problem solving skills for gifted students

Engaging Gifted Students in Solving Real Problems Creatively: Implementing the Real Engagement in Active Problem-Solving (REAPS) Teaching/Learning Model in Australasian and Pacific Rim Contexts

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• First Online: 09 January 2021
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• C. June Maker 2 &
• Myra Wearne 3  

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We believe that engaging students in solving problems they perceive as real and relevant in their lives, combined with differentiation, is an effective way to nurture giftedness and talent in all domains while also discovering hidden talents and providing a setting for developing all students’ strengths, interests, and passions. In this chapter, we describe a teaching model made up of three other evidence-based teaching models with a common goal of enhancing students’ ability to think creatively, critically, and collaboratively while learning essential content-related ideas and skills. We demonstrate the model’s comprehensiveness as a way to: differentiate the curriculum for all levels of learners and children with varied types of abilities, inclusive of gifted students; outline the guiding paradigms of thinking that led to its creation; give an overview of the evidence-based models that form the framework and methods of teaching that make up Real Engagement in Active Problem-Solving (REAPS); describe ways it has been implemented in Australasian and Pacific Rim contexts; provide examples from classrooms in Korea, Australia, China, and New Zealand; introduce a long-term, whole-school collaboration to improve the model and test its effectiveness; and summarise results of research.

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Zimmerman, R. H., Maker, C. J., & Pease, R. (2017). add the following at the end of the reference: Department of Disability and Psychoeducational Studies, University of Arizona, Tucson, AZ, USA.

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Maker, C.J., Wearne, M. (2021). Engaging Gifted Students in Solving Real Problems Creatively: Implementing the Real Engagement in Active Problem-Solving (REAPS) Teaching/Learning Model in Australasian and Pacific Rim Contexts. In: Smith, S.R. (eds) Handbook of Giftedness and Talent Development in the Asia-Pacific. Springer International Handbooks of Education. Springer, Singapore. https://doi.org/10.1007/978-981-13-3041-4_40

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Gifted Lesson Plans: A List of Resources

Below are some of our community’s favorite educator books and websites on lesson plans listed in alphabetical order.*

• 20 Ideas for Teaching Gifted Kids in the Middle School & High School Receive some of the best ideas and lessons developed by master teachers in this book by Joel McIntosh. Both this and its sequel,  10 More Ideas for Teaching Gifted Kids in the Middle School & High School , feature ideas for starting mentorship programs, teaching history using scientific surveys, producing documentaries, and more. A Trip Around the World This book contains lesson plans, maps, facts, words and phrases, and activities are provided for 15 countries on six different continents helping students learn about countries and cultures around the world. Other curriculum areas are incorporated in the activities provided along with teaching notes, blackline maps, extension activities, a list of foreign words and phrases, and a bibliography of fiction and non-fiction books for each country to help to organize the study. Autonomous Learner Model Resource Book This book includes activities and strategies to support the development of autonomous learners. More than 40 activities are included, all geared to the emotional, social, cognitive, and physical development of students. Teachers may use these activities and strategies with the entire class, small groups, or with individuals who are ready to be independent, self-directed, lifelong learners. Challenging Units for Gifted Learners: Teaching the Way Gifted Students Think – Language Arts Challenging Units for Gifted Learners: Teaching the Way Gifted Students Think – Math These books are series designed to help teachers provide the stimulating curricula that will nurture this potential in school. Creating Effective Programs for Gifted Students With Learning Disabilities This book provides a road map for understanding assessment and programming for GTLD students in the era of Response to Intervention. The book helps educators understand the often frustrating experiences GTLD students face in the classroom and identify accommodations and adaptations that allow these bright students to demonstrate their gifts and compensate for their processing challenges. Through an examination of current research and case studies, the reader will be introduced to what must be considered when identifying and developing programming for this underserved population. Demystifying Differentiation in Middle School: Tools, Strategies and Activities to Use NOW A book designed for middle school teachers who are interested in curriculum differentiation. Offers detailed lessons in over 35 topics, such as language arts, math, science, and social studies, covering four different teaching strategies. Differentiated Activities and Assessments Using the Common Core Standards This book show educators how to use differentiated curriculum, differentiated instruction, and differentiated assessment with the Common Core State Standards. The book includes over 50 topics in language arts, math, social studies, science, and interdisciplinary topics. Differentiation That Really Works: Strategies From Real Teachers for Real Classrooms (Grades K-2) This book provides educators with time-saving teaching strategies and lesson ideas based on ease of implementation, ability to modify and inherent opportunities for differentiation. Through years of working with teachers the authors, Dr. Cheryll M. Adams and Dr. Rebecca L. Pierce, pass along four classroom components focused on including differentiated learning strategies, anchoring activities, classroom management, and differentiated assessment. The book also includes templates and sample lessons that can be used to develop customized materials, along with comments from teachers who have used the strategies. Five in a Row The three volumes of the Five in a Row curriculum provide 55 lesson plans covering social studies, language, art, applied math and science. Designed for a homeschool setting, these lessons would also be appropriate in a conventional school. Although the original Five in a Row was designed for children ages 4 to 8, families of profoundly gifted children will find these guides more appropriate for the preschool years. The accompanying Five in a Row website offers sample lessons, an online newsletter, and curriculum user discussion boards. I’m Not Just Gifted: Social-Emotional Curriculum for Guiding Gifted Children What traits and characteristics define successful people? Why do gifted children, in particular, need a strong affective curricula in order to maximize their potential? These questions and more are explored in this guide to helping gifted children in grades 4–7 as they navigate the complicated social and emotional aspects of their lives. Including lesson plans, worksheets, and connections to Common Core State Standards, this is a practical guide necessary for anyone serving and working with gifted children. Instructional Units for Gifted and Talented Learners The creative lessons covered in this book by master teachers cover all of the core academic areas for grades K-6. Lessons include standards-based objectives, interdisciplinary connections that can be explored and discussed and assessments strategies for each unit of instruction. Lessons From the Middle: High-End Learning for Middle School Students In addition to the 12 model lessons provided, this book from Sandra Kaplan and Michael Cannon, includes a step-by-step guide to developing lessons that emphasize depth and complexity. All of the materials focus on ways to align the middle school curriculum with established national standards and offer strategies to evaluate learner achievement. Order in the Court – A Mock Trial Simulation Order in the Court: A Mock Trial Simulation gives students the opportunity to conduct a trial based on a classic fairytale in order to develop their courtroom skills. After developing the necessary vocabulary, students participate in the trial of Ms. Petunia Pig v. Mr. B. B. Wolf. Students not only learn the concepts, but they also learn valuable teamwork and time management skills. Designed for students grades 6-8, the unit culminates in a full mock-trial enactment. Picturing Math This unique book uses picture books to teach elementary students math concepts. Author Colleen Kessler feels strongly that all students should be challenged to experience and learn new things every day. She covers problem solving, geometry, algebra, measurement and probability. Grades 2-4. Project-Based Learning for Gifted Students: A Handbook for the 21st-Century Classroom This book makes the case that project-based learning is ideal for the gifted classroom, focusing on student choice, teacher responsibility, and opportunities for differentiation. The book guides teachers to create a project-based learning environment in their own classroom, walking them step-by-step through topics and processes such as linking projects with standards, finding the right structure, and creating a practical classroom environment. Project-Based Learning for Gifted Students also provides helpful examples and lessons that all teachers can use to get started. Ready-to-Use Differentiation Strategies – Grades 6-8 Ready-to-Use Differentiation Strategies introduces various activities and strategies that can be implemented in any content area in grades 6–8. Each differentiation strategy encourages higher level thinking and intellectual risk taking while accommodating different learning styles. This book also provides templates that can be used to develop new lessons using each strategy. Designed for students grades 6-8, Ready-to-Use Differentiation Strategies provides an easy-to-use way to begin differentiating for all students in the classroom. Researching All Learners: Making Differentiation Work This book provides research-based strategies, instructional responses to the way students’ brains learn best, successful guidelines to effectively manage the learning environment, and a teaching palette of 40 strategies for differentiating instruction. Splash! Monitoring and Measurement Applications for Young Learners This book is a mathematics unit for high-ability learners in kindergarten and first grade focusing on concepts related to linear measurement, the creativity elements of fluency and flexibility, and the overarching, interdisciplinary concept of models. The unit consists of 13 lessons centered on the idea of designing a community pool. Students examine the question of why we measure, the importance of accuracy in measurement, and the various units and tools of measurement. STEM to STEAM Education for Gifted Students: Using Specific Communication Arts Lessons with Nanotechnology, Solar, Biomass, Robotics, & Other STEM Topics In this book, the authors present detailed lessons for integrating Eight STEM Education Areas with Communication Arts Lessons. These detailed lessons emphasize writing essays, descriptions and poems, and completing various exercises related to the following STEM Areas: Nanotechnology, Solar, Internet, Inventing, Music, Electric Vehicles, MOOCS, Biomass, and Robotics. The Appendices contain further information about the importance and promise of STEM Education. Super Smart Math – 180 Warm-Ups and Challenging Activities In Super Smart Math challenges, author Rebecca George helps students to think critcally while providing activities and problems that become increasingly difficult as the students progress through each section. Organized by mathematical topics for grades 5-8. The 10 Things All Future Mathematicians and Scientists Must Know (But Are Rarely Taught) Edward Zaccaro presents this book full of classroom lessons, readings and discussion starters. It reveals the things our future mathematicians and scientists must know in order to prevent tragedies such as the Challenger explosion and the failure of the Mars Orbiter. The NEW RtI: Response to Intelligence This book provides practical advise for instructors who are looking to successfully incorporate students of all skill levels into their classroom. The book advocates for gifted children while supporting the concept that all children on the learning continuum grow and continue to learn. Unicorns Are Real: A Right-Brained Approach to Learning This best-seller by Barbara Meister Vitale, provides sixty-five practical, easy-to-follow lessons to develop the much ignored right-brain tendencies of children. Her methods have been successfully demonstrated at workshops, in-service training sessions, and at several major educational conventions nationwide. Writing Instruction for Verbally Talented Youth: The Johns Hopkins Model The book by Ben Reynolds contains specific lesson plans, student assignments, and criteria and suggestions for evaluation of student work. The book contains the complete content of the first writing courses for verbally talented youth designed by the Center for Talented Youth at Johns Hopkins University in the early 1980’s. This course was designed originally for 7th grade students who scored 430 or above on the verbal section of the SAT. Writing Success Through Poetry Grades 4-8 will gain insight from this book offering practical questions to facilitate Socratic-style discussions and explorations of literary concepts found within poems. Author, Susan Lipson, provides 25 original poems as prompts for students to use as inspiration for their own poetry and prose.

