversity and different cultures.

Several of the researchers I talked with also pointed out that, in bilingual education, non-English-dominant students and their families tend to feel that their home language is heard and valued, compared with a classroom where the home language is left at the door in favor of English.

This can improve students' sense of belonging and increase parent involvement in their children's education, including behaviors like reading to children.

"Many parents fear their language is an obstacle, a problem, and if they abandon it their child will integrate better," says Antonella Sorace of the University of Edinburgh. "We tell them they're not doing their child a favor by giving up their language."

Protection against cognitive decline and dementia.

File this away as a very, very long-range payoff. Researchers have found that actively using two languages seems to have a protective effect against age-related dementia — perhaps relating to the changes in brain structure we talked about earlier.

Specifically, among patients with Alzheimer's in a Canadian study, a group of bilingual adults performed on par with a group of monolingual adults in terms of cognitive tests and daily functioning. But when researchers looked at the two groups' brains, they found evidence of brain atrophy that was five to seven years more advanced in the bilingual group. In other words, the adults who spoke two languages were carrying on longer at a higher level despite greater degrees of damage.

The coda, and a caution

One theme that was striking in speaking to all these researchers was just how strongly they advocated for dual-language classrooms.

Thomas and Collier have advised many school systems on how to expand their dual-language programs, and Sorace runs " Bilingualism Matters ," an international network of researchers who promote bilingual education projects.

This type of advocacy among scientists is unusual; even more so because the "bilingual advantage hypothesis" is being challenged once again. A review of studies published last year found that cognitive advantages failed to appear in 83 percent of published studies, though in a separate meta-analysis, the sum of effects was still significantly positive.

One potential explanation offered by the researchers I spoke with is that advantages that are measurable in the very young and very old tend to fade when testing young adults at the peak of their cognitive powers.

And, they countered that no negative effects of bilingual education have been found. So, they argue that even if the advantages are small, they are still worth it.

Not to mention one obvious, outstanding fact underlined by many of these researchers: "Bilingual children can speak two languages! That's amazing," says Bialystok.

• Open access
• Published: 14 May 2024

Protocol for a scoping review study on learning plan use in undergraduate medical education

• Anna Romanova   ORCID: orcid.org/0000-0003-1118-1604 1 ,
• Claire Touchie 1 ,
• Sydney Ruller 2 ,
• Victoria Cole 3 &
• Susan Humphrey-Murto 4  

Systematic Reviews volume  13 , Article number:  131 ( 2024 ) Cite this article

Metrics details

The current paradigm of competency-based medical education and learner-centredness requires learners to take an active role in their training. However, deliberate and planned continual assessment and performance improvement is hindered by the fragmented nature of many medical training programs. Attempts to bridge this continuity gap between supervision and feedback through learner handover have been controversial. Learning plans are an alternate educational tool that helps trainees identify their learning needs and facilitate longitudinal assessment by providing supervisors with a roadmap of their goals. Informed by self-regulated learning theory, learning plans may be the answer to track trainees’ progress along their learning trajectory. The purpose of this study is to summarise the literature regarding learning plan use specifically in undergraduate medical education and explore the student’s role in all stages of learning plan development and implementation.

Following Arksey and O’Malley’s framework, a scoping review will be conducted to explore the use of learning plans in undergraduate medical education. Literature searches will be conducted using multiple databases by a librarian with expertise in scoping reviews. Through an iterative process, inclusion and exclusion criteria will be developed and a data extraction form refined. Data will be analysed using quantitative and qualitative content analyses.

By summarising the literature on learning plan use in undergraduate medical education, this study aims to better understand how to support self-regulated learning in undergraduate medical education. The results from this project will inform future scholarly work in competency-based medical education at the undergraduate level and have implications for improving feedback and supporting learners at all levels of competence.

Scoping review registration:

Open Science Framework osf.io/wvzbx.

Peer Review reports

Competency-based medical education (CBME) has transformed the approach to medical education to focus on demonstration of acquired competencies rather than time-based completion of rotations [ 1 ]. As a result, undergraduate and graduate medical training programs worldwide have adopted outcomes-based assessments in the form of entrustable professional activities (EPAs) comprised of competencies to be met [ 2 ]. These assessments are completed longitudinally by multiple different evaluators to generate an overall impression of a learner’s competency.

In CBME, trainees will progress along their learning trajectory at individual speeds and some may excel while others struggle to achieve the required knowledge, skills or attitudes. Therefore, deliberate and planned continual assessment and performance improvement is required. However, due to the fragmented nature of many medical training programs where learners rotate through different rotations and work with many supervisors, longitudinal observation is similarly fragmented. This makes it difficult to determine where trainees are on their learning trajectories and can affect the quality of feedback provided to them, which is a known major influencer of academic achievement [ 3 ]. As a result, struggling learners may not be identified until late in their training and the growth of high-performing learners may be stifled [ 4 , 5 , 6 ].

Bridging this continuity gap between supervision and feedback through some form of learner handover or forward feeding has been debated since the 1970s and continues to this day [ 5 , 7 , 8 , 9 , 10 , 11 ]. The goal of learner handover is to improve trainee assessment and feedback by sharing their performance and learning needs between supervisors or across rotations. However, several concerns have been raised about this approach including that it could inappropriately bias subsequent assessments of the learner’s abilities [ 9 , 11 , 12 ]. A different approach to keeping track of trainees’ learning goals and progress along their learning trajectories is required. Learning plans (LPs) informed by self-regulated learning (SRL) theory may be the answer.

SRL has been defined as a cyclical process where learners actively control their thoughts, actions and motivation to achieve their goals [ 13 ]. Several models of SRL exist but all entail that the trainee is responsible for setting, planning, executing, monitoring and reflecting on their learning goals [ 13 ]. According to Zimmerman’s SRL model, this process occurs in three stages: forethought phase before an activity, performance phase during an activity and self-reflection phase after an activity [ 13 ]. Since each trainee leads their own learning process and has an individual trajectory towards competence, this theory relates well to the CBME paradigm which is grounded in learner-centredness [ 1 ]. However, we know that medical students and residents have difficulty identifying their own learning goals and therefore need guidance to effectively partake in SRL [ 14 , 15 , 16 , 17 ]. Motivation has also emerged as a key component of SRL, and numerous studies have explored factors that influence student engagement in learning [ 18 , 19 ]. In addition to meeting their basic psychological needs of autonomy, relatedness and competence, perceived learning relevance through meaningful learning activities has been shown to increase trainee engagement in their learning [ 19 ].

