| 1. |
- Kononowicz, A. A., et al.
(författare)
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Virtual patient simulations for health professional education
- 2016
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Ingår i: Cochrane Database of Systematic Reviews. - : John Wiley & Sons. - 1469-493X. ; :5
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Forskningsöversikt (refereegranskat)abstract
- The objective of this review is to evaluate the effectiveness of virtual patient simulation as an educational intervention versus traditional learning, other types of e‐Learning interventions and other forms of virtual patient simulation interventions for delivering pre‐registration and post‐registration healthcare professional education. We will primarily assess the impact of these interventions on learners’ knowledge, skills and attitudes. Our secondary objective is to assess the cost‐effectiveness of these interventions.
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| 2. |
- Kononowicz, Andrzej A., et al.
(författare)
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Virtual Patient Simulations in Health Professions Education : Systematic Review and Meta-Analysis by the Digital Health Education Collaboration
- 2019
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 21:7
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Forskningsöversikt (refereegranskat)abstract
- Background: Virtual patients are interactive digital simulations of clinical scenarios for the purpose of health professions education. There is no current collated evidence on the effectiveness of this form of education.Objective: The goal of this study was to evaluate the effectiveness of virtual patients compared with traditional education, blended with traditional education, compared with other types of digital education, and design variants of virtual patients in health professions education. The outcomes of interest were knowledge, skills, attitudes, and satisfaction.Methods: We performed a systematic review on the effectiveness of virtual patient simulations in pre- and postregistration health professions education following Cochrane methodology. We searched 7 databases from the year 1990 up to September 2018. No language restrictions were applied. We included randomized controlled trials and cluster randomized trials. We independently selected studies, extracted data, and assessed risk of bias and then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models.Results: A total of 51 trials involving 4696 participants met our inclusion criteria. Furthermore, 25 studies compared virtual patients with traditional education, 11 studies investigated virtual patients as blended learning, 5 studies compared virtual patients with different forms of digital education, and 10 studies compared different design variants. The pooled analysis of studies comparing the effect of virtual patients to traditional education showed similar results for knowledge (standardized mean difference [SMD]=0.11, 95% CI -0.17 to 0.39, I-2=74%, n=927) and favored virtual patients for skills (SMD=0.90, 95% CI 0.49 to 1.32, I-2=88%, n=897). Studies measuring attitudes and satisfaction predominantly used surveys with item-by-item comparison. Trials comparing virtual patients with different forms of digital education and design variants were not numerous enough to give clear recommendations. Several methodological limitations in the included studies and heterogeneity contributed to a generally low quality of evidence.Conclusions: Low to modest and mixed evidence suggests that when compared with traditional education, virtual patients can more effectively improve skills, and at least as effectively improve knowledge. The skills that improved were clinical reasoning, procedural skills, and a mix of procedural and team skills. We found evidence of effectiveness in both high-income and low-and middle-income countries, demonstrating the global applicability of virtual patients. Further research should explore the utility of different design variants of virtual patients.
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| 3. |
- Stathakarou, N., et al.
(författare)
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Teams managing civilian and military complex trauma: What are the competencies required in austere environments and the potential of simulation technology to address them?
- 2021
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Ingår i: Health Informatics Journal. - : SAGE Publications. - 1460-4582 .- 1741-2811. ; 27:4
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Tidskriftsartikel (refereegranskat)abstract
- Surgical training in civilian hospitals may not be sufficient for managing complex trauma in a setting where such care is not commonly practiced. Understanding the challenges that civilian teams face when moving to austere environments can inform the competencies that need to be trained. The aim of this study was to explore the competencies required in austere environments for teams managing complex trauma, and how they can be trained with simulation technologies. Ethnographic field observations were conducted, and field notes were synthesized. The field notes were structured with the elements of Activity Theory to generate the teams' competencies that need to be trained. A literature review was conducted to verify the results and identify examples of relevant simulation modalities. The analysis resulted in a structured list of competencies for civilian teams to manage complex trauma in an austere environment and recommendations which simulation technologies could be used in training of those competencies based on published studies. Our study contributes to understanding the challenges that civilian teams face when operating in an austere environment. A systematized list of competencies with suggested simulation technologies directs future research to improve quality of complex trauma training in civilian and military collaboration.
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| 4. |
- Wagner, F. L., et al.