Engineering the Future offers lessons, activities, and classroom strategies to assist educators in teaching young people STEM oriented content.

* Some links on this page go to Bookshop.org and are affiliate links. While these books are available from many retailers, all links that go to Bookshop.org help support the Davidson Institute’s mission and continuing work to support profoundly gifted students and their families.

Feel free to share your go-to gifted education resources in the comments below!

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But first, the big picture, 1. offer the most difficult first, 2. pre-test for volunteers, 3. prepare to take it up, 4. speak to student interests, 5. enable gifted students to work together, 6. plan for tiered learning, "it's just good teaching".

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3 Strategies for Supporting Gifted and Talented Students

While gifted and talented (G&T) students have many heightened skill sets and abilities, if not supported properly, they risk falling behind in school despite the lack of national attention compared to other student demographics.

One reason for this is the prevailing myth that G&T students should be able to excel on their own. According to the National Association for Gifted Children , the truth is that without proper support and guidance, these students can easily become bored and frustrated, leading to “low achievement, despondency, or unhealthy work habits.”

Below are three strategies you can implement in your classrooms to help G&T students reach their full potential.

1. Combat Perfectionism

While every student is different and has unique social and emotional needs, research shows that G&T students on average feel more isolated and are less sensitive to how their peers perceive them. Additionally, students may suffer from anxiety, social withdrawal, low self-esteem and excessive perfectionism . These negative emotions can feel magnified, especially if children feel like they are overwhelmed with expectations set by teachers or parents. 

According to the Institute for Educational Advancement (IEA), a nonprofit organization that focuses on supporting the academic needs and opportunities of gifted children, around 20% of gifted children suffer from perfectionism to the point where it causes problems.

A few tips recommended by the IEA to address this include:

• Speaking to students honestly about your own mistakes and how these setbacks led to future success.  
• Promoting the importance of the process as opposed to the outcome of a particular project.  
• Help them find humor in mistakes and encourage them to not take mistakes so seriously.  
• Encourage them to remove the idea of “being perfect” from their identity.  
• Set limits and help them set boundaries on the amount of time they’re working on any one task or assignment.

2. Embrace Enrichment Opportunities

Incorporating enrichment opportunities has long represented a crucial cornerstone of effective G&T education. In a paper published in Education Sciences , researchers trace this national approach to as early as 1985, when researchers first began categorizing different types of enrichment based on their intended outcomes and use cases.

Today, there exist significantly more types of enrichment for students. As highlighted in the report, types that are of particular interest to G&T students include :

• Strength-Based Learning Opportunities This strategy considers students’ academic strengths, interests and learning preferences to create activities that are both naturally appealing and designed to further develop their natural strengths and interests.  
• Critical/Creative Thinking and Problem Solving These learning opportunities are designed to provide students with opportunities to use critical and creative thinking and problem solving to interpret a challenge and then use open-ended thinking to produce multiple ideas and solutions.  
• Differentiated Instruction (Curriculum Compacting) Targeted to Student Needs In this approach, instructional and curricular modifications are made to meet the needs of students on an individual level to ensure that instruction and content are more challenging and advanced, as needed.

3. Consider Invention Education

One effective way to implement the above enrichment styles is through invention education, a hands-on pedagogy that challenges students to solve real-world problems by building invention prototypes.

With this strategy, not only do G&T students have the opportunity to pursue solutions that most interest them, but because such projects are open-ended in nature, they invite students to develop their critical thinking and problem-solving skills. In this way, invention education allows for naturally occurring differentiated instruction, giving students full autonomy as to how they want to solve a given problem or challenge.

In Florida’s Pinellas County School District, district officials partnered with the National Inventors Hall of Fame ® to support their G&T students using our engaging invention education curricula. To learn more about their experience, we invite you to check out this blog !

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• Differentiated Instruction Strategies for Gifted Students

This article covers everything you need to know about Differentiated Instruction Strategies for Gifted Students, including best practices and examples.

It enables teachers to identify the strengths and weaknesses of each student and to provide instruction that is tailored to the individual’s learning style and needs. Differentiated instruction is especially important for gifted students , as they often have unique learning needs that require specialized instruction. It is important to differentiate instruction for gifted students because they often possess a wide range of abilities, which require different levels of instructional support. For example, a gifted student may excel in math, but struggle with reading comprehension.

By differentiating instruction, teachers can ensure that all students receive an education that meets their individual needs. Differentiating instruction for gifted students involves providing instruction that is tailored to their unique abilities and needs. This can include increasing the level of complexity in assignments, providing additional opportunities for enrichment, and allowing students to work at their own pace. Additionally, teachers should create activities that challenge gifted students without overwhelming them, and provide opportunities for creative problem solving.

To effectively differentiate instruction for gifted students, teachers must first identify the needs of each student. This can be done by observing student behavior, assessing student work, and speaking with parents and other teachers. Once these needs have been identified, teachers can develop differentiated instruction plans that provide appropriate challenges and support for each student. When creating differentiated instruction plans, teachers should consider the student’s interests, strengths, and weaknesses.

For example, if a gifted student is highly advanced in math, the teacher could create an individualized plan that provides challenging math assignments while also providing additional support in weaker areas such as reading comprehension or writing skills. By providing individualized instruction plans for each student, teachers can ensure that all students are receiving the support they need to succeed. Differentiating instruction for gifted students also involves providing activities that challenge them without overwhelming them. This can be done by allowing students to work at their own pace and by providing enrichment activities that are tailored to their interests and abilities.

Differentiation Strategies for Gifted Students

Content differentiation, process differentiation, product differentiation, environment differentiation, curriculum-based differentiation, best practices for differentiated instruction for gifted students.

By understanding each student’s unique abilities and needs, teachers can create personalized learning experiences that will engage and challenge them. Teachers can assess each student’s current knowledge and areas of need in order to provide the most appropriate instruction for their individual needs. Providing flexible learning environments is also important for providing effective differentiated instruction for gifted students. Teachers can create a variety of learning experiences that will engage and challenge the students. This includes providing multiple pathways to demonstrate mastery of content, allowing choice in how they participate in activities, and offering a range of activities that vary in complexity.

Additionally, teachers can provide options for students to work independently or in small groups depending on their individual preferences. Allowing students to take ownership of their learning is another important component of differentiated instruction for gifted students. Teachers should give students the autonomy to explore their interests and take control of their own learning. This could include providing opportunities for student-led research projects, allowing students to choose the topics they would like to learn more about, and giving them time to explore their ideas through creative projects or activities. Finally, utilizing technology is an important part of providing effective differentiated instruction for gifted students. Technology can be used to provide engaging and meaningful learning experiences that meet the needs of each student.

Teachers can use technology to create personalized learning paths and interactive activities that will challenge and engage gifted students. Additionally, technology can be used to facilitate collaboration between students and allow them to share their ideas in a safe and engaging environment. By utilizing these best practices, teachers can provide effective differentiated instruction for gifted students. Through recognizing individual student needs, providing flexible learning environments, allowing students to take ownership of their learning, and utilizing technology, teachers can create personalized learning experiences that will engage and challenge gifted students. Examples of how these practices can be implemented in the classroom include providing multiple pathways to demonstrate mastery of content, allowing choice in how they participate in activities, offering a range of activities that vary in complexity, providing opportunities for student-led research projects, allowing students to choose the topics they would like to learn more about, and giving them time to explore their ideas through creative projects or activities. Differentiated instruction is an important strategy for ensuring that gifted students receive the appropriate level of academic challenge.

This article discussed a variety of strategies for differentiating instruction, such as tiered assignments, flexible grouping, and self-paced learning. It also explored best practices to ensure effective differentiated instruction, including providing clarity of expectations, providing choice within assignments, and allowing for individualized support. Finally, this article provided examples of how to implement differentiated instruction in the classroom. By applying these strategies and best practices, educators can create an optimal learning environment for gifted students. In conclusion, differentiated instruction is an effective way to provide gifted students with an appropriate level of challenge and support.

Educators should use the strategies discussed in this article to create an optimal learning environment for gifted students in their classrooms.