LPs are a well-known tool across many educational fields including CBME that can provide trainees with meaningful learning activities since they help them direct their own learning goals in a guided fashion [ 20 ]. Also known as personal learning plans, learning contracts, personal action plans, personal development plans, and learning goals, LPs are documents that outline the learner’s roadmap to achieve their learning goals. They require the learner to self-identify what they need to learn and why, how they are going to do it, how they will know when they are finished, define the timeframe for goal achievement and assess the impact of their learning [ 20 ]. In so doing, LPs give more autonomy to the learner and facilitate objective and targeted feedback from supervisors. This approach has been described as “most congruent with the assumptions we make about adults as learners” [ 21 ].

LP use has been explored across various clinical settings and at all levels of medical education; however, most of the experience lies in postgraduate medical education [ 22 ]. Medical students are a unique learner population with learning needs that appear to be very well suited for using LPs for two main reasons. First, their education is often divided between classroom and clinical settings. During clinical training, students need to be more independent in setting learning goals to meet desired competencies as their education is no longer outlined for them in a detailed fashion by the medical school curriculum [ 23 ]. SRL in the workplace is also different than in the classroom due to additional complexities of clinical care that can impact students’ ability to self-regulate their learning [ 24 ]. Second, although most medical trainees have difficulty with goal setting, medical students in particular need more guidance compared to residents due to their relative lack of experience upon which they can build within the SRL framework [ 25 ]. LPs can therefore provide much-needed structure to their learning but should be guided by an experienced tutor to be effective [ 15 , 24 ].

LPs fit well within the learner-centred educational framework of CBME by helping trainees identify their learning needs and facilitating longitudinal assessment by providing supervisors with a roadmap of their goals. In so doing, they can address current issues with learner handover and identification as well as remediation of struggling learners. Moreover, they have the potential to help trainees develop lifelong skills with respect to continuing professional development after graduation which is required by many medical licensing bodies.

An initial search of the JBI Database, Cochrane Database, MEDLINE (PubMed) and Google Scholar conducted in July–August 2022 revealed a paucity of research on LP use in undergraduate medical education (UGME). A related systematic review by van Houten–Schat et al. [ 24 ] on SRL in the clinical setting identified three interventions used by medical students and residents in SRL—coaching, LPs and supportive tools. However, only a couple of the included studies looked specifically at medical students’ use of LPs, so this remains an area in need of more exploration. A scoping review would provide an excellent starting point to map the body of literature on this topic.

The objective of this scoping review will therefore be to explore LP use in UGME. In doing so, it will address a gap in knowledge and help determine additional areas for research.

This study will follow Arksey and O’Malley’s [ 26 ] five-step framework for scoping review methodology. It will not include the optional sixth step which entails stakeholder consultation as relevant stakeholders will be intentionally included in the research team (a member of UGME leadership, a medical student and a first-year resident).

Step 1—Identifying the research question

The overarching purpose of this study is to “explore the use of LPs in UGME”. More specifically we seek to achieve the following:

Summarise the literature regarding the use of LPs in UGME (including context, students targeted, frameworks used)

Explore the role of the student in all stages of the LP development and implementation

Determine existing research gaps

Step 2—Identifying relevant studies

An experienced health sciences librarian (VC) will conduct all searches and develop the initial search strategy. The preliminary search strategy is shown in Appendix A (see Additional file 2). Articles will be included if they meet the following criteria [ 27 ]:

Participants

Medical students enrolled at a medical school at the undergraduate level.

Any use of LPs by medical students. LPs are defined as a document, usually presented in a table format, that outlines the learner’s roadmap to achieve their learning goals [ 20 ].

Any stage of UGME in any geographic setting.

Types of evidence sources

We will search existing published and unpublished (grey) literature. This may include research studies, reviews, or expert opinion pieces.

Search strategy

With the assistance of an experienced librarian (VC), a pilot search will be conducted to inform the final search strategy. A search will be conducted in the following electronic databases: MEDLINE, Embase, Education Source, APA PsycInfo and Web of Science. The search terms will be developed in consultation with the research team and librarian. The search strategy will proceed according to the JBI Manual for Evidence Synthesis three-step search strategy for reviews [ 27 ]. First, we will conduct a limited search in two appropriate online databases and analyse text words from the title, abstracts and index terms of relevant papers. Next, we will conduct a second search using all identified key words in all databases. Third, we will review reference lists of all included studies to identify further relevant studies to include in the review. We will also contact the authors of relevant papers for further information if required. This will be an iterative process as the research team becomes more familiar with the literature and will be guided by the librarian. Any modifications to the search strategy as it evolves will be described in the scoping review report. As a measure of rigour, the search strategy will be peer-reviewed by another librarian using the PRESS checklist [ 28 ]. No language or date limits will be applied.

Step 3—Study selection

The screening process will consist of a two-step approach: screening titles/abstracts and, if they meet inclusion criteria, this will be followed by a full-text review. All screening will be done by two members of the research team and any disagreements will be resolved by an independent third member of the team. Based on preliminary inclusion criteria, the whole research team will first pilot the screening process by reviewing a random sample of 25 titles/abstracts. The search strategy, eligibility criteria and study objectives will be refined in an iterative process. We anticipate several meetings as the topic is not well described in the literature. A flowchart of the review process will be generated. Any modifications to the study selection process will be described in the scoping review report. The papers will be excluded if a full text is not available. The search results will be managed using Covidence software.

Step 4—Charting the data

A preliminary data extraction tool is shown in Appendix B (see Additional file 3 ). Data will be extracted into Excel and will include demographic information and specific details about the population, concept, context, study methods and outcomes as they relate to the scoping review objectives. The whole research team will pilot the data extraction tool on ten articles selected for full-text review. Through an iterative process, the final data extraction form will be refined. Subsequently, two members of the team will independently extract data from all articles included for full-text review using this tool. Charting disagreements will be resolved by the principal and senior investigators. Google Translate will be used for any included articles that are not in the English language.

Step 5—Collating, summarising and reporting the results

Quantitative and qualitative analyses will be used to summarise the results. Quantitative analysis will capture descriptive statistics with details about the population, concept, context, study methods and outcomes being examined in this scoping review. Qualitative content analysis will enable interpretation of text data through the systematic classification process of coding and identifying themes and patterns [ 29 ]. Several team meetings will be held to review potential themes to ensure an accurate representation of the data. The PRISMA Extension for Scoping Reviews (PRISMA-ScR) will be used to guide the reporting of review findings [ 30 ]. Data will be presented in tables and/or diagrams as applicable. A descriptive summary will explain the presented results and how they relate to the scoping review objectives.

By summarising the literature on LP use in UGME, this study will contribute to a better understanding of how to support SRL amongst medical students. The results from this project will also inform future scholarly work in CBME at the undergraduate level and have implications for improving feedback as well as supporting learners at all levels of competence. In doing so, this study may have practical applications by informing learning plan incorporation into CBME-based curricula.

We do not anticipate any practical or operational issues at this time. We assembled a team with the necessary expertise and tools to complete this project.

Availability of data and materials

All data generated or analysed during this study will be included in the published scoping review article.

