Project

Developing, implementing, and disseminating an adaptive clinical reasoning curriculum for healthcare students and educators (DID-ACT)

Goal: Clinical reasoning is a complex set of abilities healthcare students have to learn during their studies and continue to further develop in the workplace. Clinical reasoning encompasses the application of knowledge to collect and integrate information from various sources to arrive at a diagnosis and management plan for patients in a shared decision-making process. Due to its multifactorial nature and unconscious components it is both, difficult to learn and teach.
A lack of clinical reasoning abilities is a primary cause of cognitive errors in patient care and threats to patient safety including unnecessary pain, treatments, or procedures for patients and increasing the costs of healthcare.
Despite the importance of clinical reasoning for the workplace of healthcare professionals and patient safety there is still a lack of structured and explicit teaching, learning, and assessment of clinical reasoning in healthcare education. Such a training can help to improve patient safety and reduce costs.

Therefore, the aim of this project is to fill this gap and conceptualize, develop, evaluate, and disseminate a clinical reasoning curriculum in
healthcare education for students and a train-the-trainer course for educators on how to teach clinical reasoning.

Both, the train-the-trainer course and the student curriculum will leverage best practices in instruction, assessment and clinical reasoning theory and combine online and face-to-face teaching components to achieve optimal learning effects. To facilitate dissemination, the curriculum will be adaptable to existing curricula, enabling curriculum managers and educators to adopt it in a step-wise approach and integrate it into existing courses. This process will be
supported by publishing guidelines.

The project is funded by an EU Erasmus+ Knowledge Alliance grant.
More information can be found at www.did-act.eu

Disclaimer: The European Commission's support for the production of this publication does not constitute an endorsement of the contents, which reflect the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein

Methods: Questionnaire-Based Surveys, interviews, Design thinking, social network analysis

Date: 1 January 2020 - 31 December 2022

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Project log

Inga Hege
added an update
Our team will present interesting results of our project at the upcoming AMEE this year, which will take place at the end of August as hybrid event in Lyon, France. Topics we will cover include international aspects of our project, needs regarding teaching and assessment of clinical reasoning, and the results of our pilot implementations.
Finally, we are also offering a pre-conference workshop, lead by Monika Sobocan, on a Teaching clinical reasoning toolkit.
More information about AMEE can be found on their website: https://amee.org/conferences/amee-2022
We are looking forward to seeing you there!
 
Inga Hege
added an update
At the end of March we published the evaluation results of our student curriculum pilots.
Overall, students agreed the piloted DID-ACT learning units improved their clinical reasoning skills. As a special strength of the curriculum students frequently named the benefit of virtual patients and cases integrated into the learning units. Another highlight were small-group group discussions, often conducted in multinational teams which broadened their views on clinical reasoning. However, we also received several requests for modifications of the developed learning material that we will address in the “refinement of course based on pilot implementation” stage of the project.
 
Inga Hege
added an update
WIthin the DID-ACT project we piloted our train-the-trainer learning units in the last few month with educators across Europe and from different health professions.
For more information please visit our latest blog post at https://did-act.eu/category/news/
At the moment we are piloting our learning units for students and will publish first results at the beginning of next year!
 