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Shahid Lakha

Shahid Lakha is a seasoned educational consultant with a rich history in the independent education sector and EdTech. With a solid background in Physics, Shahid has cultivated a career that spans tutoring, consulting, and entrepreneurship. As an Educational Consultant at Spires Online Tutoring since October 2016, he has been instrumental in fostering educational excellence in the online tutoring space. Shahid is also the founder and director of Specialist Science Tutors, a tutoring agency based in West London, where he has successfully managed various facets of the business, including marketing, web design, and client relationships. His dedication to education is further evidenced by his role as a self-employed tutor, where he has been teaching Maths, Physics, and Engineering to students up to university level since September 2011. Shahid holds a Master of Science in Photon Science from the University of Manchester and a Bachelor of Science in Physics from the University of Bath.

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Creative thinking, engagement, and perseverance: How puzzles directly support gifted students

Updated: Jan 26

Creative thinking sparks innovation and problem-solving. When coupled with perseverance, creativity becomes an unstoppable force. For gifted children, whose minds are brimming with potential, fostering creative thinking, engagement, and perseverance is paramount.

Gifted children are a unique group who possess exceptional cognitive abilities. These abilities can span various domains, such as mathematics, science, language, music, and the arts. Gifted children often exhibit an insatiable curiosity, a penchant for deep exploration, and a voracious appetite for learning.

The Significance of Creative Thinking, Engagement, and Perseverance

Creative Thinking ignites innovation. It enables children to approach problems from unconventional angles, generate new ideas, and connect seemingly unrelated concepts. Creative thinking is the bridge between knowledge and innovation, and it is vital for solving complex, real-world problems.

Engagement in learning is the driving force behind sustained interest and motivation. When children are engaged in their learning, they are more likely to invest time and effort, leading to deeper understanding and higher achievement. It fosters a love for learning that extends beyond the classroom.

Perseverance is the ability to persist in the face of challenges and setbacks. It is the fuel that keeps the creative engine running. For gifted children, who often encounter complex problems and high expectations, perseverance is a critical trait that leads to long-term success.

Puzzles, like those Solving Fun creates, are a applicative tool for nurturing creative thinking, engagement, and perseverance in gifted children. Here's why:

Cognitive Stimulation: Logic puzzles challenge the mind and promote creative problem-solving. They require solvers to use their critical thinking skills to deduce patterns and solutions, enhancing their cognitive abilities.

Versatility: Puzzles come in various levels of difficulty, allowing parents and educators to tailor the puzzles to a child's abilities. This adaptability ensures that the puzzles remain engaging and challenging.

Enjoyment and Engagement: Puzzles from Solving Fun are specifically designed to be interesting and engaging for various types of thinkers. When children find learning fun, they are more likely to be motivated and deeply engaged in the problem-solving process.

Perseverance Building: Logic and wordplay puzzles inherently require perseverance. They present challenges that may not have immediate solutions, teaching solvers the value of persistence and the satisfaction of overcoming obstacles; a lesson that generalizes to many different situations.

Incorporating Logic Puzzles into Gifted Education

To effectively harness the benefits of logic puzzles in your class and to promote perseverance, consider the following strategies:

Identify Interests: Recognize the areas of interest and strengths of the child. Select puzzles that align with their passions to foster engagement and perseverance.

Gradual Progression: Begin with puzzles of moderate difficulty and gradually increase complexity as the child's skills improve. This progression ensures that the child remains challenged and engaged, promoting perseverance.

Encourage Reflection: Encourage gifted children to reflect on their problem-solving strategies and creative thinking processes. This self-awareness promotes metacognition, which is valuable for lifelong learning and perseverance.

Celebrate Achievements and Effort: Celebrate both small and significant achievements. Praise the child's effort and perseverance in tackling challenging puzzles. Positive reinforcement encourages continued engagement and perseverance.

Creative thinking, engagement, and perseverance are the cornerstones of nurturing the potential of gifted children. Puzzles provide an exciting and effective means to enhance creative thinking skills, promote engagement, and build perseverance in these young minds. By fostering creative, engaged, and persistent learners, we empower gifted children to tackle future challenges, make meaningful contributions to society, and continue to push the boundaries of human knowledge and innovation.

For more strategies to help facilitate creative thinking, check out Solving Fun’s Solving Guide at www.solvingfun.com/solvingguide or contact us at [email protected].

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Logic Puzzles for Gifted Students

Do you ever ask yourself “How can I challenge my gifted and talented students in math?”

Gifted and talented students make up approximately 10% of students in each class. As educators, it’s our responsibility to provide these students with challenging and engaging learning opportunities to help them reach their full potential!

One way to challenge gifted and talented students is by incorporating math logic puzzles into the classroom. Math logic puzzles are fun and engaging challenges that require critical thinking, problem solving, reasoning, and logic skills. They come in many forms, including Sudoku, brain teasers, algebraic reasoning puzzles and more. These puzzles provide a great opportunity for gifted and talented students to develop their skills and to be challenged in a way that is both fun and rewarding.

Make sure you scroll to the end for some FREE logic puzzles for gifted and talented students to try in your classroom!

What are Logic Puzzles?

So, what’s the deal with math logic puzzles?

Alright, let’s break it down: math logic puzzles are basically fun little challenges that make you think critically and logically.

You might have done Sudoku, brain teasers or algebraic reasoning puzzles before. Those are all examples of math logic puzzles.

But why are these puzzles so great? Well, they’re like brain workouts, they help improve your critical thinking skills, problem solving abilities, and reasoning skills.

Plus, they’re just plain fun! There’s something satisfying about finally cracking a tricky puzzle after working on it for a while.

Not only are they fun, but the challenge of solving a logic puzzle produces dopamine in the brain. Dopamine is a neurotransmitter that’s associated with feelings of pleasure and reward, and it’s released when we accomplish something challenging or exciting. This means that solving a puzzle makes you feel good!

This means that incorporating math logic puzzles into the classroom can increase engagement among gifted and talented students. When students are engaged in their learning, they’re more likely to participate, stay focused, and retain information. By providing challenging and fun math logic puzzles, you can help keep your gifted students engaged and motivated to learn.

How Can I Use Logic Puzzles?

Here are some tips for using math logic puzzles to challenge gifted and talented students in your classroom:

Warm-up:  Include a problem in a whole class warm-up to help engage students in the math lesson and switch on students’ critical thinking skills.

Whole Class Lesson: When I first introduce logic puzzles to my students I do it in a whole class lesson. I display the full-sized version on my Interactive Whiteboard, and we work through each line together. I use lots of think aloud statements e.g. “We know that the llama equals 5 and the answer is 15, so what could the missing value be?”

Math Centres: I print out the task cards and have them ready to go for independent math centres. Having the different levels makes it so easy to give each group a level that not only challenges them, but also allows them to work independently.

Early Finishers:  We’ve all had that student that finished their work super-fast and craves a challenge! These logic puzzles are perfect early finisher tasks that engage and challenge students in meaningful work.

Plenary:  End a math lesson on operations using logic puzzles to review the lesson objectives and consolidate learning.

By incorporating math logic puzzles into your teaching practices, you can challenge and engage your gifted and talented students in a fun and meaningful way. Happy puzzling!

Examples of Math Logic Puzzles for Gifted and Talented Students

There are many types of math logic puzzles that can be used to challenge gifted and talented students . Here are some examples:

Sudoku: This classic number puzzle requires players to fill in a grid with numbers so that each row, column, and sub grid contains every number from 1 to 9. These can also be visual pictures rather than numbers.

Brain teasers: These puzzles involve a question or statement that requires critical thinking and problem-solving to solve. For example, a riddle might ask “What is always in front of you but can’t be seen?” (Answer: the future).

Arithmetic puzzles: These puzzles require players to use basic arithmetic operations to solve problems. For example, a puzzle might replace number using pictures and students need to determine the missing numbers in a sequence of equations using given information.

Algebraic reasoning puzzles: These puzzles require players to use algebraic concepts to solve problems. For example, a puzzle might ask students to determine the value of a variable based on an equation and a set of given conditions.

“What number am I?” riddles: These puzzles involve a set of clues that students use to determine a number that satisfies all of the given conditions. For example, a riddle might ask “I am a two-digit number. I am a multiple of 3. The sum of my digits is 9. What number am I?” (Answer: 27)

As a teacher, you can find many resources for logic puzzles that you can use in your classroom in my tpt store and on my website.

So there you have it! Math logic puzzles can be a great way to challenge and engage your gifted and talented students in the classroom. By using puzzles like Sudoku, brain teasers, algebraic reasoning puzzles, and more, you can help your students develop critical thinking and problem solving skills while also having a bit of fun with maths.

The best part? Research has shown that challenges like math logic puzzles can actually produce dopamine in the brain, which can boost motivation and engagement in the classroom.

You can find a heap of resources to support you to challenge you gifted students on my website

and TPT store .

If you want to try out some FREE logic puzzles you can grab them here.

So why not give it a try and see what your students think? They might just surprise you with their logic and problem solving skills.

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Home > GRADSCHOOL > GRADSCHOOL_THESES > 1872

LSU Master's Theses

Problem solving strategies and metacognitive skills for gifted students in middle school.

etd-07092014-080739

Lorena Aguelo Java , Louisiana State University and Agricultural and Mechanical College Follow

Master of Natural Sciences (MNS)

Mathematics

Document Type

This study is conducted to investigate if the designed four-step method strategy (GEAR strategy adapted from Polya, 1973) in solving math problems has improved students’ performance scores and enhanced the metacognitive skills of gifted students. The respondents of this study include middle school gifted students who took math eight course in the school year 2013-2014 at Westdale Middle School in East Baton Rouge Parish School System. There are four classes of math eight gifted students who participated in the study. The classes were chosen randomly for experimental and controlled group and were equalized on the basis of the pre-test results of the Module 1 Edusoft Test and the Metacognitive Activities Inventory (MCAI) questionnaire form. During the 4-week period, the experimental group received GEAR strategy while the controlled group used any method they had learned in solving math word problems systematically or nonsystematical way. After the 4-week training period, the results of paired-sample t-test showed that the experimental group’s post-test scores on Module 2 Edusoft test have increased but not overwhelmingly, however, there is a significant difference of their MCAI post-test. The results imply that GEAR strategy does affect the metacognitive skills of middle school gifted students in problem solving and creates a marginal improvement on their classroom performance. This study provides the discussions, implications, and suggestions.