Abbreviations

• Competency-based medical education

Entrustable professional activity

• Learning plan
• Self-regulated learning
• Undergraduate medical education

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This study will be supported through grants from the Department of Medicine at the Ottawa Hospital and the University of Ottawa. The funding bodies had no role in the study design and will not have any role in the collection, analysis and interpretation of data or writing of the manuscript.

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AR designed and drafted the protocol. CT and SH contributed to the refinement of the research question, study methods and editing of the manuscript. VC designed the initial search strategy. All authors reviewed the manuscript for final approval. The review guarantors are CT and SH. The corresponding author is AR.

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AR is a clinician teacher and Assistant Professor with the Division of General Internal Medicine at the University of Ottawa. She is also the Associate Director for the internal medicine clerkship rotation at the General campus of the Ottawa Hospital.

CT is a Professor of Medicine with the Divisions of General Internal Medicine and Infectious Diseases at the University of Ottawa. She is also a member of the UGME Competence Committee at the University of Ottawa and an advisor for the development of a new school of medicine at Toronto Metropolitan University.

SH is an Associate Professor with the Department of Medicine at the University of Ottawa and holds a Tier 2 Research Chair in Medical Education. She is also the Interim Director for the Research Support Unit within the Department of Innovation in Medical Education at the University of Ottawa.

CT and SH have extensive experience with medical education research and have numerous publications in this field.

SR is a Research Assistant with the Division of General Internal Medicine at the Ottawa Hospital Research Institute.

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Additional file 1. prisma-p 2015 checklist., 13643_2024_2553_moesm2_esm.docx.

Additional file 2: Appendix A. Preliminary search strategy [ 31 ].

Additional file 3: Appendix B. Preliminary data extraction tool.

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Romanova, A., Touchie, C., Ruller, S. et al. Protocol for a scoping review study on learning plan use in undergraduate medical education. Syst Rev 13 , 131 (2024). https://doi.org/10.1186/s13643-024-02553-w

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The role of counseling for non-traditional students in formal higher education: a scoping review provisionally accepted.

• 1 Department of Pedagogy and Primary Education, National and Kapodistrian University of Athens, Greece

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Since the mid-20th century, the number of adult students enrolled in formal higher education (HE) programs has significantly increased. The profile of non-traditional students differs significantly from that of traditional students in terms of their characteristics, learning methods, obstacles and challenges, motivations for learning, and conditions for effective learning. Unlike traditional students, adult students often balance family, work, and educational responsibilities, necessitating a more nuanced approach to support and guidance. However, most HE institutions primarily serve the needs of traditional student populations, which results in limited support available to adult students. This scoping review aimed to explore and map the existing literature on the role of adult (or non-traditional) students counseling in the context of formal HE. We focused on literature related to academic advising for non-traditional students in formal HE, restricting our search to both empirical and non-empirical articles published in peer-reviewed journals between 2010 and 2022. Employing Arksey and O'Malley's scoping review method and the PRISMA-ScR Checklist, we searched four databases (EBSCOhost, Crossref, Semantic Scholar, and ERIC), supplemented by a manual search. Of the 1,330 articles identified and screened, 25 studies met the eligibility criteria. Our review included 17 empirical and eight non-empirical studies, with the majority conducted in the USA (21 of 25). Thematic analysis revealed five key research areas (or themes): academic advising practices, perceptions of advising, technology, and advising, advising models, and academic success. The most common research theme, advising practices for adult (undergraduate and doctoral) students, constituted 52% of the studies (n=13). Drawing from our analysis, we discuss current trends and future development in advising non-traditional students within formal HE settings. The added value of academic advising for adult students is explored, and any potential gaps in research literature knowledge are identified.

Keywords: Academic advising, Counseling, non-traditional students, adult students, higher education

Received: 25 Dec 2023; Accepted: 16 May 2024.

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* Correspondence: Ms. Panagiota Stamou, National and Kapodistrian University of Athens, Department of Pedagogy and Primary Education, Athens, Greece

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• Published: 16 May 2024

Competency gap among graduating nursing students: what they have achieved and what is expected of them

• Majid Purabdollah 1 , 2 ,
• Vahid Zamanzadeh 2 , 3 ,
• Akram Ghahramanian 2 , 4 ,
• Leila Valizadeh 2 , 5 ,
• Saeid Mousavi 2 , 6 &
• Mostafa Ghasempour 2 , 4  

BMC Medical Education volume  24 , Article number:  546 ( 2024 ) Cite this article

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Nurses’ professional competencies play a significant role in providing safe care to patients. Identifying the acquired and expected competencies in nursing education and the gaps between them can be a good guide for nursing education institutions to improve their educational practices.

In a descriptive-comparative study, students’ perception of acquired competencies and expected competencies from the perspective of the Iranian nursing faculties were collected with two equivalent questionnaires consisting of 85 items covering 17 competencies across 5 domains. A cluster sampling technique was employed on 721 final-year nursing students and 365 Iranian nursing faculties. The data were analyzed using descriptive statistics and independent t-tests.

The results of the study showed that the highest scores for students’ acquired competencies and nursing faculties’ expected competencies were work readiness and professional development, with mean of 3.54 (SD = 0.39) and 4.30 (SD = 0.45), respectively. Also, the lowest score for both groups was evidence-based nursing care with mean of 2.74 (SD = 0.55) and 3.74 (SD = 0.57), respectively. The comparison of competencies, as viewed by both groups of the students and the faculties, showed that the difference between the two groups’ mean scores was significant in all 5 core-competencies and 17 sub-core competencies ( P  < .001). Evidence-based nursing care was the highest mean difference (mean diff = 1) and the professional nursing process with the lowest mean difference (mean diff = 0.70).

The results of the study highlight concerns about the gap between expected and achieved competencies in Iran. Further research is recommended to identify the reasons for the gap between the two and to plan how to reduce it. This will require greater collaboration between healthcare institutions and nursing schools.

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Introduction| Background

Nursing competence refers to a set of knowledge, skills, and behaviors that are necessary to successfully perform roles or responsibilities [ 1 ]. It is crucial for ensuring the safe and high-quality care of patients [ 2 , 3 , 4 , 5 ]. However, evaluating nursing competence is challenging due to the complex, dynamic, and multi factorial nature of the clinical environment [ 3 ]. The introduction of nursing competencies and their assessment as a standard measure of clinical performance at the professional level has been highlighted by the Association of American Colleges of Nursing [ 6 , 7 ]. As a result, AACN (2020) introduces competence assessment as an emerging concept in nursing education [ 7 ].

