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The study involved anonymous educational surveys administered to clinical medical graduate students via an online platform. According to the Measures for the Ethical Review of Life Sciences and Medical Research Involving Humans (National Health Commission of the People\u2019s Republic of China, 2023 revision) and the Regulations on the Ethical Review of Biomedical Research Involving Humans (2016), research involving solely anonymous educational surveys that do not collect sensitive personal health information, biological samples, or clinical intervention data may be exempt from formal ethics committee review. Ethics approval was deemed unnecessary according to national regulations, as this study met the following criteria: (1) anonymous survey design without collection of identifiable personal health information; (2) educational outcome assessment without clinical interventions; (3) all participants were adult graduate students providing informed consent prior to participation. Informed consent to participate was obtained from all participants. Prior to completing the online questionnaire, participants were informed of the study's purpose, procedures, data handling practices, and confidentiality measures. Participants voluntarily consented to participate by clicking \"I agree\" on the informed consent page of the online survey platform.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. This manuscript does not contain any identifying images, individual personal details, or clinical information that could compromise participant anonymity.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1660"}}