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Article History

Received: 2 December 2025

Accepted: 12 May 2026

First Online: 22 May 2026

Declarations

:

: The authors declare no competing interests.

: The study protocol was reviewed and approved by Thai Binh University of Medicine and Pharmacy (Approval code: 528, date of approval: April 01, 2025). The study was performed according to the good clinical practices recommended by the Declaration of Helsinki and its amendments. All participants provided their informed consent before participating to the study. Identifying information (names and class codes) was stored in a password-protected file separate from the analytical dataset. Only the research team had access to this file for the purpose of contacting students for confirmatory examinations. Before data analysis, all identifiers were removed and replaced with anonymous study codes to ensure confidentiality.

: Generative AI and AI-assisted technologies were not used in data analysis, interpretation and writing process.