On the other hand, the main responsibility of nursing education is to prepare graduates who have the necessary competencies to provide safe and quality care [ 3 ]. Although it is believed that it is impossible to teach everything to students, acquiring some competencies requires entering a real clinical setting and gaining work experience [ 8 ]. However, nursing students are expected to be competent to ensure patient safety and quality of care after graduation [ 9 ]. To the extent that the World Health Organization (WHO), while expressing concern about the low quality of nursing education worldwide, has recommended investing in nursing education and considers that the future to require nurses who are theoretically and clinically competent [ 5 ]. Despite efforts, the inadequate preparation of newly graduated nursing students and doubts about the competencies acquired in line with expectations to provide safe care for entering the nursing setting have become a global concern [ 10 , 11 , 12 , 13 ]. The results of studies in this field are different. The results of Amsalu et al. showed that the competence of newly graduated nursing students to provide quality and safe care was not satisfactory [ 14 ]. Some studies have also highlighted shortcomings in students’ “soft” skills, such as technical competency, critical thinking, communication, teamwork, helping roles, and professionalism [ 15 ]. Additionally, prior research has indicated that several nursing students have an unrealistic perception of their acquired competencies before entering the clinical setting and they report a high level of competence [ 2 ]. In other study, Hickerson et al. showed that the lack of preparation of nursing students is associated with an increase in patient errors and poor patient outcomes [ 16 ]. Some studies also discussed nursing competencies separately; Such as patient safety [ 17 ], clinical reasoning [ 18 ], interpersonal communication [ 19 ], and evidence-based care competence [ 20 ].

On the other hand, the growing need for safe nursing care and the advent of new educational technologies, the emergence of infectious diseases has increased the necessity of nursing competence. As a result, the nursing profession must be educated to excellence more than ever before [ 5 , 21 , 22 ]. Therefore, the self-assessment of students’ competence levels as well as the evaluation of nursing managers about the competencies expected from them is an essential criterion for all healthcare stakeholders, educators, and nursing policymakers to ensure the delivery of safe, and effective nursing care [ 9 , 23 , 24 ].

However, studies of nurse managers’ perceptions of the competence of newly graduated nursing students are limited and mostly conducted at the national level. Hence, further investigation is needed in this field [ 25 , 26 ]. Some other studies have been carried out according to the context and the needs of societies [ 3 , 26 , 27 , 28 ]. The results of some other studies in the field of students’ self-assessment of perceived competencies and managers’ and academic staff’s assessment of expected competency levels are different and sometimes contradictory, and there is the “academic-clinical gap” between expected and achieved competencies [ 25 , 29 , 30 ]. A review of the literature showed that this gap has existed for four decades, and the current literature shows that it has not changed much over time. The academe and practice settings have also been criticized for training nurses who are not sufficiently prepared to fully engage in patient care [ 1 ]. Hence, nursing managers must understand the expected competencies of newly graduated students, because they have a more complete insight into the healthcare system and the challenges facing the nursing profession. Exploration of these gaps can reveal necessities regarding the work readiness of nursing graduates and help them develop their competencies to enter the clinical setting [ 1 , 25 ].

Although research has been carried out on this topic in other countries, the educational system in those countries varies from that of Iran’s nursing education [ 31 , 32 ]. Iran’s nursing curriculum has tried to prepare nurses who have the necessary competencies to meet the care needs of society. Despite the importance of proficiency in nursing education, many nursing graduates often report feeling unprepared to fulfill expected competencies and they have deficiencies in applying their knowledge and experience in practice [ 33 ]. Firstly, the failure to define and identify the expected competencies in the nursing curriculum of Iran led to the absence of precise and efficient educational objectives. Therefore, it is acknowledged that the traditional nursing curriculum of Iran focuses more on lessons organization than competencies [ 34 ]. Secondly, insufficient attention has been given to the scheduling, location, and level of competencies in the nursing curriculum across different semesters [ 35 ]. Thirdly, the large volume of content instead of focusing on expected competencies caused nursing graduates challenged to manage complex situations [ 36 ]. Therefore, we should not expect competencies such as critical thinking, clinical judgment, problem-solving, decision-making, management, and leadership from nursing students and graduates in Iran [ 37 ]. Limited research has been conducted in this field in Iran. Studies have explored the cultural competence of nursing students [ 38 ] and psychiatric nurses [ 39 ]. Additionally, the competence priorities of nurses in acute care have been investigated [ 40 ], as well as the competency dimensions of nurses [ 41 ].

In Iran, after receiving the diploma, the students participate in a national exam called Konkur. Based on the results of this exam, they enter the field of nursing without conducting an aptitude test interview and evaluating individual and social characteristics. The 4-year nursing curriculum in Iran has 130 units including 22 general, 54 specific, 15 basic sciences, and 39 internship units. In each semester, several workshops are held according to the syllabus [ 42 ]. Instead of the expected competencies, a list of general competencies is specified as learning outcomes in the program. Accepted students based on their rank in the exam and their choice in public and Islamic Azad Universities (non-profit), are trained with a common curriculum. Islamic Azad Universities are not supported by government funding and are managed autonomously, this problem limits the access to specialized human resources and sufficient educational fields, and the lower salaries of faculty members in Azad Universities compared to the government system, students face serious challenges. Islamic Azad Universities must pay exorbitant fees to medical universities for training students in clinical departments and medical training centers, doubling these Universities’ financial problems. In some smaller cities, these financial constraints cause students to train in more limited fields of clinical training and not experience much of what they have learned in the classroom in practice and the real world of nursing. The evaluation of learners in the courses according to the curriculum is based on formative and summative evaluation with teacher-made tests, checklists, clinical assignments, conferences, and logbooks. The accreditation process of nursing schools includes two stages internal evaluation, which is done by surveying students, professors and managers of educational groups, and external accreditation is done by the nursing board. After completing all their courses, to graduate, students must participate in an exam called “Final”, which is held by each faculty without the supervision of an accreditation institution, the country’s assessment organization or the Ministry of Health, and obtain at least a score of 10 out of 20 to graduate.

Therefore, we conducted this comprehensive study as the first study in Iran to investigate the difference between the expected and perceived competence levels of final year nursing students. The study’s theoretical framework is based on Patricia Benner’s “From Novice to Expert” model [ 43 ].

Materials and methods

The present study had the following three objectives:

Determining self-perceived competency levels from the perspective of final year nursing students in Iran.

Determining expected levels of competency from the perspective of nursing faculties in Iran.

To determine the difference between the expected competencies from the perspective of nursing faculties and the achieved competencies from the perspective of final-year nursing students.

This study is a descriptive-comparative study.

First, we obtained a list of all nursing schools in the provinces of Iran from the Ministry of Health ( n  = 31). From 208 Universities, 72 nursing schools were randomly selected using two-stage cluster sampling. Among the selected faculties, we chose 721 final-year nursing students and 365 nursing faculties who met the eligibility criteria for the study. Final-year nursing students who consented to participate in the study were selected. Full-time faculty members with at least 2 years of clinical experience and nurse managers with at least 5 years of clinical education experience were also included. In this study, nursing managers, in addition to their educational roles in colleges, also have managerial roles in the field of nursing. Some of these roles include nursing faculty management, nursing board member, curriculum development and review, planning and supervision of nursing education, evaluation, and continuous improvement of nursing education. The selection criteria were based on the significant role that managers play in nursing education and curriculum development [ 44 ]. Non-full-time faculty members and managers without clinical education experience were excluded from the study.