(författare)
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Current status and ongoing needs for the teaching and assessment of clinical reasoning – an international mixed-methods study from the students` and teachers` perspective
- 2024
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Ingår i: BMC Medical Education. - : BioMed Central (BMC). - 1472-6920. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Clinical reasoning (CR) is a crucial ability that can prevent errors in patient care. Despite its important role, CR is often not taught explicitly and, even when it is taught, typically not all aspects of this ability are addressed in health professions education. Recent research has shown the need for explicit teaching of CR for both students and teachers. To further develop the teaching and learning of CR we need to improve the understanding of students' and teachers' needs regarding content as well as teaching and assessment methods for a student and trainer CR curriculum. Methods: Parallel mixed-methods design that used web-surveys and semi-structured interviews to gather data from both students (nsurvey = 100; ninterviews = 13) and teachers (nsurvey = 112; ninterviews = 28). The interviews and surveys contained similar questions to allow for triangulation of the results. This study was conducted as part of the EU-funded project DID-ACT (https://did-act.eu). Results: Both the surveys and interview data emphasized the need for content in a clinical reasoning (CR) curriculum such as “gathering, interpreting and synthesizing patient information”, “generating differential diagnoses”, “developing a diagnostic and a treatment plan” and “collaborative and interprofessional aspects of CR”. There was high agreement that case-based learning and simulations are most useful for teaching CR. Clinical and oral examinations were favored for the assessment of CR. The preferred format for a train-the-trainer (TTT)-course was blended learning. There was also some agreement between the survey and interview participants regarding contents of a TTT-course (e.g. teaching and assessment methods for CR). The interviewees placed special importance on interprofessional aspects also for the TTT-course. Conclusions: We found some consensus on needed content, teaching and assessment methods for a student and TTT-course in CR. Future research could investigate the effects of CR curricula on desired outcomes, such as patient care.
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| 5. |
- Berman, Anne H., et al.
(författare)
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Virtual Patients in a Behavioral Medicine Massive Open Online Course (MOOC) : A Qualitative and Quantitative Analysis of Participants' Perceptions
- 2017
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Ingår i: Academic Psychiatry. - : Springer Science and Business Media LLC. - 1042-9670 .- 1545-7230. ; 41:5, s. 631-641
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Tidskriftsartikel (refereegranskat)abstract
- Objective The purpose of this article is to explore learners' perceptions of using virtual patients in a behavioral medicine Massive Open Online Course (MOOCs) and thereby describe innovative ways of disseminating knowledge in health-related areas. Methods A 5-week MOOC on behavioral medicine was hosted on the edX platform. The authors developed two branched virtual patients consisting of video recordings of a live standardized patient, with multiple clinical decision points and narration unfolding depending on learners' choices. Students interacted with the virtual patients to treat stress and sleep problems. Answers to the exit survey and participant comments from the discussion forum were analyzed qualitatively and quantitatively. Results In total, 19,236 participants enrolled in the MOOC, out of which 740 received the final certificate. The virtual patients were completed by 2317 and 1640 participants respectively. Among survey respondents (n = 442), 83.1% agreed that the virtual patient exercise was helpful. The qualitative analysis resulted in themes covering what it was like to work with the virtual patient, with subthemes on learner-centered education, emotions/eustress, game comparisons, what the participants learned, what surprised them, how confident participants felt about applying interventions in practice, suggestions for improvement, and previous experiences of virtual patients. Conclusions Students were enthusiastic about interacting with the virtual patients as a means to apply new knowledge about behavioral medicine interventions. The most common suggestion was to incorporate more interactive cases with various levels of complexity. Further research should include patient outcomes and focus on interprofessional aspects of learning with virtual patients in a MOOC.
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| 6. |
- Hadadgar, Arash, et al.
