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- Edelbring, Samuel, PhD, Docent, 1969-, et al.
(författare)
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Interprofessionell simulering är engagerande och relevant [Interprofessional simulation: an engaging and relevant technique for teamwork practice]
- 2019
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Ingår i: Läkartidningen. - Stockholm, Sweden : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 116
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Tidskriftsartikel (refereegranskat)abstract
- Stakeholders in healthcare and education find interprofessional teamwork to be crucial for todays complex healthcare. Consequently, the students need to prepare for future collaboration with other professions. Interprofessional simulation (IPS) is a technique in which several professions can engage together in clinical scenarios. Using a survey we studied the perceived relevance of two IPS settings in which last-year medical and nursing students participated in acute care scenarios. The findings showed that students perceive IPS as being highly relevant and that students from the other profession contributed to their learning. IPS holds promise as a pedagogical tool towards future interprofessional competence. However, pedagogical improvements can be made, and the professional perspectives can be better balanced. Furthermore, in order to equip students with broader interprofessional competence, scenarios should include several professions and a variety of clinical contexts.
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| 3. |
- Falk, Wiebke, 1978-, et al.
(författare)
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Epidural analgesia and mortality after colorectal cancer surgery : A retrospective cohort study
- 2021
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Ingår i: Annals of Medicine and Surgery. - : Elsevier. - 2049-0801. ; 66
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Tidskriftsartikel (refereegranskat)abstract
- Background: Epidural analgesia (EA) has been the standard of care after major abdominal surgery for many years. This study aimed to correlate EA with postoperative complications, short- and long-term mortality in patients with and without EA after open surgery (OS) and minimally invasive surgery (MIS) for colorectal cancer.Methods: Patient, clinical and outcome data were obtained from the Swedish Colorectal Cancer Registry and the Swedish Perioperative Registry. All adult patients diagnosed with colorectal cancer without metastases who underwent elective curative MIS or OS for colorectal cancer between January 2016 and December 2018 and who had data recorded in both registries, were included in the study. Data were analyzed for OS and MIS procedures separately. A Poisson regression model was used to investigate the association between EA and the outcomes of interest.Results: Five thousand seven hundred sixty-two patients were included in the study, 2712 in the MIS and 3050 patients in the OS group. After adjusting for patient specific and clinically relevant variables in the regression model, no statistically significant difference in risk for complications; 30-day, 90-day, and up to 3-year mortality following either MIS or OS could be detected between the EA+ and EA-cohorts.Conclusions: In this large study cohort, EA as part of the comprehensive care provided was not associated with a reduction in postoperative complications risk or improved 30-day, 90-day, or 3-year survival after MIS or OS for colorectal cancer.
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| 5. |
- Falk, Wiebke, 1978-
(författare)
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Epidural Analgesia for Colorectal Cancer Surgery : Experimental and Clinical studies
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Epidural analgesia (EA) with local anaesthetics and opioids is used for pain management after colorectal cancer (CRC) surgery. In recent years, a possible beneficial effect of EA on cancer recurrence and survival after surgery has been proposed. The aim of this thesis was to study the effects of EA on short- and long-term postoperative outcomes after CRC surgery with curative intent.Study I, an in vitro study, investigated the effects of two different local anaesthetics, lidocaine and ropivacaine, on cell viability and cell proliferation in colon cancer cell lines SW480 and SW620. Neither lidocaine nor ropivacaine reduced cell viability or proliferation at systemically, by epidural administration achievable concentrations.In study II, the effect of EA on the systemic level of different cytokines as a marker of inflammation was studied. Except for a reduced level of the anti-inflammatory cytokine IL-10, no other significant effects of EA on the systemic cytokine levels at two time points postoperatively could be shown, when compared to patients receiving intravenous morphine.Study III was an epidemiological study, examining the question if EA affects postoperative complications and mortality after surgery using data from the Swedish Colorectal Cancer Registry and the Swedish Perioperative Registry. No association between EA and a reduction in postoperative complications or mortality could be established.Study IV, a randomised, controlled trial, the effects of EA on diseasefree survival (DFS), postoperative complications and pain after surgery were compared to patient-controlled intravenous analgesia with morphine. Apart from superior pain relief during the first postoperative day, no significant effects of EA on the occurrence of postoperative complications, length of hospital stay or DFS were found.
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| 6. |
- Fredholm, Angelica, et al.
(författare)
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Authenticity made visible in medical students' experiences of feeling like a doctor
- 2019
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Ingår i: International Journal of Medical Education. - : International Journal of Medical Education. - 2042-6372. ; 10, s. 113-121
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To interpret the phenomenon of authenticity made visible in medical students' experiences of feeling like a doctor, i.e., how authenticity took shape in narratives about feeling like a doctor in clinical situations where students were challenged to be independent and to a high degree make choices and clinical decisions.Methods: The conducted research was positioned within phenomenological hermeneutic research tradition, interpreting participants' experiences in a life-world perspective using narrative inquiry. Fifteen medical students in their fifth year were interviewed focusing on clinical situations. An abductive analysis approach was used to discover patterns and to interpret data following a phenomenological hermeneutic research method for textual interpretation.Results: The analysis resulted in a thematic structure of findings: Opportunity to experience authenticity through creating relationships; Opportunity to experience authenticity through responsibility; Opportunity to experience authenticity through independence, managing wholeness, and follow-up processes; Opportunity to experience authenticity through being able to reason and discern. Overarching the four themes was the perceived need for attachment, i.e. attachment to patients, to supervisors, to the workplace, to the situation and reasoning and knowledge.Conclusions: Essential for the experience of feeling like a doctor was authentic situations that resulted in the experienced members of a community of practice and the perceived development of a professional identity. These findings can advance the understanding of how clinical education should be organized to facilitate professional identity development.