Document Availability at the Time of Submission

Release the entire work immediately for access worldwide.

Recommended Citation

Java, Lorena Aguelo, "Problem Solving Strategies and Metacognitive Skills for Gifted Students in Middle School" (2014). LSU Master's Theses . 1872. https://repository.lsu.edu/gradschool_theses/1872

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Harhad, Ameziane

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• Open access
• Published: 11 May 2024

Nursing students’ stressors and coping strategies during their first clinical training: a qualitative study in the United Arab Emirates

• Jacqueline Maria Dias 1 ,
• Muhammad Arsyad Subu 1 ,
• Nabeel Al-Yateem 1 ,
• Fatma Refaat Ahmed 1 ,
• Syed Azizur Rahman 1 , 2 ,
• Mini Sara Abraham 1 ,
• Sareh Mirza Forootan 1 ,
• Farzaneh Ahmad Sarkhosh 1 &
• Fatemeh Javanbakh 1  

BMC Nursing volume  23 , Article number:  322 ( 2024 ) Cite this article

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Metrics details

Understanding the stressors and coping strategies of nursing students in their first clinical training is important for improving student performance, helping students develop a professional identity and problem-solving skills, and improving the clinical teaching aspects of the curriculum in nursing programmes. While previous research have examined nurses’ sources of stress and coping styles in the Arab region, there is limited understanding of these stressors and coping strategies of nursing students within the UAE context thereby, highlighting the novelty and significance of the study.

A qualitative study was conducted using semi-structured interviews. Overall 30 students who were undergoing their first clinical placement in Year 2 at the University of Sharjah between May and June 2022 were recruited. All interviews were recorded and transcribed verbatim and analyzed for themes.

During their first clinical training, nursing students are exposed to stress from different sources, including the clinical environment, unfriendly clinical tutors, feelings of disconnection, multiple expectations of clinical staff and patients, and gaps between the curriculum of theory classes and labatories skills and students’ clinical experiences. We extracted three main themes that described students’ stress and use of coping strategies during clinical training: (1) managing expectations; (2) theory-practice gap; and (3) learning to cope. Learning to cope, included two subthemes: positive coping strategies and negative coping strategies.

Conclusions

This qualitative study sheds light from the students viewpoint about the intricate interplay between managing expectations, theory practice gap and learning to cope. Therefore, it is imperative for nursing faculty, clinical agencies and curriculum planners to ensure maximum learning in the clinical by recognizing the significance of the stressors encountered and help students develop positive coping strategies to manage the clinical stressors encountered. Further research is required look at the perspective of clinical stressors from clinical tutors who supervise students during their first clinical practicum.

Peer Review reports

Nursing education programmes aim to provide students with high-quality clinical learning experiences to ensure that nurses can provide safe, direct care to patients [ 1 ]. The nursing baccalaureate programme at the University of Sharjah is a four year program with 137 credits. The programmes has both theoretical and clinical components withs nine clinical courses spread over the four years The first clinical practicum which forms the basis of the study takes place in year 2 semester 2.

Clinical practice experience is an indispensable component of nursing education and links what students learn in the classroom and in skills laboratories to real-life clinical settings [ 2 , 3 , 4 ]. However, a gap exists between theory and practice as the curriculum in the classroom differs from nursing students’ experiences in the clinical nursing practicum [ 5 ]. Clinical nursing training places (or practicums, as they are commonly referred to), provide students with the necessary experiences to ensure that they become proficient in the delivery of patient care [ 6 ]. The clinical practicum takes place in an environment that combines numerous structural, psychological, emotional and organizational elements that influence student learning [ 7 ] and may affect the development of professional nursing competencies, such as compassion, communication and professional identity [ 8 ]. While clinical training is a major component of nursing education curricula, stress related to clinical training is common among students [ 9 ]. Furthermore, the nursing literature indicates that the first exposure to clinical learning is one of the most stressful experiences during undergraduate studies [ 8 , 10 ]. Thus, the clinical component of nursing education is considered more stressful than the theoretical component. Students often view clinical learning, where most learning takes place, as an unsupportive environment [ 11 ]. In addition, they note strained relationships between themselves and clinical preceptors and perceive that the negative attitudes of clinical staff produce stress [ 12 ].

The effects of stress on nursing students often involve a sense of uncertainty, uneasiness, or anxiety. The literature is replete with evidence that nursing students experience a variety of stressors during their clinical practicum, beginning with the first clinical rotation. Nursing is a complex profession that requires continuous interaction with a variety of individuals in a high-stress environment. Stress during clinical learning can have multiple negative consequences, including low academic achievement, elevated levels of burnout, and diminished personal well-being [ 13 , 14 ]. In addition, both theoretical and practical research has demonstrated that increased, continual exposure to stress leads to cognitive deficits, inability to concentrate, lack of memory or recall, misinterpretation of speech, and decreased learning capacity [ 15 ]. Furthermore, stress has been identified as a cause of attrition among nursing students [ 16 ].

Most sources of stress have been categorized as academic, clinical or personal. Each person copes with stress differently [ 17 ], and utilizes deliberate, planned, and psychological efforts to manage stressful demands [ 18 ]. Coping mechanisms are commonly termed adaptation strategies or coping skills. Labrague et al. [ 19 ] noted that students used critical coping strategies to handle stress and suggested that problem solving was the most common coping or adaptation mechanism used by nursing students. Nursing students’ coping strategies affect their physical and psychological well-being and the quality of nursing care they offer. Therefore, identifying the coping strategies that students use to manage stressors is important for early intervention [ 20 ].

Studies on nursing students’ coping strategies have been conducted in various countries. For example, Israeli nursing students were found to adopt a range of coping mechanisms, including talking to friends, engaging in sports, avoiding stress and sadness/misery, and consuming alcohol [ 21 ]. Other studies have examined stress levels among medical students in the Arab region. Chaabane et al. [ 15 ], conducted a systematic review of sudies in Arab countries, including Saudi Arabia, Egypt, Jordan, Iraq, Pakistan, Oman, Palestine and Bahrain, and reported that stress during clinical practicums was prevalent, although it could not be determined whether this was limited to the initial clinical course or occurred throughout clinical training. Stressors highlighted during the clinical period in the systematic review included assignments and workload during clinical practice, a feeling that the requirements of clinical practice exceeded students’ physical and emotional endurance and that their involvement in patient care was limited due to lack of experience. Furthermore, stress can have a direct effect on clinical performance, leading to mental disorders. Tung et al. [ 22 ], reported that the prevalence of depression among nursing students in Arab countries is 28%, which is almost six times greater than the rest of the world [ 22 ]. On the other hand, Saifan et al. [ 5 ], explored the theory-practice gap in the United Arab Emirates and found that clinical stressors could be decreased by preparing students better for clinical education with qualified clinical faculty and supportive preceptors.

The purpose of this study was to identify the stressors experienced by undergraduate nursing students in the United Arab Emirates during their first clinical training and the basic adaptation approaches or coping strategies they used. Recognizing or understanding different coping processes can inform the implementation of corrective measures when students experience clinical stress. The findings of this study may provide valuable information for nursing programmes, nurse educators, and clinical administrators to establish adaptive strategies to reduce stress among students going clinical practicums, particularly stressors from their first clinical training in different healthcare settings.

A qualitative approach was adopted to understand clinical stressors and coping strategies from the perspective of nurses’ lived experience. Qualitative content analysis was employed to obtain rich and detailed information from our qualitative data. Qualitative approaches seek to understand the phenomenon under study from the perspectives of individuals with lived experience [ 23 ]. Qualitative content analysis is an interpretive technique that examines the similarities and differences between and within different areas of text while focusing on the subject [ 24 ]. It is used to examine communication patterns in a repeatable and systematic way [ 25 ] and yields rich and detailed information on the topic under investigation [ 23 ]. It is a method of systematically coding and categorizing information and comprises a process of comprehending, interpreting, and conceptualizing the key meanings from qualitative data [ 26 ].

Setting and participants

This study was conducted after the clinical rotations ended in April 2022, between May and June in the nursing programme at the College of Health Sciences, University of Sharjah, in the United Arab Emirates. The study population comprised undergraduate nursing students who were undergoing their first clinical training and were recruited using purposive sampling. The inclusion criteria for this study were second-year nursing students in the first semester of clinical training who could speak English, were willing to participate in this research, and had no previous clinical work experience. The final sample consisted of 30 students.

Research instrument

The research instrument was a semi structured interview guide. The interview questions were based on an in-depth review of related literature. An intensive search included key words in Google Scholar, PubMed like the terms “nursing clinical stressors”, “nursing students”, and “coping mechanisms”. Once the questions were created, they were validated by two other faculty members who had relevant experience in mental health. A pilot test was conducted with five students and based on their feedback the following research questions, which were addressed in the study.

How would you describe your clinical experiences during your first clinical rotations?

In what ways did you find the first clinical rotation to be stressful?

What factors hindered your clinical training?