Inga Hege
added 3 research items
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.
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.
Samuel Edelbring
added 9 research items
Synthesizing evidence from randomized controlled trials of digital health education poses some challenges. These include a lack of clear categorization of digital health education in the literature; constantly evolving concepts, pedagogies, or theories; and a multitude of methods, features, technologies, or delivery settings. The Digital Health Education Collaboration was established to evaluate the evidence on digital education in health professions; inform policymakers, educators, and students; and ultimately, change the way in which these professionals learn and are taught. The aim of this paper is to present the overarching methodology that we use to synthesize evidence across our digital health education reviews and to discuss challenges related to the process. For our research, we followed Cochrane recommendations for the conduct of systematic reviews; all reviews are reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidance. This included assembling experts in various digital health education fields; identifying gaps in the evidence base; formulating focused research questions, aims, and outcome measures; choosing appropriate search terms and databases; defining inclusion and exclusion criteria; running the searches jointly with librarians and information specialists; managing abstracts; retrieving full-text versions of papers; extracting and storing large datasets, critically appraising the quality of studies; analyzing data; discussing findings; drawing meaningful conclusions; and drafting research papers. The approach used for synthesizing evidence from digital health education trials is commonly regarded as the most rigorous benchmark for conducting systematic reviews. Although we acknowledge the presence of certain biases ingrained in the process, we have clearly highlighted and minimized those biases by strictly adhering to scientific rigor, methodological integrity, and standard operating procedures. This paper will be a valuable asset for researchers and methodologists undertaking systematic reviews in digital health education.
Stakeholders in healthcare and education find interprofessional teamwork to be crucial for today's 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.
Background Interprofessional collaboration is increasingly important in healthcare, but interprofessional education (IPE) faces challenges, such as different study programmes with varied schedules and campuses. These challenges can be met, in part, by using web-based virtual patients (VPs) as a tool in IPE. However, demands for relevant patient presentations and clinical practice increase when VPs are used by students from different programmes. The aim of this study was to improve the presentation of professional perspectives regarding nurses and physicians and their collaboration in order to increase the clinical authenticity of existing VPs. Methods Clinical observations were conducted to gain familiarity with the context. Semi-structured interviews were performed with individual nurses and physicians with experience of patients with leg ulcers. The interviews were recorded, transcribed and analysed using thematic analysis. Results The clinical observations exposed a lack of interprofessional collaboration in practice with regard to patients with leg ulcers. The interview analysis resulted in two themes: Clinical care and Organizational structure. The theme Clinical care included nursing with a holistic approach to the patient and awareness of the patient’s well-being, including nutrition and home situation. The theme Organizational structure revealed a lack of teamwork in primary care. The interviewees stressed learning together and sharing responsibility, and they emphasised the importance of implementing interprofessional learning in the education of nurses and physicians in order to stimulate future teamwork. The VP should offer a broad medical history so that healthcare students are made aware of how a disease can affect the patient’s social situation, and thereby illustrate the importance of interprofessional collaboration. The information should also be comprehensive and clear, leading to a diagnosis, so the student can gain clinical knowledge and build a foundation for discussion of treatment. Conclusions Interviews and observations in clinical practice can be used to enhance authenticity in VPs for interprofessional learning. A thorough look at authentic clinical environments can enrich and improve educational settings using VPs, and it can highlight the challenges students can encounter in clinical care of the patient and in an organisation with regard to interprofessional collaboration.
Inga Hege
added an update
Today our latest project-related publication has been published:
Parodis I, Andersson L, Durning SJ, Hege I, Knez J, Kononowicz AA, Lidskog M, Petreski T, Szopa M, Edelbring S. Clinical Reasoning Needs to Be Explicitly Addressed in Health Professions Curricula: Recommendations from a European Consortium. Int. J. Environ. Res. Public Health 2021, 18(21), 11202
The full text can be accessed at https://www.mdpi.com/1660-4601/18/21/11202/htm
 
Inga Hege
added an update
The Medical Education Forum (https://www.mp.pl/mef/2021/) was held online this year with pre-recorded presentations and a vivid Q&A session via video conferencing. Five DID-ACT partners had the opportunity to present on clinical reasoning, virtual patients, workplace-based assessment, and interprofessional education. To view the recorded presentations please visit:
 
Inga Hege
added an update
Recently we published the blueprint for our DID-ACT clinical reasoning curriculum and train-the-trainer course. This blueprint serves as a guideline for the development of the specific learning units. The blueprint is available at https://did-act.eu/curricular-blueprint/
Any feedback and comments are welcome!
 