(författare)
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Creating and validating e-cases as educational tools in general practitioners' continuing medical education context
- 2018
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Ingår i: Bio-Algorithms and Med-Systems. - : Walter de Gruyter. - 1895-9091 .- 1896-530X. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study aimed at creating electronic cases (e-cases) and analyzing their validity as a diagnostic assessment tool within the context of continuing medical education (CME) to measure general practitioners' (GPs) knowledge of common infectious disease. Methods: We designed assessment e-cases in an electronic CME platform. The e-cases were designed to measure GPs' knowledge about diagnosis and treatment of common infectious disease in outpatient settings. The data collected were analyzed for five forms of evidence: content, response process, internal structure, relations with other variables and consequences. Results: A total of 46 GPs participated in the study. Among them, 87% perceived the e-cases as resembling the patients whom they visit in their everyday practice. Although attendance in this activity made 85% of the participants more cautious about prescription of antibiotics, we could not detect any statistically significant association between the assessment scores and the physicians' previous antibiotic prescription. The diagnos- e tic assessment with e-cases was supported by most of the elements of validity evidence, including content, response process, internal structure and consequences. Conclusions: Overall, evidence suggests that using e-cases might be a valid diagnostic assessment CME activity to measure GPs' knowledge of common infectious disease, but more research is necessary.
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| 7. |
- Hege, Inga, et al.
(författare)
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A qualitative analysis of virtual patient descriptions in healthcare education based on a systematic literature review
- 2016
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Ingår i: BMC Medical Education. - : BioMed Central. - 1472-6920. ; 16
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Forskningsöversikt (refereegranskat)abstract
- Background: Virtual Patients (VPs) have been in the focus of research in healthcare education for many years. The aim of our study was to analyze how virtual patients are described in the healthcare education literature, and how the identified concepts relate to each other.Methods: We performed a literature review and extracted 185 descriptions of virtual patients from the articles. In a qualitative content analysis approach we inductively-deductively developed categories and deducted subcategories. We constructed a concept map to illustrate these concepts and their interrelations.Results: We developed the following five main categories: Patient, Teacher, Virtual Patient, Curriculum, and Learner. The concept map includes these categories and highlights aspects such as the under-valued role of patients in shaping their virtual representation and opposing concepts, such as standardization of learner activity versus learner-centeredness.Conclusions: The presented concept map synthesizes VP descriptions and serves as a basis for both, VP use and discussions of research topics related to virtual patients.
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| 8. |
- Hege, Inga, et al.
(författare)
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Developing a European longitudinal and interprofessional curriculum for clinical reasoning
- 2023
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Ingår i: Diagnosis. - : Walter de Gruyter GmbH. - 2194-8011 .- 2194-802X.
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Tidskriftsartikel (refereegranskat)abstract
- Clinical reasoning is a complex and crucial ability health professions students need to acquire during their education. Despite its importance, explicit clinical reasoning teaching is not yet implemented in most health professions educational programs. Therefore, we carried out an international and interprofessional project to plan and develop a clinical reasoning curriculum with a train-the-trainer course to support educators in teaching this curriculum to students. We developed a framework and curricular blueprint. Then we created 25 student and 7 train-the-trainer learning units and we piloted 11 of these learning units at our institutions. Learners and faculty reported high satisfaction and they also provided helpful suggestions for improvements. One of the main challenges we faced was the heterogeneous understanding of clinical reasoning within and across professions. However, we learned from each other while discussing these different views and perspectives on clinical reasoning and were able to come to a shared understanding as the basis for developing the curriculum. Our curriculum fills an important gap in the availability of explicit clinical reasoning educational materials both for students and faculty and is unique with having specialists from different countries, schools, and professions. Faculty time and time for teaching clinical reasoning in existing curricula remain important barriers for implementation of clinical reasoning teaching.
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| 9. |
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| 10. |
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| 11. |
- Kononowicz, Andrzej A., et al.
(författare)
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The need for longitudinal clinical reasoning teaching and assessment : Results of an international survey
- 2020
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Ingår i: Medical teacher. - : Taylor & Francis. - 0142-159X .- 1466-187X. ; 42:4, s. 457-462
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Tidskriftsartikel (refereegranskat)abstract
- Background: Clinical reasoning is a key ability essential for practising health professionals. However, little is known about the current global adoption of clinical reasoning teaching and assessment.Purpose: We aimed to provide insights into how clinical reasoning is deliberately taught and assessed in curricula worldwide and to identify needs and perceived barriers for teaching clinical reasoning to students and educators.Methods: A questionnaire was devised by an international expert group and distributed in a large international medical education community. Data were collected in 2018 and analysed using descriptive statistics. We identified themes in free-text responses using content analysis.Results: Three hundred and thirteen responses from 76 countries were collected. Most respondents were from Europe (34%). While the presence of a longitudinal clinical reasoning curriculum was only reported by 28%, 85% stated that such a curriculum was needed. The lack of awareness of the need to explicitly teach clinical reasoning was the most commonly identified barrier. For assessment, the greatest need identified was for more workplace-based assessment.Conclusions: Global respondents indicate the need to implement explicit longitudinal clinical reasoning curricula. Our findings suggest that efforts should be put into improving faculty development, including evidence-based materials on how to teach and assess clinical reasoning.