How did you cope with the stressors you encountered in clinical training?

Which strategies helped you cope with the clinical stressors you encountered?

Data collection

Semi-structured interviews were chosen as the method for data collection. Semi structured interviews are a well-established approach for gathering data in qualitative research and allow participants to discuss their views, experiences, attitudes, and beliefs in a positive environment [ 27 ]. This approach allows for flexibility in questioning thereby ensuring that key topics related to clinical learning stressors and coping strategies would be explored. Participants were given the opportunity to express their views, experiences, attitudes, and beliefs in a positive environment, encouraging open communication. These semi structured interviews were conducted by one member of the research team (MAS) who had a mental health background, and another member of the research team who attended the interviews as an observer (JMD). Neither of these researchers were involved in teaching the students during their clinical practicum, which helped to minimize bias. The interviews took place at the University of Sharjah, specifically in building M23, providing a familiar and comfortable environment for the participant. Before the interviews were all students who agreed to participate were provided with an explanation of the study’s purpose. The time and location of each interview were arranged. Before the interviews were conducted, all students who provided consent to participate received an explanation of the purpose of the study, and the time and place of each interview were arranged to accommodate the participants’ schedules and preferences. The interviews were conducted after the clinical rotation had ended in April, and after the final grades had been submitted to the coordinator. The timings of the interviews included the month of May and June which ensured that participants have completed their practicum experience and could reflect on the stressors more comprehensively. The interviews were audio-recorded with the participants’ consent, and each interview lasted 25–40 min. The data were collected until saturation was reached for 30 students. Memos and field notes were also recorded as part of the data collection process. These additional data allowed for triangulation to improve the credibility of the interpretations of the data [ 28 ]. Memos included the interviewers’ thoughts and interpretations about the interviews, the research process (including questions and gaps), and the analytic progress used for the research. Field notes were used to record the interviewers’ observations and reflections on the data. These additional data collection methods were important to guide the researchers in the interpretation of the data on the participants’ feelings, perspectives, experiences, attitudes, and beliefs. Finally, member checking was performed to ensure conformability.

Data analysis

The study used the content analysis method proposed by Graneheim and Lundman [ 24 ]. According to Graneheim and Lundman [ 24 ], content analysis is an interpretive technique that examines the similarities and differences between distinct parts of a text. This method allows researchers to determine exact theoretical and operational definitions of words, phrases, and symbols by elucidating their constituent properties [ 29 ]. First, we read the interview transcripts several times to reach an overall understanding of the data. All verbatim transcripts were read several times and discussed among all authors. We merged and used line-by-line coding of words, sentences, and paragraphs relevant to each other in terms of both the content and context of stressors and coping mechanisms. Next, we used data reduction to assess the relationships among themes using tables and diagrams to indicate conceptual patterns. Content related to stress encountered by students was extracted from the transcripts. In a separate document, we integrated and categorized all words and sentences that were related to each other in terms of both content and context. We analyzed all codes and units of meaning and compared them for similarities and differences in the context of this study. Furthermore, the emerging findings were discussed with other members of the researcher team. The final abstractions of meaningful subthemes into themes were discussed and agreed upon by the entire research team. This process resulted in the extraction of three main themes in addition to two subthemes related to stress and coping strategies.

Ethical considerations

The University of Sharjah Research Ethics Committee provided approval to conduct this study (Reference Number: REC 19-12-03-01-S). Before each interview, the goal and study procedures were explained to each participant, and written informed consent was obtained. The participants were informed that participation in the study was voluntary and that they could withdraw from the study at any time. In the event they wanted to withdraw from the study, all information related to the participant would be removed. No participant withdrew from the study. Furthermore, they were informed that their clinical practicum grade would not be affected by their participation in this study. We chose interview locations in Building M23that were private and quiet to ensure that the participants felt at ease and confident in verbalizing their opinions. No participant was paid directly for involvement in this study. In addition, participants were assured that their data would remain anonymous and confidential. Confidentiality means that the information provided by participants was kept private with restrictions on how and when data can be shared with others. The participants were informed that their information would not be duplicated or disseminated without their permission. Anonymity refers to the act of keeping people anonymous with respect to their participation in a research endeavor. No personal identifiers were used in this study, and each participant was assigned a random alpha-numeric code (e.g., P1 for participant 1). All digitally recorded interviews were downloaded to a secure computer protected by the principal investigator with a password. The researchers were the only people with access to the interview material (recordings and transcripts). All sensitive information and materials were kept secure in the principal researcher’s office at the University of Sharjah. The data will be maintained for five years after the study is completed, after which the material will be destroyed (the transcripts will be shredded, and the tapes will be demagnetized).

In total, 30 nursing students who were enrolled in the nursing programme at the Department of Nursing, College of Health Sciences, University of Sharjah, and who were undergoing their first clinical practicum participated in the study. Demographically, 80% ( n  = 24) were females and 20% ( n  = 6) were male participants. The majority (83%) of study participants ranged in age from 18 to 22 years. 20% ( n  = 6) were UAE nationals, 53% ( n  = 16) were from Gulf Cooperation Council countries, while 20% ( n  = 6) hailed from Africa and 7% ( n  = 2) were of South Asian descent. 67% of the respondents lived with their families while 33% lived in the hostel. (Table  1 )

Following the content analysis, we identified three main themes: (1) managing expectations, (2) theory-practice gap and 3)learning to cope. Learning to cope had two subthemes: positive coping strategies and negative coping strategies. An account of each theme is presented along with supporting excerpts for the identified themes. The identified themes provide valuable insight into the stressors encountered by students during their first clinical practicum. These themes will lead to targeted interventions and supportive mechanisms that can be built into the clinical training curriculum to support students during clinical practice.

Theme 1: managing expectations

In our examination of the stressors experienced by nursing students during their first clinical practicum and the coping strategies they employed, we identified the first theme as managing expectations.

The students encountered expectations from various parties, such as clinical staff, patients and patients’ relatives which they had to navigate. They attempted to fulfil their expectations as they progressed through training, which presented a source of stress. The students noted that the hospital staff and patients expected them to know how to perform a variety of tasks upon request, which made the students feel stressed and out of place if they did not know how to perform these tasks. Some participants noted that other nurses in the clinical unit did not allow them to participate in nursing procedures, which was considered an enormous impediment to clinical learning, as noted in the excerpt below:

“…Sometimes the nurses… They will not allow us to do some procedures or things during clinical. And sometimes the patients themselves don’t allow us to do procedures” (P5).

Some of the students noted that they felt they did not belong and felt like foreigners in the clinical unit. Excerpts from the students are presented in the following quotes;

“The clinical environment is so stressful. I don’t feel like I belong. There is too little time to build a rapport with hospital staff or the patient” (P22).

“… you ask the hospital staff for some guidance or the location of equipment, and they tell us to ask our clinical tutor …but she is not around … what should I do? It appears like we do not belong, and the sooner the shift is over, the better” (P18).

“The staff are unfriendly and expect too much from us students… I feel like I don’t belong, or I am wasting their (the hospital staff’s) time. I want to ask questions, but they have loads to do” (P26).

Other students were concerned about potential failure when working with patients during clinical training, which impacted their confidence. They were particularly afraid of failure when performing any clinical procedures.

“At the beginning, I was afraid to do procedures. I thought that maybe the patient would be hurt and that I would not be successful in doing it. I have low self-confidence in doing procedures” (P13).

The call bell rings, and I am told to answer Room No. XXX. The patient wants help to go to the toilet, but she has two IV lines. I don’t know how to transport the patient… should I take her on the wheelchair? My eyes glance around the room for a wheelchair. I am so confused …I tell the patient I will inform the sister at the nursing station. The relative in the room glares at me angrily … “you better hurry up”…Oh, I feel like I don’t belong, as I am not able to help the patient… how will I face the same patient again?” (P12).

Another major stressor mentioned in the narratives was related to communication and interactions with patients who spoke another language, so it was difficult to communicate.

“There was a challenge with my communication with the patients. Sometimes I have communication barriers because they (the patients) are of other nationalities. I had an experience with a patient [who was] Indian, and he couldn’t speak my language. I did not understand his language” (P9).

Thus, a variety of expectations from patients, relatives, hospital staff, and preceptors acted as sources of stress for students during their clinical training.

Theme 2: theory-practice gap

Theory-practice gaps have been identified in previous studies. In our study, there was complete dissonance between theory and actual clinical practice. The clinical procedures or practices nursing students were expected to perform differed from the theory they had covered in their university classes and skills lab. This was described as a theory–practice gap and often resulted in stress and confusion.

“For example …the procedures in the hospital are different. They are different from what we learned or from theory on campus. Or… the preceptors have different techniques than what we learned on campus. So, I was stress[ed] and confused about it” (P11).

Furthermore, some students reported that they did not feel that they received adequate briefing before going to clinical training. A related source of stress was overload because of the volume of clinical coursework and assignments in addition to clinical expectations. Additionally, the students reported that a lack of time and time management were major sources of stress in their first clinical training and impacted their ability to complete the required paperwork and assignments:

“…There is not enough time…also, time management at the hospital…for example, we start at seven a.m., and the handover takes 1 hour to finish. They (the nurses at the hospital) are very slow…They start with bed making and morning care like at 9.45 a.m. Then, we must fill [out] our assessment tool and the NCP (nursing care plan) at 10 a.m. So, 15 only minutes before going to our break. We (the students) cannot manage this time. This condition makes me and my friends very stressed out. -I cannot do my paperwork or assignments; no time, right?” (P10).