The instrument used in this study is a questionnaire developed and psychometrically tested in a doctoral nursing dissertation [ 45 ]. To design the tool, the competencies expected of undergraduate nursing students in Iran and worldwide were first identified through a scoping review using the methodology recommended by the Joanna Briggs Institute (JBI) and supported by the PAGER framework. Summative content analysis by Hsieh and Shannon (2005) was used for analysis, which included: counting and comparing keywords and content, followed by interpretation of textual meaning. In the second step, the results of the first step were used to create tool statements. Then the validity of the instrument was checked by face validity, content validity (determination of the ratio and index of content validity), and validity of known groups. Its reliability was also checked by internal consistency using Cronbach’s alpha method and stability using the test-retest method. The competency questionnaire comprises 85 items covering 17 competencies across 5 domains: “individualized care” (4 competencies with 21 items), “evidence-based nursing care” (2 competencies with 10 items), “professional nursing process” (3 competencies with 13 items), “nursing management” (2 competencies with 16 items), and “work readiness and professional development” (6 competencies with 25 items) [ 45 ]. “The Bondy Rating Scale was utilized to assess the competency items, with ratings ranging from 1 (Dependent) to 5 (Independent) on a 5-point Likert scale [ 46 ]. The first group (nursing students) was asked to indicate the extent to which they had acquired each competency. The second group (nursing faculties) was asked to specify the level to which they expected nursing students to achieve each competency.

Data collection

First, the researcher contacted the deans and managers of the selected nursing schools by email to obtain permission. After explaining the aims of the study and the sampling method, we obtained the telephone number of the representative of the group of final year nursing students and also the email of the faculty members. The representative of the student group was then asked to forward the link to the questionnaire to 10 students who were willing to participate in the research. Informed consent for students to participate in the online research was provided through the questionnaires, while nursing faculty members who met the eligibility criteria for the study received an informed consent form attached to the email questionnaire. The informed consent process clarified the study objectives and ensured anonymity of respondent participation in the research, voluntary agreement to participate and the right to revoke consent at any time. An electronic questionnaire was then sent to 900 final year nursing students and 664 nursing faculties (from 4 March 2023 to 11 July 2023). Reminder emails were sent to nursing faculty members three times at two-week intervals. The attrition rate in the student group was reported to be 0 (no incomplete questionnaires). However, four questionnaires from nursing faculty members were discarded because of incomplete responses. Of the 900 questionnaires sent to students and 664 sent to nursing faculties, 721 students and 365 nursing faculty members completed the questionnaire. The response rates were 79% and 66% respectively.

Data were analyzed using SPSS version 22. Frequencies and percentages were used to report categorical variables and mean and standard deviations were used for quantitative variables. The normality of the quantitative data was confirmed using the Shapiro-Wilk and Skewness tests. An independent t-test was used for differences between the two groups.

Data analysis revealed that out of 721 students, 441 (61.20%) was female. The mean and deviation of the students’ age was 22.50 (SD = 1.21). Most of the students 577 (80%) were in their final semester. Also, of the total 365 faculties, the majority were female 253 (69.31%) with a mean of age 44.06 (SD = 7.46) and an age range of 22–65. The academic rank of most nursing faculty members 156 (21.60%) was assistant professor (Table  1 ).

The results of the study showed that in both groups the highest scores achieved by the students and expected by the nursing faculty members were work readiness and professional development with a mean and standard deviation of 3.54 (0.39) and 4.30 (0.45) respectively. The lowest score for both groups was also evidence-based nursing care with a mean and standard deviation of 2.74 (0.55) for students and 3.74 (0.57) for nursing faculty members (Table  2 ).

Also, the result of the study showed that the highest expected competency score from the nursing faculty members’ point of view was the safety subscale. In other words, faculty members expected nursing students to acquire safety competencies at the highest level and to be able to provide safe care independently according to the rating scale (Mean = 4.51, SD = 0.45). The mean score of the competencies achieved by the students was not above 3.77 in any of the subscales and the highest level of competency achievement according to self-report of students was related to safety competencies (mean = 3.77, SD = 0.51), preventive health services (mean = 3.69, SD = 0.79), values and ethical codes (mean = 3.67, SD = 0.77), and procedural/clinical skills (mean = 3.67, SD = 0.71). The other competency subscales from the perspective of the two groups are presented in Table  3 , from highest to lowest score.

The analysis of core competencies achieved and expected from both students’ and nursing faculty members’ perspectives revealed that, firstly, there was a significant difference between the mean scores of the two groups in all five core competencies ( P  < .001) and that the highest mean difference was related to evidence-based care with mean diff = 1 and the lowest mean difference was related to professional care process with mean diff = 0.70 (Table  4 ).

Table  5 indicates that there was a significant difference between the mean scores achieved by students and nursing faculty members in all 5 core competencies and 17 sub-core Competencies ( p  < .001).

The study aimed to determine the difference between nursing students’ self-perceived level of competence and the level of competence expected of them by their nursing faculty members. The study results indicate that students scored highest in work readiness and professional development. However, they were not independent in this competency and required support. The National League for Nursing (NLN) recognizes nursing professional development as the goal of nursing education programs [ 47 ] However, Aguayo-Gonzalez [ 48 ] believes that the appropriate time for professional development is after entering a clinical setting. This theme includes personal characteristics, legality, clinical/ procedural skills, patient safety, preventive health services, and mentoring competence. Personality traits of nursing students are strong predictors of coping with nursing stress, as suggested by Imus [ 49 ]. These outcomes reflect changes in students’ individual characteristics during their nursing education. Personality changes, such as the need for patience and persistence in nursing care and understanding the nurse identity prepare students for the nursing profession, which is consistent with the studies of Neishabouri et al. [ 50 ]. Although the students demonstrated a higher level of competence in this theme, an examination of the items indicates that they can still not adapt to the challenges of bedside nursing and to use coping techniques. This presents a concerning issue that requires attention and resolution. Previous studies have shown that nursing education can be a very stressful experience [ 51 , 52 , 53 ].

Of course, there is no consensus on the definition of professionalism and the results of studies in this field are different. For example, Akhtar et al. (2013) identified common viewpoints about professionalism held by nursing faculty and students, and four viewpoints emerged humanists, portrayers, facilitators, and regulators [ 54 ]. The findings of another study showed that nursing students perceived vulnerability, symbolic representation, role modeling, discontent, and professional development are elements that show their professionalism [ 55 ]. The differences indicate that there may be numerous contextual variables that affect individuals’ perceptions of professionalism.