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| 12. |
- Kyaw, Bhone Myint, et al.
(författare)
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Virtual Reality for Health Professions Education : Systematic Review and Meta-Analysis by the Digital Health Education Collaboration
- 2019
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Ingår i: Journal of Medical Internet Research. - : JMIR PUBLICATIONS, INC. - 1438-8871. ; 21:1
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Forskningsöversikt (refereegranskat)abstract
- Background: Virtual reality (VR) is a technology that allows the user to explore and manipulate computer-generated real or artificial three-dimensional multimedia sensory environments in real time to gain practical knowledge that can be used in clinical practice. Objective: The aim of this systematic review was to evaluate the effectiveness of VR for educating health professionals and improving their knowledge, cognitive skills, attitudes, and satisfaction. Methods: We performed a systematic review of the effectiveness of VR in pre- and postregistration health professions education following the gold standard Cochrane methodology. We searched 7 databases from the year 1990 to August 2017. No language restrictions were applied. We included randomized controlled trials and cluster-randomized trials. We independently selected studies, extracted data, and assessed risk of bias, and then, we compared the information in pairs. We contacted authors of the studies for additional information if necessary. All pooled analyses were based on random-effects models. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to rate the quality of the body of evidence. Results: A total of 31 studies (2407 participants) were included. Meta-analysis of 8 studies found that VR slightly improves postintervention knowledge scores when compared with traditional learning (standardized mean difference [SMD]=0.44; 95% CI 0.18-0.69; I-2=49%; 603 participants; moderate certainty evidence) or other types of digital education such as online or offline digital education (SMD=0.43; 95% CI 0.07-0.79; I-2=78%; 608 participants [8 studies]; low certainty evidence). Another meta-analysis of 4 studies found that VR improves health professionals' cognitive skills when compared with traditional learning (SMD=1.12; 95% CI 0.81-1.43; I-2=0%; 235 participants; large effect size; moderate certainty evidence). Two studies compared the effect of VR with other forms of digital education on skills, favoring the VR group (SMD=0.5; 95% CI 0.32-0.69; I-2=0%; 467 participants; moderate effect size; low certainty evidence). The findings for attitudes and satisfaction were mixed and inconclusive. None of the studies reported any patient-related outcomes, behavior change, as well as unintended or adverse effects of VR. Overall, the certainty of evidence according to the GRADE criteria ranged from low to moderate. We downgraded our certainty of evidence primarily because of the risk of bias and/or inconsistency. Conclusions: We found evidence suggesting that VR improves postintervention knowledge and skills outcomes of health professionals when compared with traditional education or other types of digital education such as online or offline digital education. The findings on other outcomes are limited. Future research should evaluate the effectiveness of immersive and interactive forms of VR and evaluate other outcomes such as attitude, satisfaction, cost-effectiveness, and clinical practice or behavior change.
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| 13. |
- Parodis, Ioannis, 1981-, et al.
(författare)
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Clinical Reasoning Needs to Be Explicitly Addressed in Health Professions Curricula : Recommendations from a European Consortium
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:21
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Tidskriftsartikel (refereegranskat)abstract
- Clinical reasoning entails the application of knowledge and skills to collect and integrate information, typically with the goal of arriving at a diagnosis and management plan based on the patient's unique circumstances and preferences. Evidence-informed, structured, and explicit teaching and assessment of clinical reasoning in educational programs of medical and other health professions remain unmet needs. We herein summarize recommendations for clinical reasoning learning objectives (LOs), as derived from a consensus approach among European and US researchers and health professions educators. A four-step consensus approach was followed: (1) identification of a convenience sample of the most relevant and applied national LO catalogues for health professions educational programs (N = 9) from European and US countries, (2) extraction of LOs related to clinical reasoning and translation into English, (3) mapping of LOs into predefined categories developed within the Erasmus+ Developing, implementing, and disseminating an adaptive clinical reasoning curriculum for healthcare students and educators (DID-ACT) consortium, and (4) synthesis of analysis findings into recommendations for how LOs related to clinical reasoning could be presented and incorporated in LO catalogues, upon consensus. Three distinct recommendations were formulated: (1) make clinical reasoning explicit, (2) emphasize interprofessional and collaboration aspects of clinical reasoning, and (3) include aspects of teaching and assessment of clinical reasoning. In addition, the consortium understood that implementation of bilingual catalogues with English as a common language might contribute to lower heterogeneity regarding amount, structure, and level of granularity of clinical reasoning LOs across countries. These recommendations will hopefully motivate and guide initiatives towards the implementation of LOs related to clinical reasoning in existing and future LO catalogues.