“Stressful. There is a lot of work to do in clinical. My experiences are not really good with this course. We have a lot of things to do, so many assignments and clinical procedures to complete” (P16).

The participants noted that the amount of required coursework and number of assignments also presented a challenge during their first clinical training and especially affected their opportunity to learn.

“I need to read the file, know about my patient’s condition and pathophysiology and the rationale for the medications the patient is receiving…These are big stressors for my learning. I think about assignments often. Like, we are just focusing on so many assignments and papers. We need to submit assessments and care plans for clinical cases. We focus our time to complete and finish the papers rather than doing the real clinical procedures, so we lose [the] chance to learn” (P25).

Another participant commented in a similar vein that there was not enough time to perform tasks related to clinical requirements during clinical placement.

“…there is a challenge because we do not have enough time. Always no time for us to submit papers, to complete assessment tools, and some nurses, they don’t help us. I think we need more time to get more experiences and do more procedures, reduce the paperwork that we have to submit. These are challenges …” (P14).

There were expectations that the students should be able to carry out their nursing duties without becoming ill or adversely affected. In addition, many students reported that the clinical environment was completely different from the skills laboratory at the college. Exposure to the clinical setting added to the theory-practice gap, and in some instances, the students fell ill.

One student made the following comment:

“I was assisting a doctor with a dressing, and the sight and smell from the oozing wound was too much for me. I was nauseated. As soon as the dressing was done, I ran to the bathroom and threw up. I asked myself… how will I survive the next 3 years of nursing?” (P14).

Theme 3: learning to cope

The study participants indicated that they used coping mechanisms (both positive and negative) to adapt to and manage the stressors in their first clinical practicum. Important strategies that were reportedly used to cope with stress were time management, good preparation for clinical practice, and positive thinking as well as engaging in physical activity and self-motivation.

“Time management. Yes, it is important. I was encouraging myself. I used time management and prepared myself before going to the clinical site. Also, eating good food like cereal…it helps me very much in the clinic” (P28).

“Oh yeah, for sure positive thinking. In the hospital, I always think positively. Then, after coming home, I get [to] rest and think about positive things that I can do. So, I will think something good [about] these things, and then I will be relieved of stress” (P21).

Other strategies commonly reported by the participants were managing their breathing (e.g., taking deep breaths, breathing slowly), taking breaks to relax, and talking with friends about the problems they encountered.

“I prefer to take deep breaths and breathe slowly and to have a cup of coffee and to talk to my friends about the case or the clinical preceptor and what made me sad so I will feel more relaxed” (P16).

“Maybe I will take my break so I feel relaxed and feel better. After clinical training, I go directly home and take a long shower, going over the day. I will not think about anything bad that happened that day. I just try to think about good things so that I forget the stress” (P27).

“Yes, my first clinical training was not easy. It was difficult and made me stressed out…. I felt that it was a very difficult time for me. I thought about leaving nursing” (P7).

I was not able to offer my prayers. For me, this was distressing because as a Muslim, I pray regularly. Now, my prayer time is pushed to the end of the shift” (P11).

“When I feel stress, I talk to my friends about the case and what made me stressed. Then I will feel more relaxed” (P26).

Self-support or self-motivation through positive self-talk was also used by the students to cope with stress.

“Yes, it is difficult in the first clinical training. When I am stress[ed], I go to the bathroom and stand in the front of the mirror; I talk to myself, and I say, “You can do it,” “you are a great student.” I motivate myself: “You can do it”… Then, I just take breaths slowly several times. This is better than shouting or crying because it makes me tired” (P11).

Other participants used physical activity to manage their stress.

“How do I cope with my stress? Actually, when I get stressed, I will go for a walk on campus” (P4).

“At home, I will go to my room and close the door and start doing my exercises. After that, I feel the negative energy goes out, then I start to calm down… and begin my clinical assignments” (P21).

Both positive and negative coping strategies were utilized by the students. Some participants described using negative coping strategies when they encountered stress during their clinical practice. These negative coping strategies included becoming irritable and angry, eating too much food, drinking too much coffee, and smoking cigarettes.

“…Negative adaptation? Maybe coping. If I am stressed, I get so angry easily. I am irritable all day also…It is negative energy, right? Then, at home, I am also angry. After that, it is good to be alone to think about my problems” (P12).

“Yeah, if I…feel stress or depressed, I will eat a lot of food. Yeah, ineffective, like I will be eating a lot, drinking coffee. Like I said, effective, like I will prepare myself and do breathing, ineffective, I will eat a lot of snacks in between my free time. This is the bad side” (P16).

“…During the first clinical practice? Yes, it was a difficult experience for us…not only me. When stressed, during a break at the hospital, I will drink two or three cups of coffee… Also, I smoke cigarettes… A lot. I can drink six cups [of coffee] a day when I am stressed. After drinking coffee, I feel more relaxed, I finish everything (food) in the refrigerator or whatever I have in the pantry, like chocolates, chips, etc” (P23).

These supporting excerpts for each theme and the analysis offers valuable insights into the specific stressors faced by nursing students during their first clinical practicum. These insights will form the basis for the development of targeted interventions and supportive mechanisms within the clinical training curriculum to better support students’ adjustment and well-being during clinical practice.

Our study identified the stressors students encounter in their first clinical practicum and the coping strategies, both positive and negative, that they employed. Although this study emphasizes the importance of clinical training to prepare nursing students to practice as nurses, it also demonstrates the correlation between stressors and coping strategies.The content analysis of the first theme, managing expectations, paves the way for clinical agencies to realize that the students of today will be the nurses of tomorrow. It is important to provide a welcoming environment where students can develop their identities and learn effectively. Additionally, clinical staff should foster an environment of individualized learning while also assisting students in gaining confidence and competence in their repertoire of nursing skills, including critical thinking, problem solving and communication skills [ 8 , 15 , 19 , 30 ]. Another challenge encountered by the students in our study was that they were prevented from participating in clinical procedures by some nurses or patients. This finding is consistent with previous studies reporting that key challenges for students in clinical learning include a lack of clinical support and poor attitudes among clinical staff and instructors [ 31 ]. Clinical staff with positive attitudes have a positive impact on students’ learning in clinical settings [ 32 ]. The presence, supervision, and guidance of clinical instructors and the assistance of clinical staff are essential motivating components in the clinical learning process and offer positive reinforcement [ 30 , 33 , 34 ]. Conversely, an unsupportive learning environment combined with unwelcoming clinical staff and a lack of sense of belonging negatively impact students’ clinical learning [ 35 ].

The sources of stress identified in this study were consistent with common sources of stress in clinical training reported in previous studies, including the attitudes of some staff, students’ status in their clinical placement and educational factors. Nursing students’ inexperience in the clinical setting and lack of social and emotional experience also resulted in stress and psychological difficulties [ 36 ]. Bhurtun et al. [ 33 ] noted that nursing staff are a major source of stress for students because the students feel like they are constantly being watched and evaluated.

We also found that students were concerned about potential failure when working with patients during their clinical training. Their fear of failure when performing clinical procedures may be attributable to low self-confidence. Previous studies have noted that students were concerned about injuring patients, being blamed or chastised, and failing examinations [ 37 , 38 ]. This was described as feeling “powerless” in a previous study [ 7 , 12 ]. In addition, patients’ attitudes towards “rejecting” nursing students or patients’ refusal of their help were sources of stress among the students in our study and affected their self-confidence. Self-confidence and a sense of belonging are important for nurses’ personal and professional identity, and low self-confidence is a problem for nursing students in clinical learning [ 8 , 39 , 40 ]. Our findings are consistent with a previous study that reported that a lack of self-confidence was a primary source of worry and anxiety for nursing students and affected their communication and intention to leave nursing [ 41 ].

In the second theme, our study suggests that students encounter a theory-practice gap in clinical settings, which creates confusion and presents an additional stressors. Theoretical and clinical training are complementary elements of nursing education [ 40 ], and this combination enables students to gain the knowledge, skills, and attitudes necessary to provide nursing care. This is consistent with the findings of a previous study that reported that inconsistencies between theoretical knowledge and practical experience presented a primary obstacle to the learning process in the clinical context [ 42 ], causing students to lose confidence and become anxious [ 43 ]. Additionally, the second theme, the theory-practice gap, authenticates Safian et al.’s [ 5 ] study of the theory-practice gap that exists United Arab Emirates among nursing students as well as the need for more supportive clinical faculty and the extension of clinical hours. The need for better time availability and time management to complete clinical tasks were also reported by the students in the study. Students indicated that they had insufficient time to complete clinical activities because of the volume of coursework and assignments. Our findings support those of Chaabane et al. [ 15 ]. A study conducted in Saudi Arabia [ 44 ] found that assignments and workload were among the greatest sources of stress for students in clinical settings. Effective time management skills have been linked to academic achievement, stress reduction, increased creativity [ 45 ], and student satisfaction [ 46 ]. Our findings are also consistent with previous studies that reported that a common source of stress among first-year students was the increased classroom workload [ 19 , 47 ]. As clinical assignments and workloads are major stressors for nursing students, it is important to promote activities to help them manage these assignments [ 48 ].

Another major challenge reported by the participants was related to communicating and interacting with other nurses and patients. The UAE nursing workforce and population are largely expatriate and diverse and have different cultural and linguistic backgrounds. Therefore, student nurses encounter difficulty in communication [ 49 ]. This cultural diversity that students encounter in communication with patients during clinical training needs to be addressed by curriculum planners through the offering of language courses and courses on cultural diversity [ 50 ].