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| 8. |
- Gummesson, Christina, et al.
(författare)
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Entrustable professional activities (EPAs) for undergraduate medical education : development and exploration of social validity
- 2023
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Ingår i: BMC Medical Education. - : BioMed Central (BMC). - 1472-6920. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The development of entrustable professional activities (EPAs) as a framework for work-based training and assessment in undergraduate medical education has become popular. EPAs are defined as units of a professional activity requiring adequate knowledge, skills, and attitudes, with a recognized output of professional labor, independently executable within a time frame, observable and measurable in its process and outcome, and reflecting one or more competencies. Before a new framework is implemented in a specific context, it is valuable to explore social validity, that is, the acceptability by relevant stakeholders.Aim: The aim of our work was to define Core EPAs for undergraduate medical education and further explore the social validity of the constructs.Method and material: In a nationwide collaboration, EPAs were developed using a modified Delphi procedure and validated according to EQual by a group consisting of teachers nominated from each of the seven Swedish medical schools, two student representatives, and an educational developer (n = 16). In the next step, social validity was explored in a nationwide survey. The survey introduced the suggested EPAs. For each EPA, the importance of the EPA was rated, as was the rater’s perception of the present graduates’ required level of supervision when performing the activity. Free-text comments were also included and analyzed.Results: Ten Core EPAs were defined and validated. The validation scores for EQual ranged from 4.1 to 4.9. The nationwide survey had 473 responders. All activities were rated as “important” by most responders, ranging from 54 to 96%. When asked how independent current graduates were in performing the ten activities, 6 to 35% reported “independent”. The three themes of the free text comments were: ‘relevant target areas and content’; ‘definition of the activities’; and ‘clinical practice and learning’.Conclusion: Ten Core EPAs were defined and assessed as relevant for Swedish undergraduate medical education. There was a consistent gap between the perceived importance and the certainty that the students could perform these professional activities independently at the time of graduation. These results indicate that the ten EPAs may have a role in undergraduate education by creating clarity for all stakeholders.
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| 9. |
- Hedlund, Jakob, 1991-, et al.
(författare)
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Nurse anaesthetists' experiences of student nurse anaesthetist learning during clinical practice : a qualitative interview study
- 2024
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Ingår i: BMC Nursing. - : BioMed Central (BMC). - 1472-6955. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The professional role of a nurse anaesthetist involves taking a pedagogical approach towards students, including supervision during clinical practice. Although supervisors are facilitators of student learning, they are offered little training in adult learning principles. The aim of this study was to describe supervisors' experience of student nurse anaesthetist learning during clinical practice in the operating room.METHOD: In this qualitative interview study, 12 semi-structured individual interviews were carried out with clinical supervising nurse anaesthetists. The data were analysed inductively using thematic analysis.RESULTS: The results are illustrated with one theme and five sub-themes. The clinical learning situation of student nurse anaesthetists is described as a reflection of different cultures coming together. The operating room environment is a new context to students, and students enter with different clinical background and experiences. There is tension in facilitating student learning due to demands for productivity; supervisors suggest the use of separate operating rooms with a special focus on learning in the future.CONCLUSION: Clinical practice facilitates student learning and is a parallel process to routine care. Thus, it requires the cultures of higher education and healthcare organizations to co-exist. This is illustrated with the theme "Contributing to students' future professional roles by bridging the hospital and university cultures". In the operating room, student learning is challenged by a new context and time pressure as shown by subthemes. To overcome challenges and support student learning in the operating room from a supervisors' perspective, interprofessional student teams are suggested as a future approach and need to be further investigated.
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| 10. |
- Hedlund, Jakob, 1991-, et al.
(författare)
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Student Nurse Anesthetists' and Supervisors' Perspectives of Learning in the Operating Room : An Integrative Review
- 2024
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Ingår i: Journal of Perianesthesia Nursing. - : Elsevier. - 1089-9472 .- 1532-8473. ; 39:2, s. 303-310.e8
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Forskningsöversikt (refereegranskat)abstract
- PURPOSE: The purpose of this review was to identify supporting and hindering factors for student nurse anesthetists' (SNAs') learning in the operating room during clinical practice, from students' and supervisors' perspectives.DESIGN: An integrative review.METHODS: Systematic searches were conducted in Medline, Cinahl, PsycInfo, and ERIC. Search terms were related to nurse anesthetist, education, operating room context, and clinical setting. Searches were performed at three points in time and in total 1,530 unique articles were identified. After screening using Covidence and using Joanna Briggs Institute appraisal tools, 34 articles remained. These were analyzed inductively using a constant comparison method.FINDINGS: Supporting factors include preparation before clinical practice, clearly stated expectations, a respectful relationship with the supervisor, daily planning and communication, and constructive feedback. Hindering factors include lack of time, disruptive behavior from supervisors or other team members, and environmental factors such as a high room temperature and noisy environment.CONCLUSIONS: SNAs' learning situation in the operating room resembles undergraduate nurses' learning during clinical practice. Educators and supervisors can take several actions to promote SNAs' learning. Further research is warranted on the effect of teamwork on SNAs' learning.
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