The legal aspects of nursing were the next item in this theme that students needed help with. The findings of studies regarding the legal competence of newly graduated nursing students are contradictory reported that only one-third of nurse managers were satisfied with the legal competence of newly graduated nursing students [ 56 , 57 ]. Whereas the other studies showed that legality was the highest acquired competence for newly graduated nursing students [ 58 , 59 ]. However, the results of this study indicated that legality may be a challenge for newly graduated nursing students. Benner [ 43 ] highlighted the significant change for new graduates in that they now have full legal and professional responsibility for the patient. Tong and Epeneter [ 60 ] also reported that facing an ethical dilemma is one of the most stressful factors for new graduates. Therefore, the inexperience of new graduates cannot reduce the standard of care that patients expect from them [ 60 ]. Legal disputes regarding the duties and responsibilities of nurses have increased with the expansion of their roles. This is also the case in Iran. Nurses are now held accountable by law for their actions and must be aware of their legal obligations. To provide safe healthcare services, it is essential to know of professional, ethical, and criminal laws related to nursing practice. The nursing profession is accountable for the quality of services delivered to patients from both professional and legal perspectives. Therefore, it is a valuable finding that nurse managers should support new graduates to better deal with ethical dilemmas. Strengthening ethical education in nursing schools necessitates integrating real cases and ethical dilemmas into the curriculum. Especially, Nursing laws are missing from Iran’s undergraduate nursing curriculum. By incorporating authentic case studies drawn from clinical practice, nursing schools provide students with opportunities to engage in critical reflection, ethical analysis, and moral deliberation. These real cases challenge students to apply ethical principles to complex and ambiguous situations, fostering the development of ethical competence and moral sensitivity. Furthermore, ethical reflection and debriefing sessions during clinical experiences enable students to discuss and process ethical challenges encountered in practice, promoting self-awareness, empathy, and professional growth. Overall, by combining theoretical instruction with practical application and the use of real cases, nursing schools can effectively prepare future nurses to navigate ethical dilemmas with integrity and compassion.

However, the theme of evidence-based nursing care was the lowest scoring, indicating that students need help with this theme. The findings from studies conducted in this field are varied. A limited number of studies reported that nursing students were competent to implement evidence-based care [ 61 ], while other researchers reported that nursing students’ attitudes toward evidence-based care to guide clinical decisions were largely negative [ 20 , 62 ]. The principal barriers to implementing evidence-based care are lack of authority to change patient care policy, slow dissemination of evidence and lack of time at the bedside to implement evidence [ 10 ], and lack of knowledge and awareness of the process of searching databases and evaluating research [ 63 ]. While the European Higher Education Area (EHEA) framework and the International Council of Nurses Code of Ethics introduce the ability to identify, critically appraise, and apply scientific information as expected learning outcomes for nursing students [ 64 , 65 ], the variation in findings highlights the complexity of the concept of competence and its assessment [ 23 ]. Evidence-Based Nursing (EBN) education for nursing students is most beneficial when it incorporates a multifaceted approach. Interactive workshops play a crucial role, providing students with opportunities to critically appraise research articles, identify evidence-based practices, and apply them to clinical scenarios. Simulation-based learning further enhances students’ skills by offering realistic clinical experiences in a safe environment. Additionally, clinical rotations offer invaluable opportunities for students to observe and participate in evidence-based practices under the guidance of experienced preceptors. Journal clubs foster a culture of critical thinking and ongoing learning, where students regularly review and discuss current research articles. Access to online resources such as databases and evidence-based practice guidelines allows students to stay updated on the latest evidence and best practices. To bridge the gap between clinical practice and academic theory, collaboration between nursing schools and healthcare institutions is essential. This collaboration can involve partnerships to create clinical learning environments that prioritize evidence-based practice, inter professional education activities to promote collaboration across disciplines, training and support for clinical preceptors, and continuing education opportunities for practicing nurses to strengthen their understanding and application of EBN [ 66 ]. By implementing these strategies, nursing education programs can effectively prepare students to become competent practitioners who integrate evidence-based principles into their clinical practice, ultimately improving patient outcomes.

The study’s findings regarding the second objective showed that nursing faculty members expected students to achieve the highest level of competence in work readiness and professional development, and the lowest in evidence-based nursing care competence. The results of the studies in this area revealed that there is a lack of clarity about the level of competence of newly graduated nursing students and that confusion about the competencies expected of them has become a major challenge [ 13 , 67 ]. Evidence of nurse managers’ perceptions of newly graduated nursing student’s competence is limited and rather fragmented. There is a clear need for rigorous empirical studies with comprehensive views of managers, highlighting the key role of managers in the evaluation of nurse competence [ 1 , 9 ]. Some findings also reported that nursing students lacked competence in primary and specialized care after entering a real clinical setting [ 68 ] and that nursing managers were dissatisfied with the competence of students [ 30 ].

The results of the present study on the third objective confirmed the gap between expected and achieved competence requirements. The highest average difference was related to evidence-based nursing care, and the lowest mean difference was related to the professional nursing process. The findings from studies in this field vary. For instance, Brown and Crookes [ 13 ] reported that newly graduated nursing students were not independent in at least 26 out of 30 competency domains. Similar studies have also indicated that nursing students need a structured program after graduation to be ready to enter clinical work [ 30 ]. It can be stated that the nursing profession does not have clear expectations of the competencies of newly graduated nursing students, and preparing them for entry into clinical practice is a major challenge for administrators [ 13 ]. These findings can be explained by the Duchscher transition shock [ 69 ]. It is necessary to support newly graduated nursing students to develop their competence and increase their self-confidence.

The interesting but worrying finding was the low expectations of faculty members and the low scores of students in the theme of evidence-based care. However, nursing students need to keep their competencies up to date to provide safe and high-quality care. The WHO also considers the core competencies of nurse educators to be the preparation of effective, efficient, and skilled nurses who can teach the evidence-based learning process and help students apply it clinically [ 44 ]. The teaching of evidence-based nursing care appears to vary across universities, and some clinical Faculties do not have sufficient knowledge to support students. In general, it can be stated that the results of the present study are in line with the context of Iran. Some of the problems identified include a lack of attention to students’ academic talent, a lack of a competency-based curriculum, a gap between theory and clinical practice, and challenges in teaching and evaluating the achieved competencies [ 42 ].

Strengths and limitations

The study was conducted on a national level with a sizable sample. It is one of the first studies in Iran to address the gap between students’ self-perceived competence levels and nursing faculty members’ expected competency levels. Nevertheless, one of the limitations of the study is the self-report nature of the questionnaire, which may lead to social desirability bias. In addition, the COVID-19 pandemic coinciding with the student’s first and second years could potentially impact their educational quality and competencies. The limitations established during the outbreak negatively affected the nursing education of students worldwide.