Regarding the third and final theme, nursing students in clinical training are unable to avoid stressors and must learn to cope with or adapt to them. Previous research has reported a link between stressors and the coping mechanisms used by nursing students [ 51 , 52 , 53 ]. In particular, the inability to manage stress influences nurses’ performance, physical and mental health, attitude, and role satisfaction [ 54 ]. One such study suggested that nursing students commonly use problem-focused (dealing with the problem), emotion-focused (regulating emotion), and dysfunctional (e.g., venting emotions) stress coping mechanisms to alleviate stress during clinical training [ 15 ]. Labrague et al. [ 51 ] highlighted that nursing students use both active and passive coping techniques to manage stress. The pattern of clinical stress has been observed in several countries worldwide. The current study found that first-year students experienced stress during their first clinical training [ 35 , 41 , 55 ]. The stressors they encountered impacted their overall health and disrupted their clinical learning. Chaabane et al. [ 15 ] reported moderate and high stress levels among nursing students in Bahrain, Egypt, Iraq, Jordan, Oman, Pakistan, Palestine, Saudi Arabia, and Sudan. Another study from Bahrain reported that all nursing students experienced moderate to severe stress in their first clinical placement [ 56 ]. Similarly, nursing students in Spain experienced a moderate level of stress, and this stress was significantly correlated with anxiety [ 30 ]. Therefore, it is imperative that pastoral systems at the university address students’ stress and mental health so that it does not affect their clinical performance. Faculty need to utilize evidence-based interventions to support students so that anxiety-producing situations and attrition are minimized.

In our study, students reported a variety of positive and negative coping mechanisms and strategies they used when they experienced stress during their clinical practice. Positive coping strategies included time management, positive thinking, self-support/motivation, breathing, taking breaks, talking with friends, and physical activity. These findings are consistent with those of a previous study in which healthy coping mechanisms used by students included effective time management, social support, positive reappraisal, and participation in leisure activities [ 57 ]. Our study found that relaxing and talking with friends were stress management strategies commonly used by students. Communication with friends to cope with stress may be considered social support. A previous study also reported that people seek social support to cope with stress [ 58 ]. Some students in our study used physical activity to cope with stress, consistent with the findings of previous research. Stretching exercises can be used to counteract the poor posture and positioning associated with stress and to assist in reducing physical tension. Promoting such exercise among nursing students may assist them in coping with stress in their clinical training [ 59 ].

Our study also showed that when students felt stressed, some adopted negative coping strategies, such as showing anger/irritability, engaging in unhealthy eating habits (e.g., consumption of too much food or coffee), or smoking cigarettes. Previous studies have reported that high levels of perceived stress affect eating habits [ 60 ] and are linked to poor diet quality, increased snacking, and low fruit intake [ 61 ]. Stress in clinical settings has also been linked to sleep problems, substance misuse, and high-risk behaviors’ and plays a major role in student’s decision to continue in their programme.

Implications of the study

The implications of the study results can be grouped at multiple levels including; clinical, educational, and organizational level. A comprehensive approach to addressing the stressors encountered by nursing students during their clinical practicum can be overcome by offering some practical strategies to address the stressors faced by nursing students during their clinical practicum. By integrating study findings into curriculum planning, mentorship programs, and organizational support structures, a supportive and nurturing environment that enhances students’ learning, resilience, and overall success can be envisioned.

Clinical level

Introducing simulation in the skills lab with standardized patients and the use of moulage to demonstrate wounds, ostomies, and purulent dressings enhances students’ practical skills and prepares them for real-world clinical scenarios. Organizing orientation days at clinical facilities helps familiarize students with the clinical environment, identify potential stressors, and introduce interventions to enhance professionalism, social skills, and coping abilities Furthermore, creating a WhatsApp group facilitates communication and collaboration among hospital staff, clinical tutors, nursing faculty, and students, enabling immediate support and problem-solving for clinical situations as they arise, Moreover, involving chief nursing officers of clinical facilities in the Nursing Advisory Group at the Department of Nursing promotes collaboration between academia and clinical practice, ensuring alignment between educational objectives and the needs of the clinical setting [ 62 ].

Educational level

Sharing study findings at conferences (we presented the results of this study at Sigma Theta Tau International in July 2023 in Abu Dhabi, UAE) and journal clubs disseminates knowledge and best practices among educators and clinicians, promoting awareness and implementation of measures to improve students’ learning experiences. Additionally we hold mentorship training sessions annually in January and so we shared with the clinical mentors and preceptors the findings of this study so that they proactively they are equipped with strategies to support students’ coping with stressors during clinical placements.

Organizational level

At the organizational we relooked at the available student support structures, including counseling, faculty advising, and career advice, throughout the nursing program emphasizing the importance of holistic support for students’ well-being and academic success as well as retention in the nursing program. Also, offering language courses as electives recognizes the value of communication skills in nursing practice and provides opportunities for personal and professional development.

For first-year nursing students, clinical stressors are inevitable and must be given proper attention. Recognizing nursing students’ perspectives on the challenges and stressors experienced in clinical training is the first step in overcoming these challenges. In nursing schools, providing an optimal clinical environment as well as increasing supervision and evaluation of students’ practices should be emphasized. Our findings demonstrate that first-year nursing students are exposed to a variety of different stressors. Identifying the stressors, pressures, and obstacles that first-year students encounter in the clinical setting can assist nursing educators in resolving these issues and can contribute to students’ professional development and survival to allow them to remain in the profession. To overcome stressors, students frequently employ problem-solving approaches or coping mechanisms. The majority of nursing students report stress at different levels and use a variety of positive and negative coping techniques to manage stress.

The present results may not be generalizable to other nursing institutions because this study used a purposive sample along with a qualitative approach and was limited to one university in the Middle East. Furthermore, the students self-reported their stress and its causes, which may have introduced reporting bias. The students may also have over or underreported stress or coping mechanisms because of fear of repercussions or personal reasons, even though the confidentiality of their data was ensured. Further studies are needed to evaluate student stressors and coping now that measures have been introduced to support students. Time will tell if these strategies are being used effectively by both students and clinical personnel or if they need to be readdressed. Finally, we need to explore the perceptions of clinical faculty towards supervising students in their first clinical practicum so that clinical stressors can be handled effectively.

Data availability

The data sets are available with the corresponding author upon reasonable request.

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Acknowledgements

The authors are grateful to all second year nursing students who voluntarily participated in the study.

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Jacqueline Maria Dias, Muhammad Arsyad Subu, Nabeel Al-Yateem, Fatma Refaat Ahmed, Syed Azizur Rahman, Mini Sara Abraham, Sareh Mirza Forootan, Farzaneh Ahmad Sarkhosh & Fatemeh Javanbakh

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JMD conceptualized the idea and designed the methodology, formal analysis, writing original draft and project supervision and mentoring. MAS prepared the methodology and conducted the qualitative interviews and analyzed the methodology and writing of original draft and project supervision. NY, FRA, SAR, MSA writing review and revising the draft. SMF, FAS, FJ worked with MAS on the formal analysis and prepared the first draft.All authors reviewed the final manuscipt of the article.

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Dr Fatma Refaat Ahmed is an editorial board member in BMC Nursing. Other authors do not have any conflict of interest

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Dias, J.M., Subu, M.A., Al-Yateem, N. et al. Nursing students’ stressors and coping strategies during their first clinical training: a qualitative study in the United Arab Emirates. BMC Nurs 23 , 322 (2024). https://doi.org/10.1186/s12912-024-01962-5

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This is a recap of a session from the 2024 ASU+GSV Summit. Watch the full session below.

In today's rapidly evolving job market, there's a crisis brewing: students are increasingly ill-prepared for the workforce. Entry-level positions are vanishing with the rise of AI and universities are struggling to prepare students for on-the-job success, leaving many feeling stranded and unqualified. But amidst this challenge lies an opportunity to bridge the gap between education and employment through innovative solutions like work-based learning programs.

Lack of Work-Based Learning Opportunities

According to a recent report from ECMC and VICE Media, a staggering 79% of high school students recognize the importance of on-the-job learning experiences during their postsecondary education. However, only half of them have access to career exploration programs. This glaring disparity underscores the urgent need for a shift in educational paradigms.

The Solution: Third-Party Organizations Connecting Employers and Learners

Enter tech-driven enterprises like Juvo Ventures , a pioneering early-stage venture capital firm founded in 2019. They're at the forefront of redefining career readiness by championing initiatives that connect students with real-world work experiences. Leaders like Dr. Courtney Hills McBeth , provost and chief academic officer at Western Governors University ( WGU ), and Katie Fang , founder and CEO of SchooLinks, which focuses on college and career readiness, are also leading the charge in revolutionizing traditional education models. 

Dana Stephenson , co-founder and CEO of Riipen , a work-based learning platform for educators, learners and employers emphasized the importance of providing students with practical experience throughout their educational journey at the 2024 ASU+GSV Summit. He highlighted the shift away from relying solely on post-graduation employment as a launching pad for careers, advocating instead for early and continuous exposure to real-world scenarios.

Dr. Ryan Craig , managing director of Achieve Partners , stressed the need for scalable solutions that seamlessly integrate employers into the education ecosystem. “You have to make it so easy that it’s turnkey for employers,” he said, underscoring the pivotal role of intermediaries in facilitating work-based learning experiences and streamlining pathways to employment. 

A Plea for Universities to Reprioritize

Dr. Hills McBeth said a key issue is focus, funding and scale, stating, “Most traditional higher ed has invested in athletics and alumni engagement and advancement offices rather than investing in employer engagement.”  

