A psychometric evaluation of the Children’s Revised Impact of Event Scale 13 (CRIES-13), which measures the posttraumatic stress disorder (PTSD) symptoms in children and adolescents caused by the coronavirus disease 2019 (COVID-19) pandemic, was conducted. We aimed to cross-culturally adapt and test the psychometric qualities of the CRIES-13 that was applied to Indonesian adolescents exposed to COVID-19 risk across gender groups. A cross-sectional study was conducted at a junior high school in Yogyakarta, Indonesia, in May 2022; 346 Indonesian adolescents aged 12 to 18 years completed the Indonesian version of the CRIES-13. The factorial validity results supported the scale’s three-factor structure (intrusion, avoidance, and arousal), which satisfied all parameter index requirements and exhibited a favorable level of internal consistency reliability. Excellent results were obtained across genders for the four-level measurement of invariance (i.e., configural, metric, scalar, and full invariance), and they met the recommended criteria. Our Cronbach’s alphas and composite reliability ratings were high (>0.7), indicating a strong correlation and reliability of the items for measuring each construct. We strongly support the use of the Indonesian CRIES-13, which was demonstrated to be valid and reliable for an adolescent population.

Purpose: This systematic review and meta-analysis evaluated educational interventions for improving type 2 diabetes prevention knowledge and preventive behaviors among children. Methods: A systematic search was conducted in PubMed, ScienceDirect, SAGE Journals, Scopus, ProQuest, MEDLINE, and the Cochrane Library for studies published between 2015 and 2025. Eligible studies were RCTs, cluster RCTs, and quasi-experimental studies evaluating diabetes prevention education among children aged approximately 6–18 years without diabetes and reporting knowledge or preventive behavior outcomes. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects meta-analyses calculated standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results: Thirteen studies were included; six were eligible for knowledge meta-analysis and four for preventive behavior meta-analysis, while the remaining studies were summarized narratively. Pooled analyses suggested that educational interventions were associated with improvements in diabetes prevention knowledge (SMD = 1.597; 95% CI: 0.796–2.398; p < 0.001) and preventive behaviors (SMD = 0.625; 95% CI: 0.162–1.089; p = 0.008). Interventions with more than four sessions and cluster RCTs appeared to show stronger effects. Substantial heterogeneity was observed, likely reflecting differences in study design, intervention duration, delivery methods, and outcome measures. Conclusion: Educational interventions appear to be associated with improved knowledge of type 2 diabetes prevention and may support preventive behaviors among children, but findings should be interpreted with caution given heterogeneity and methodological limitations. Multi-session school-based interventions, particularly those with more than four sessions, may be more promising. More rigorous studies with longer follow-up are needed.

BACKGROUND Competency-based medical education increasingly uses digital workplace assessment platforms to collect longitudinal evidence of trainees’ readiness for progressive responsibility. Entrustable professional activities (EPAs) translate competencies into observable clinical work, but individual workplace observations are context dependent and may not support dependable progression decisions. Empirical guidance remains limited on how many observations, faculty raters, EPA titles, and workplace settings are needed for a sufficient EPA portfolio. OBJECTIVE This study aimed to estimate EPA portfolio sufficiency for competency-based progression review using nationwide data from a digital workplace assessment platform in otorhinolaryngology–head and neck surgery residency training. METHODS We conducted a retrospective, nationwide cross-sectional generalizability and decision study using routinely collected EPA-based workplace assessment data from Taiwan’s E-MyWay platform. The study included completed EPA observations from accredited otorhinolaryngology–head and neck surgery residency programs between August 2022 and May 2026. Faculty-assigned entrustment–supervision ratings were scored on a 5-level national EPA scale. The resident was the object of measurement, and faculty rater, EPA title, and workplace setting were measurement facets. Generalizability analyses decomposed variance in entrustment ratings, and decision-study simulations estimated absolute dependability under alternative portfolio configurations. RESULTS The analytic sample included 45,867 EPA observations involving 466 residents and 448 faculty raters across 36 training programs, 11 EPA titles, and 5 workplace settings. Residents had a median of 88 observations and were assessed by a median of 9 faculty raters across 11 EPA titles and 5 workplace settings. Single EPA observations were insufficient for resident-level summative interpretation. In the primary generalizability study, residual variance was the largest component, accounting for 40.4% of total variance; faculty-rater variance accounted for 10.9%, and resident–faculty rater interaction accounted for 10.5%. A well-distributed 10-observation portfolio achieved a generalizability coefficient of 0.77 but an absolute dependability coefficient (Phi) of 0.65. The first scenario reaching minimally acceptable absolute dependability was 20 observations across 5 faculty raters, 5 EPA titles, and 3 workplace settings (Phi=0.76). For higher-stakes progression review, 30 observations across 6 faculty raters, 6 EPA titles, and 4 workplace settings achieved Phi=0.81. CONCLUSIONS Nationwide digital workplace assessment data showed that dependable EPA-based progression review requires both sufficient observation counts and purposeful sampling across faculty raters, EPA titles, and workplace settings. These study-derived benchmarks may help clinical competency committees, residency programs, and specialty societies monitor portfolio completeness before progression deliberation. They should complement, rather than replace, narrative feedback, case complexity, performance trajectory, and committee judgment. CLINICALTRIAL Not applicable.

Background: Competency-based medical education increasingly uses digital workplace assessment platforms to collect longitudinal evidence of trainees’ readiness for progressive responsibility. Entrustable professional activities (EPAs) translate competencies into observable clinical work, but individual workplace observations are context-dependent and may not support dependable progression decisions. Empirical guidance remains limited on how many observations, faculty raters, EPA titles, and workplace settings are needed for a dependable EPA portfolio. Objective: This study aimed to estimate EPA portfolio dependability for competency-based progression review using nationwide data from a digital workplace assessment platform in otorhinolaryngology-head and neck surgery residency training. Methods: We conducted a retrospective, nationwide cross-sectional generalizability and decision study using routinely collected EPA-based workplace assessment data from Taiwan’s E-MyWay platform. The study included completed EPA observations from accredited otorhinolaryngology-head and neck surgery residency programs between August 2022 and May 2026. Faculty-assigned entrustment-supervision ratings were scored on a 5-level national EPA scale. The resident was the object of measurement, whereas faculty rater, EPA title, and workplace setting were measurement facets. The generalizability study partitioned rating variance into resident, facet, interaction, and residual components, which were subsequently used in decision-study projections of the generalizability coefficient, Phi coefficient, and absolute standard error of measurement under alternative portfolio configurations. Results: The analytic sample included 45,526 EPA observations involving 466 residents and 448 faculty raters across 35 training programs, 11 EPA titles, and 5 workplace settings. Residents had a median of 87 (IQR 47-124) observations and were assessed by a median of 9 (IQR 6-12) faculty raters across 11 (IQR 10-11) EPA titles and 5 (IQR 4-5) workplace settings. Single EPA observations were insufficient for resident-level summative interpretation. In the primary generalizability study, residual/encounter-level variance was the largest component, accounting for 40.1% of total variance; resident variance accounted for 26.9%, faculty rater variance accounted for 10.8%, and resident × faculty rater interaction for 10.4%. A study-defined well-distributed 10-observation portfolio achieved a generalizability coefficient of 0.77 but an absolute dependability coefficient (Phi) of 0.65. A 20-observation portfolio across 5 faculty raters, 5 EPA titles, and 3 workplace settings yielded a Phi of 0.76, and a 30-observation portfolio across 6 faculty raters, 6 EPA titles, and 4 workplace settings yielded a Phi of 0.80. Conclusions: Nationwide digital workplace assessment data showed that EPA portfolio dependability reflected both observation counts and sampling breadth across faculty raters, EPA titles, and workplace settings. These study-defined portfolio configurations may help clinical competency committees, residency programs, and specialty societies monitor portfolio completeness before progression deliberation. They should complement, rather than replace, narrative feedback, case complexity, performance trajectory, and committee judgment.