Acquiring nursing competencies is the final product of nursing education. The current study’s findings suggest the existence of an academic-practice gap, highlighting the need for educators, faculty members, and nursing managers to collaborate in bridging the potential gap between theory and practice. While nursing students were able to meet some expectations, such as value and ethical codes, there is still a distance between expectations and reality. Especially, evidence-based care was identified as one of the weaknesses of nursing students. It is recommended that future research investigates the best teaching strategies and more objective assessments of competencies. The findings of this study can be used as a guide for the revision of undergraduate nursing education curricula, as well as a guide for curriculum development based on the development of competencies expected of nursing students. Nursing managers can identify existing gaps and plan to fill them and use them for the professionalization of students. This requires the design of educational content and objective assessment tools to address these competencies at different levels throughout the academic semester. This significant issue necessitates enhanced cooperation between healthcare institutions and nursing schools. Enhancing nursing education requires the implementation of concrete pedagogical strategies to bridge the gap between theoretical knowledge and practical skills. Simulation-based learning emerges as a pivotal approach, offering students immersive experiences in realistic clinical scenarios using high-fidelity simulators [ 70 ]. Interprofessional education (IPE) is also instrumental, in fostering collaboration among healthcare professionals and promoting holistic patient care. Strengthening clinical preceptorship programs is essential, with a focus on providing preceptors with formal training and ongoing support to facilitate students’ clinical experiences and transition to professional practice [ 71 ]. Integrating evidence-based practice (EBP) principles throughout the curriculum cultivates critical thinking and inquiry skills among students, while technology-enhanced learning platforms offer innovative ways to engage students and support self-directed learning [ 72 ]. Diverse and comprehensive clinical experiences across various healthcare settings ensure students are prepared for the complexities of modern healthcare delivery. By implementing these practical suggestions, nursing education programs can effectively prepare students to become competent and compassionate healthcare professionals.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors extend their gratitude to all the nursing students and faculties who took part in this study.

This article is part of research approved with the financial support of the deputy of research and technology of Tabriz University of Medical Sciences.

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Majid Purabdollah

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Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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M P: conceptualized the study, data collection, analysis and interpretation, drafting of manuscript; V Z: conceptualized the study, analysis and interpretation, drafting of manuscript; LV: conceptualized the study, data collection and analysis, manuscript revision; A Gh: conceptualized the study, data collection, analysis, and drafting of manuscript; S M: conceptualized the study, analysis, and drafting of manuscript; M Gh: data collection, analysis, and interpretation, drafting of manuscript; All authors read and approved the final manuscript.

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Purabdollah, M., Zamanzadeh, V., Ghahramanian, A. et al. Competency gap among graduating nursing students: what they have achieved and what is expected of them. BMC Med Educ 24 , 546 (2024). https://doi.org/10.1186/s12909-024-05532-w

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The Cognitive Benefits of Being Bilingual

Editor’s note:.

Today, more of the world’s population is bilingual or multilingual than monolingual. In addition to facilitating cross-cultural communication, this trend also positively affects cognitive abilities. Researchers have shown that the bilingual brain can have better attention and task-switching capacities than the monolingual brain, thanks to its developed ability to inhibit one language while using another. In addition, bilingualism has positive effects at both ends of the age spectrum: Bilingual children as young as seven months can better adjust to environmental changes, while bilingual seniors can experience less cognitive decline .

We are surrounded by language during nearly every waking moment of our lives. We use language to communicate our thoughts and feelings, to connect with others and identify with our culture, and to understand the world around us. And for many people, this rich linguistic environment involves not just one language but two or more. In fact, the majority of the world’s population is bilingual or multilingual. In a survey conducted by the European Commission in 2006, 56 percent of respondents reported being able to speak in a language other than their mother tongue. In many countries that percentage is even higher—for instance, 99 percent of Luxembourgers and 95 percent of Latvians speak more than one language. 1 Even in the United States, which is widely considered to be monolingual, one-fifth of those over the age of five reported speaking a language other than English at home in 2007, an increase of 140 percent since 1980. 2 Millions of Americans use a language other than English in their everyday lives outside of the home, when they are at work or in the classroom. Europe and the United States are not alone, either. The Associated Press reports that up to 66 percent of the world’s children are raised bilingual. 3 Over the past few decades, technological advances have allowed researchers to peer deeper into the brain to investigate how bilingualism interacts with and changes the cognitive and neurological systems.

Cognitive Consequences of Bilingualism

Research has overwhelmingly shown that when a bilingual person uses one language, the other is active at the same time. When a person hears a word, he or she doesn’t hear the entire word all at once: the sounds arrive in sequential order. Long before the word is finished, the brain’s language system begins to guess what that word might be by activating lots of words that match the signal. If you hear “can,” you will likely activate words like “candy” and “candle” as well, at least during the earlier stages of word recognition. For bilingual people, this activation is not limited to a single language; auditory input activates corresponding words regardless of the language to which they belong. 4

Some of the most compelling evidence for language co-activation comes from studying eye movements. We tend to look at things that we are thinking, talking, or hearing about. 5 A Russian-English bilingual person asked to “pick up a marker” from a set of objects would look more at a stamp than someone who doesn’t know Russian, because the Russian word for “stamp,” “ marka ,” sounds like the English word he or she heard, “marker.” 4 In cases like this, language co-activation occurs because what the listener hears could map onto words in either language. Furthermore, language co-activation is so automatic that people consider words in both languages even without overt similarity. For example, when Chinese-English bilingual people judge how alike two English words are in meaning, their brain responses are affected by whether or not the Chinese translations of those words are written similarly. 6 Even though the task does not require the bilingual people to engage their Chinese, they do so anyway.

Having to deal with this persistent linguistic competition can result in language difficulties. For instance, knowing more than one language can cause speakers to name pictures more slowly 7 and can increase tip-of-the-tongue states (where you’re unable to fully conjure a word, but can remember specific details about it, like what letter it starts with). 8 As a result, the constant juggling of two languages creates a need to control how much a person accesses a language at any given time. From a communicative standpoint, this is an important skill—understanding a message in one language can be difficult if your other language always interferes. Likewise, if a bilingual person frequently switches between languages when speaking, it can confuse the listener, especially if that listener knows only one of the speaker’s languages.