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| 14. |
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| 15. |
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| 16. |
- Stathakarou, Natalia, et al.
(författare)
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MOOC Learners' Engagement with Two Variants of Virtual Patients : A Randomised Trial
- 2018
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Ingår i: Education Sciences. - : MDPI AG. - 2227-7102. ; 8:2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Massive Open Online Courses (MOOCs) are an increasingly popular form of education in health professional education. VPs have been introduced in MOOCs to increase interactivity. There is a lack of research in understanding the reasons behind high dropout rates in MOOCs. We explored how learners interact with VPs and compared the significance of different VP designs on dropout rates. Methods: RCT of 378 participants split into two groups to interact with two VPs using different design: branching and linear. Data on node progression and VP attempts was analysed using descriptive and quantitative analysis. Results: Eight groups of learner interaction patterns were identified. The majority of learners completed the VP in a linear path in one attempt. A significant number either completed the case in a loop path in one attempt, completed in a linear path in multiple attempts or dropped out without attempting the case. VP design has a significant effect on dropout rates of learners. There is a higher dropout rate from a branched VP compared to linear VP. Discussion: Prior research showed that branched VPs are more engaging and promote greater learning compared to linear VPs. However, our results indicate that branched VPs had greater dropout compared to VPs that require less time to be solved. Conclusions: We conclude that branching had a negative effect on completion of the VP activity in the MOOC. Moreover, we believe that more complex VPs require more effort on task and this might not be a design that facilitates the interaction in a MOOC audience, where the participants might wish to acquire the basic medical knowledge offered by the course.
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| 17. |
- Sudacka, Małgorzata, et al.
(författare)
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Why is it so difficult to implement a longitudinal clinical reasoning curriculum? A multicenter interview study on the barriers perceived by European health professions educators
- 2021
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Ingår i: BMC Medical Education. - : BioMed Central. - 1472-6920. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Effective clinical reasoning is a core competency of health professionals that is necessary to assure patients' safety. Unfortunately, adoption of longitudinal clinical reasoning curricula is still infrequent. This study explores the barriers that hinder the explicit teaching of clinical reasoning from a new international perspective.METHODS: The context of this study was a European project whose aim is to develop a longitudinal clinical reasoning curriculum. We collected data in semi-structured interviews with responders from several European countries who represent various health professions and have different backgrounds, roles and experience. We performed a qualitative content analysis of the gathered data and constructed a coding frame using a combined deductive/inductive approach. The identified themes were validated by parallel coding and in group discussions among project members.RESULTS: A total of 29 respondents from five European countries participated in the interviews; the majority of them represent medicine and nursing sciences. We grouped the identified barriers into eight general themes: Time, Culture, Motivation, Clinical Reasoning as a Concept, Teaching, Assessment, Infrastructure and Others. Subthemes included issues with discussing errors and providing feedback, awareness of clinical reasoning teaching methods, and tensions between the groups of professionals involved.CONCLUSIONS: This study provides an in-depth analysis of the barriers that hinder the teaching of explicit clinical reasoning. The opinions are presented from the perspective of several European higher education institutions. The identified barriers are complex and should be treated holistically due to the many interconnections between the identified barriers. Progress in implementation is hampered by the presence of reciprocal causal chains that aggravate this situation. Further research could investigate the perceptual differences between health professions regarding the barriers to clinical reasoning. The collected insights on the complexity and diversity of these barriers will help when rolling out a long-term agenda for overcoming the factors that inhibit the implementation of clinical reasoning curricula.
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