WGU is changing that as a university that has prioritized student experience and career outcomes from the start. A nonprofit founded in 1997 by 19 U.S. governors, the online university supports students through job-aligned degree programs crafted with input from employers and built for career success. Organizations that hire WGU grads are reaping the rewards with a healthy 98% of employers saying WGU graduates meet or exceed their expectations. 

Making it Easier for Employers to Connect with Learners

Solving the career-readiness challenge is not just about connecting students with opportunities; it's also about empowering employers, especially small and medium-sized enterprises, to actively participate in shaping the future workforce. Stephenson pointed out that many companies are eager to collaborate and engage with educational institutions to identify and nurture talent, citing the success of Juvo Ventures.

One key takeaway from this discussion is the importance of making work-based learning programs accessible and adaptable. Whether it's through shorter-duration, lower-intensity experiences or more immersive apprenticeships, flexibility is paramount to accommodating the diverse needs of students and employers alike. 

More Focused State Standards

There's a growing consensus on the need for clearer, more prescriptive college and career readiness standards. Ryan Craig highlighted the current generic nature of state-level standards and calls for a more tailored approach to ensure students are equipped with the skills demanded by today's job market. 

A Collaborative Effort

The revolution in career readiness isn't just about preparing students for specific jobs; it's about cultivating a mindset of adaptability, resilience, and continuous learning. By harnessing the power of technology and collaboration between states, organizations, universities, and learners, we can transform education from a passive experience into a dynamic journey that empowers individuals to thrive in an ever-changing world. 

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Continuously work on developing both technical and soft skills, says Shivani Priyaa of Oda class

This could include communication, problem-solving, critical thinking, teamwork, adaptability, and digital literacy..

Shivani Priyaa, business head of Oda class shares her thoughts on the opportunities and challenges of the education system in India with FE Education Online.

What is the best thing about today’s education system?

Today’s education system boasts several favourable attributes. One of the most commendable aspects is its increasing emphasis on personalised learning experiences. With advancements in technology and teaching methodologies, educators can tailor their approach to cater to individual student needs, preferences, and learning styles. This customization fosters a more inclusive and engaging learning environment, where students can thrive and reach their full potential. Another notable strength of today’s education system is its emphasis on fostering critical thinking skills and creativity, preparing students to navigate an increasingly complex and dynamic world.

What is the one thing you would like to change in the system?

Making quality education from Top notch education accessible and affordable to every student.  Best Educators prioritise more holistic approaches to education that not only focus on academic achievement but also on nurturing students’ mental health and emotional well-being. This could involve implementing comprehensive support systems and resources to address the mental health needs of students, creating environments that foster open communication and destigmatize seeking help when needed. By prioritising the holistic development of students, we can create a more supportive and inclusive educational experience that equips them with the resilience and skills necessary for success in all aspects of their lives.

What is the role digital has played in the evolution of the education system?

The digital revolution has profoundly transformed the education system, revolutionising how knowledge is accessed, disseminated, and applied. Digital technology has expanded access to education, breaking down geographical barriers and providing opportunities for remote learning. Moreover, digital technology has revolutionised assessment methods, offering instant feedback, data-driven insights, and adaptive testing, enabling educators to tailor instruction to student progress effectively.Overall, digital technology has been instrumental in democratising education, enhancing learning outcomes, and preparing students for success in the digital age.

  What has been the disadvantage of digital in education?

While it’s true that every revolution brings about both positive and negative aspects, it’s crucial to acknowledge and address the disadvantages to ensure that the benefits of the revolution can be maximised while mitigating any potential harm.By focusing on the positives, we can harness the transformative power of digital technology to enhance education, increase access, and improve learning outcomes. Improving digital reach, particularly in rural areas, is crucial for ensuring equitable access to education and bridging the digital divide. Rural communities often face challenges such as limited internet infrastructure, lack of access to affordable devices, and lower levels of digital literacy, which can hinder their ability to fully participate in digital learning opportunities.

What is the career advice you would like to give to students?  

For Generation Alpha students, who are growing up in a rapidly evolving digital landscape, here are some career advice tips to consider:

a. Explore your interests-Take the time to explore different subjects, hobbies, and activities to identify your interests and passions. Your career is more likely to be fulfilling and enjoyable if it aligns with what you love to do.

b. Set Clear Goals: Define your career goals and objectives early on, but remain open to new opportunities and experiences. Setting clear goals can help you stay focused and motivated as you work towards achieving them.

c. Build Your Skills: Continuously work on developing both technical and soft skills that are essential for success in your chosen field. This could include communication, problem-solving, critical thinking, teamwork, adaptability, and digital literacy.

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The risk-taking activity that ‘helicopter parents’ should allow their kids to experience

Editor’s note: The views expressed in this commentary are solely those of the writers. CNN is showcasing the work of The Conversation , a collaboration between journalists and academics to provide news analysis and commentary. The content is produced solely by The Conversation.

There is ongoing concern about the impact of “ helicopter parenting ” on children’s growth and development.

Keen to ensure the best outcomes for their children, helicopter parents tend to hover over their kids, constantly trying to prevent misadventure or harm.

But child experts say this can lead to a  lack of resilience and tenacity  in children. Children can also struggle with problem-solving and initiative.

How can we overcome this?

We are educators who study risky environments. Our  new research  looks at parents’ perceptions of an outdoor play park. It shows how outdoor parks provide opportunities for children to engage in risky play and develop independence and problem-solving skills.

The importance of risk

Risk-taking means engaging in any behavior or activity with an uncertain physical, social, emotional or financial outcome.

Risk is an everyday part of life, from driving a car to buying a house at auction or climbing a ladder.

We cannot eliminate risk, so we need to learn how to navigate it. It means taking responsibility for assessing potential consequences and taking necessary precautions. For example, crossing the road carries risk, but we learn how to look for cars or cross at traffic lights if the road is busy.

Recognizing and appropriately responding to risk-taking is an integral aspect of children’s growth and development. In 1998, US educator and wilderness guide Jeff Liddle  observed risk was instrumental  to lifelong learning.

Outdoor experiences are particularly good places to  develop skills around risk  because they are not a controlled environment. For example, no two trees are the same to climb, and conditions can vary depending on the weather.

READ MORE: ‘It’s not fair!’ Kids grumble and complain for a reason. Here’s how to handle it

In a  new study , we surveyed parents and caregivers about children’s risk-taking in the Boongaree nature play park in Berry, New South Wales.

The park includes fixed equipment such as slides and climbing ropes as well as natural elements such as water, stone, timber, sand and greenery.

We chose Boongaree after it became the focus of media and social media debate due to a  spate of injuries , including broken bones. The Daily Mail  suggested  it was Australia’s “most dangerous playground.” Following community concerns, the park’s tunnel slide was  replaced  in May with another slide with less “momentum.”

Over multiple visits to the park in June, we recruited 302 adults to complete a survey about their children’s park use. We then followed up with a closed Facebook group of 56 parents from the same group.

READ MORE: From pests to pollutants, keeping schools healthy and clean is no simple task

The benefits of risk

We asked parents to share their views about the park, and they told us risky park play had many benefits. These included allowing children to:

• be challenged and solve problems

• connect to the outdoors

• direct their own play

• be physically active

• be creative and curious

• demonstrate confidence and independence and

• build social capacity, by sharing equipment and taking turns.

As one parent told us: “The look on children’s faces as they reach the top of climbing ropes and start walking across the bridges is fabulous — grit and determination, followed by a big deep breath. …”

Another parent spoke of the importance of giving kids the opportunity to “make their own decisions about the risk they want to take, how high or how fast they will go.”

Yet another parent described how the park gave children the “freedom to play in any way they feel comfortable.”

READ MORE: Bluey teaches children and parents alike about how play supports creativity — and other life lessons

How to support your child in outdoor, risky play

So next time you go to the park, how can you support your child to take appropriate risks? Here are some tips, based on  our work  on children, risk and outdoor play:

Start with a positive mindset:  Playgrounds are designed to develop physical and social skills. So be prepared for your child to try new things at the park (rather than just play it safe with the same old equipment).

Be ready to support — and to stand back:  There are times when it is best to stand back and let children experience the equipment or the area for themselves. There are others where parents are needed. So keep a monitoring eye on things. But don’t assume you will be helping all the time.

Language matters:  Try to steer away from language such as “be careful.” This can set children up to be afraid of a situation. Reframe your language to something more supportive such as “Is there a stronger piece of wood to put your foot on?” or “Have you seen the hole over there?”

You could also say something like, “Look around, do you want to explore left or right?” This prompts your child to think about the best approach for them and builds self-confidence and problem-solving skills.

Give useful advice:  Help children with specific guidance on how to use equipment safely. For example, when climbing you could say, “Use three points of contact, two hands and one foot on that ladder.”

Let the child decide:  Allow your child to decide what pieces of equipment they use and how far they climb. Do not push them to complete activities they are not comfortable with. And by the same token, intervene only when the equipment is clearly above their skill development level.

Have fun:  Show excitement, join in the imaginative games and reinforce the message that it is acceptable to say no or yes to challenge — both choices are OK!

READ MORE: Can parents give their children too much attention?

Tonia Gray is a professor in the Centre for Educational Research at Western Sydney University in Australia. Jaydene Barnes is an associate lecturer at Western Sydney University. Marion Sturges is an academic professional adviser and lecturer in education at Western Sydney University. The authors wish to acknowledge Amanda Lloyd, who contributed to the research on which this article is based. The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article and have disclosed no relevant affiliations beyond their academic appointment.

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