To maintain the relative balance between two languages, the bilingual brain relies on executive functions, a regulatory system of general cognitive abilities that includes processes such as attention and inhibition. Because both of a bilingual person’s language systems are always active and competing, that person uses these control mechanisms every time she or he speaks or listens. This constant practice strengthens the control mechanisms and changes the associated brain regions. 9 – 12

Bilingual people often perform better on tasks that require conflict management. In the classic Stroop task , people see a word and are asked to name the color of the word’s font. When the color and the word match (i.e., the word “red” printed in red), people correctly name the color more quickly than when the color and the word don’t match (i.e., the word “red” printed in blue). This occurs because the word itself (“red”) and its font color (blue) conflict. The cognitive system must employ additional resources to ignore the irrelevant word and focus on the relevant color. The ability to ignore competing perceptual information and focus on the relevant aspects of the input is called inhibitory control. Bilingual people often perform better than monolingual people at tasks that tap into inhibitory control ability. Bilingual people are also better than monolingual people at switching between two tasks; for example, when bilinguals have to switch from categorizing objects by color (red or green) to categorizing them by shape (circle or triangle), they do so more rapidly than monolingual people, 13 reflecting better cognitive control when changing strategies on the fly.

Changes in Neurological Processing and Structure

Studies suggest that bilingual advantages in executive function are not limited to the brain’s language networks. 9 Researchers have used brain imaging techniques like functional magnetic resonance imaging (fMRI) to investigate which brain regions are active when bilingual people perform tasks in which they are forced to alternate between their two languages. For instance, when bilingual people have to switch between naming pictures in Spanish and naming them in English, they show increased activation in the dorsolateral prefrontal cortex (DLPFC), a brain region associated with cognitive skills like attention and inhibition. 14 Along with the DLPFC, language switching has been found to involve such structures as the anterior cingulate cortex (ACC), bilateral supermarginal gyri, and left inferior frontal gyrus (left-IFG), regions that are also involved in cognitive control. 9 The left-IFG in particular, often considered the language production center of the brain, appears to be involved in both linguistic 15 and non-linguistic cognitive control. 16

The neurological roots of the bilingual advantage extend to subcortical brain areas more traditionally associated with sensory processing. When monolingual and bilingual adolescents listen to simple speech sounds (e.g., the syllable “da”) without any intervening background noise, they show highly similar brain stem responses to the auditory information. When researchers play the same sound to both groups in the presence of background noise, the bilingual listeners’ neural response is considerably larger, reflecting better encoding of the sound’s fundamental frequency, 17 a feature of sound closely related to pitch perception. To put it another way, in bilingual people, blood flow (a marker for neuronal activity) is greater in the brain stem in response to the sound. Intriguingly, this boost in sound encoding appears to be related to advantages in auditory attention. The cognitive control required to manage multiple languages appears to have broad effects on neurological function, fine-tuning both cognitive control mechanisms and sensory processes.

Beyond differences in neuronal activation, bilingualism seems to affect the brain’s structure as well. Higher proficiency in a second language, as well as earlier acquisition of that language, correlates with higher gray matter volume in the left inferior parietal cortex. 18 Researchers have associated damage to this area with uncontrolled language switching, 19 suggesting that it may play an important role in managing the balance between two languages. Likewise, researchers have found white matter volume changes in bilingual children 20 and older adults. 21 It appears that bilingual experience not only changes the way neurological structures process information, but also may alter the neurological structures themselves.

Improvements in Learning

Being bilingual can have tangible practical benefits. The improvements in cognitive and sensory processing driven by bilingual experience may help a bilingual person to better process information in the environment, leading to a clearer signal for learning. This kind of improved attention to detail may help explain why bilingual adults learn a third language better than monolingual adults learn a second language. 22 The bilingual language-learning advantage may be rooted in the ability to focus on information about the new language while reducing interference from the languages they already know. 23 This ability would allow bilingual people to more easily access newly learned words, leading to larger gains in vocabulary than those experienced by monolingual people who aren’t as skilled at inhibiting competing information.

Furthermore, the benefits associated with bilingual experience seem to start quite early—researchers have shown bilingualism to positively influence attention and conflict management in infants as young as seven months. In one study, researchers taught babies growing up in monolingual or bilingual homes that when they heard a tinkling sound, a puppet appeared on one side of a screen. Halfway through the study, the puppet began appearing on the opposite side of the screen. In order to get a reward, the infants had to adjust the rule they’d learned; only the bilingual babies were able to successfully learn the new rule. 24 This suggests that even for very young children, navigating a multilingual environment imparts advantages that transfer beyond language.

Protecting Against Age-Related Decline

The cognitive and neurological benefits of bilingualism also extend into older adulthood. Bilingualism appears to provide a means of fending off a natural decline of cognitive function and maintaining what is called “cognitive reserve.” 9 , 25 Cognitive reserve refers to the efficient utilization of brain networks to enhance brain function during aging. Bilingual experience may contribute to this reserve by keeping the cognitive mechanisms sharp and helping to recruit alternate brain networks to compensate for those that become damaged during aging. Older bilingual people enjoy improved memory 26 and executive control 9 relative to older monolingual people, which can lead to real-world health benefits.

In addition to staving off the decline that often comes with aging, bilingualism can also protect against illnesses that hasten this decline, like Alzheimer’s disease. In a study of more than 200 bilingual and monolingual patients with Alzheimer’s disease, bilingual patients reported showing initial symptoms of the disease at about 77.7 years of age—5.1 years later than the monolingual average of 72.6. Likewise, bilingual patients were diagnosed 4.3 years later than the monolingual patients (80.8 years of age and 76.5 years of age, respectively). 25 In a follow-up study, researchers compared the brains of bilingual and monolingual patients matched on the severity of Alzheimer’s symptoms. Surprisingly, the brains of bilingual people showed a significantly higher degree of physical atrophy in regions commonly associated with Alzheimer’s disease. 27 In other words, the bilingual people had more physical signs of disease than their monolingual counterparts, yet performed on par behaviorally, even though their degree of brain atrophy suggested that their symptoms should be much worse. If the brain is an engine, bilingualism may help to improve its mileage, allowing it to go farther on the same amount of fuel.

The cognitive and neurological benefits of bilingualism extend from early childhood to old age as the brain more efficiently processes information and staves off cognitive decline. What’s more, the attention and aging benefits discussed above aren’t exclusive to people who were raised bilingual; they are also seen in people who learn a second language later in life. 25 , 28 The enriched cognitive control that comes along with bilingual experience represents just one of the advantages that bilingual people enjoy. Despite certain linguistic limitations that have been observed in bilinguals (e.g., increased naming difficulty 7 ), bilingualism has been associated with improved metalinguistic awareness (the ability to recognize language as a system that can be manipulated and explored), as well as with better memory, visual-spatial skills, and even creativity. 29 Furthermore, beyond these cognitive and neurological advantages, there are also valuable social benefits that come from being bilingual, among them the ability to explore a culture through its native tongue or talk to someone with whom you might otherwise never be able to communicate. The cognitive, neural, and social advantages observed in bilingual people highlight the need to consider how bilingualism shapes the activity and the architecture of the brain, and ultimately how language is represented in the human mind, especially since the majority of speakers in the world experience life through more than one language.

Article available online at http://www.dana.org/news/cerebrum/detail.aspx?id=39638