Inga Hege
added an update
For our Polish speaking community:
Szopa M, Sudacka M, Kononowicz AA. Jak Z Sukcesem Wdrożyć Efektywne Nauczanie Rozumowania Klinicznego Na Kierunkach Medycznych? Alma Mater. 2021; 222-223:34-6. this article is accessible on-line (in Polish): https://issuu.com/alma-mater/docs/alma_mater_222-223/36
 
Inga Hege
added an update
As part of the project's workpackage 2 we published a set of overall learning outcomes for the DID-ACT clinical reasoning curriculum. They are aligned with 14 related themes, such as theories, collaborative aspects, or cognitive errors: https://did-act.instruct.eu/course/view.php?id=5
Any feedback or suggestions are more than welcome!
 
Inga Hege
added an update
If you are interested in evaluating clinical reasoning student activities, please check out our DID-ACT project report. In this report we describe various evaluation instruments and also provide a collection of survey questions. It is available on the project website under:
 
Inga Hege
added an update
As part of the project's second workpackage we published our curricular framework, which includes the pedagogical approach, learning objectives, teaching & assessment methods, and learners progression. In addition we included examples on selected topics in which we outline the learning units that will be developed in our next workpackages.
 
Inga Hege
added a research item
The COVID-19 pandemic posed new global challenges for teaching. We met these challenges as an international collaboration by adapting a collection of virtual patients for clinical reasoning training to this novel context.
Inga Hege
added an update
See our latest blog post by Andrzej Kononowicz on the DID-ACT E-Poster presentation at the AMEE 2020 virtual conference: http://did-act.eu/?p=535
 
Inga Hege
added an update
The DID-ACT team completed the needs analysis for implementing a clinical reasoning curriculum. We laid a special emphasis on identifying barriers and preoccupations and interestingly our study participants most often mentioned cultural barriers for introducing such a curriculum. More information including the complete report is available on our website (http://did-act.eu/?p=499)
 
Inga Hege
added an update
In this short paper we report about adaptations we made to the current collection of virtual patients developed to deliberately practice clinical reasoning. The collection is freely available on https://crt.casus.net (Login via EduGain)
More information on online clinical reasoning resources can be found on our website: http://did-act.eu/?page_id=331
 
Inga Hege
added an update
Your feedback concerning clinical reasoning is needed! If you are working in healthcare or healthcare education, please help us by completing this survey:
Thank you!
 
Inga Hege
added a project goal
Clinical reasoning is a complex set of abilities healthcare students have to learn during their studies and continue to further develop in the workplace. Clinical reasoning encompasses the application of knowledge to collect and integrate information from various sources to arrive at a diagnosis and management plan for patients in a shared decision-making process. Due to its multifactorial nature and unconscious components it is both, difficult to learn and teach.
A lack of clinical reasoning abilities is a primary cause of cognitive errors in patient care and threats to patient safety including unnecessary pain, treatments, or procedures for patients and increasing the costs of healthcare.
Despite the importance of clinical reasoning for the workplace of healthcare professionals and patient safety there is still a lack of structured and explicit teaching, learning, and assessment of clinical reasoning in healthcare education. Such a training can help to improve patient safety and reduce costs.
Therefore, the aim of this project is to fill this gap and conceptualize, develop, evaluate, and disseminate a clinical reasoning curriculum in
healthcare education for students and a train-the-trainer course for educators on how to teach clinical reasoning.
Both, the train-the-trainer course and the student curriculum will leverage best practices in instruction, assessment and clinical reasoning theory and combine online and face-to-face teaching components to achieve optimal learning effects. To facilitate dissemination, the curriculum will be adaptable to existing curricula, enabling curriculum managers and educators to adopt it in a step-wise approach and integrate it into existing courses. This process will be
supported by publishing guidelines.
The project is funded by an EU Erasmus+ Knowledge Alliance grant.
More information can be found at www.did-act.eu
Disclaimer: The European Commission's support for the production of this publication does not constitute an endorsement of the contents, which reflect the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein