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Ovitsh RK, Gupta S, Kusnoor A, Jackson JM, Roussel D, Mooney CJ, Pinto-Powell R, Appel JL, Mhaskar R, Gold J. Minding the gap: towards a shared clinical reasoning lexicon across the pre-clerkship/clerkship transition. MEDICAL EDUCATION ONLINE 2024; 29:2307715. [PMID: 38320116 PMCID: PMC10848998 DOI: 10.1080/10872981.2024.2307715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024]
Abstract
Teaching and learning of clinical reasoning are core principles of medical education. However, little guidance exists for faculty leaders to navigate curricular transitions between pre-clerkship and clerkship curricular phases. This study compares how educational leaders in these two phases understand clinical reasoning instruction. Previously reported cross-sectional surveys of pre-clerkship clinical skills course directors, and clerkship leaders were compared. Comparisons focused on perceived importance of a number of core clinical reasoning concepts, barriers to clinical reasoning instruction, level of familiarity across the undergraduate medical curriculum, and inclusion of clinical reasoning instruction in each area of the curriculum. Analyses were performed using the Mann Whitney U test. Both sets of leaders rated lack of curricular time as the largest barrier to teaching clinical reasoning. Clerkship leaders also noted a lack of faculty with skills to teach clinical reasoning concepts as a significant barrier (p < 0.02), while pre-clerkship leaders were more likely to perceive that these concepts were too advanced for their students (p < 0.001). Pre-clerkship leaders reported a higher level of familiarity with the clerkship curriculum than clerkship leaders reported of the pre-clerkship curriculum (p < 0.001). As faculty transition students from the pre-clerkship to the clerkship phase, a shared understanding of what is taught and when, accompanied by successful faculty development, may aid the development of longitudinal, milestone-based clinical reasoning instruction.
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Affiliation(s)
- Robin K. Ovitsh
- Department of Pediatrics, Downstate Health Sciences University College of Medicine, Brooklyn, NY, USA
| | - Shanu Gupta
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Anita Kusnoor
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer M. Jackson
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Danielle Roussel
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Christopher J. Mooney
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Roshini Pinto-Powell
- Department of Medicine and Medical Education, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Joel L. Appel
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida College of Medicine, Tampa, FL, USA
| | - Jonathan Gold
- Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, MI, USA
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Koelewijn G, Hennus MP, Kort HSM, Frenkel J, van Houwelingen T. Games to support teaching clinical reasoning in health professions education: a scoping review. MEDICAL EDUCATION ONLINE 2024; 29:2316971. [PMID: 38394053 PMCID: PMC10896137 DOI: 10.1080/10872981.2024.2316971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Given the complexity of teaching clinical reasoning to (future) healthcare professionals, the utilization of serious games has become popular for supporting clinical reasoning education. This scoping review outlines games designed to support teaching clinical reasoning in health professions education, with a specific emphasis on their alignment with the 8-step clinical reasoning cycle and the reflective practice framework, fundamental for effective learning. METHODS A scoping review using systematic searches across seven databases (PubMed, CINAHL, ERIC, PsycINFO, Scopus, Web of Science, and Embase) was conducted. Game characteristics, technical requirements, and incorporation of clinical reasoning cycle steps were analyzed. Additional game information was obtained from the authors. RESULTS Nineteen unique games emerged, primarily simulation and escape room genres. Most games incorporated the following clinical reasoning steps: patient consideration (step 1), cue collection (step 2), intervention (step 6), and outcome evaluation (step 7). Processing information (step 3) and understanding the patient's problem (step 4) were less prevalent, while goal setting (step 5) and reflection (step 8) were least integrated. CONCLUSION All serious games reviewed show potential for improving clinical reasoning skills, but thoughtful alignment with learning objectives and contextual factors is vital. While this study aids health professions educators in understanding how games may support teaching of clinical reasoning, further research is needed to optimize their effective use in education. Notably, most games lack explicit incorporation of all clinical reasoning cycle steps, especially reflection, limiting its role in reflective practice. Hence, we recommend prioritizing a systematic clinical reasoning model with explicit reflective steps when using serious games for teaching clinical reasoning.
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Affiliation(s)
- Gilbert Koelewijn
- Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Department of Pediatrics, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marije P. Hennus
- Department of Pediatrics, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
- Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Helianthe S. M. Kort
- Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Building Healthy Environments for Future Users Group, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Joost Frenkel
- Department of Pediatrics, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thijs van Houwelingen
- Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, the Netherlands
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Leal P, Poeira A, Mendes DA, Batalha N, Franco H, Nunes L, Marques F, Pađen L, Stefaniak M, Pérez-Perdomo A, Bangels L, Lemmens K, Amaral G. Teaching and Learning Clinical Reasoning in Nursing Education: A Student Training Course. Healthcare (Basel) 2024; 12:1219. [PMID: 38921333 PMCID: PMC11202887 DOI: 10.3390/healthcare12121219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
Clinical reasoning is an essential component of nursing. It has emerged as a concept that integrates the core competencies of quality and safety education for nurses. In cooperation with five European partners, Instituto Politécnico de Setúbal (IPS) realized the "Clinical Reasoning in Nursing and Midwifery Education and Practice" project as part of the Erasmus+ project. As a partner, our team designed a multiplier event-the student training course. The aim of this report is to describe the construction and development of this clinical reasoning training course for nursing students. We outline the pedagogical approach of an undergraduate training course on clinical reasoning in 2023, which we separated into four stages: (i) welcoming, (ii) knowledge exploration, (iii) pedagogical learning, and (iv) sharing experience. This paper presents the learning outcomes of the collaborative reflection on and integration of the clinical reasoning concept among nursing students. This educational experience fostered reflection and discussion within the teaching team of the nursing department regarding the concept, models, and teaching/learning methods for clinical reasoning, with the explicit inclusion of clinical reasoning content in the nursing curriculum. We highlight the importance of implementing long-term pedagogical strategies in nursing education.
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Affiliation(s)
- Paula Leal
- ESEL Nursing School of Lisbon, 1600-190 Lisbon, Portugal;
| | - Ana Poeira
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Campus do IPS—Estefanilha, 2910-470 Setúbal, Portugal; (A.P.); (D.A.M.); (N.B.); (H.F.); (L.N.); (F.M.)
- Comprehensive Health Research Centre [CHRC], 1150-082 Lisbon, Portugal
| | - Diana Arvelos Mendes
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Campus do IPS—Estefanilha, 2910-470 Setúbal, Portugal; (A.P.); (D.A.M.); (N.B.); (H.F.); (L.N.); (F.M.)
- Comprehensive Health Research Centre [CHRC], 1150-082 Lisbon, Portugal
| | - Nara Batalha
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Campus do IPS—Estefanilha, 2910-470 Setúbal, Portugal; (A.P.); (D.A.M.); (N.B.); (H.F.); (L.N.); (F.M.)
- Unidade Local de Saúde da Arrábida, EPE—Hospital São Bernardo, 2910-446 Setúbal, Portugal
| | - Hugo Franco
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Campus do IPS—Estefanilha, 2910-470 Setúbal, Portugal; (A.P.); (D.A.M.); (N.B.); (H.F.); (L.N.); (F.M.)
| | - Lucília Nunes
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Campus do IPS—Estefanilha, 2910-470 Setúbal, Portugal; (A.P.); (D.A.M.); (N.B.); (H.F.); (L.N.); (F.M.)
- Comprehensive Health Research Centre [CHRC], 1150-082 Lisbon, Portugal
| | - Fernanda Marques
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Campus do IPS—Estefanilha, 2910-470 Setúbal, Portugal; (A.P.); (D.A.M.); (N.B.); (H.F.); (L.N.); (F.M.)
- Comprehensive Health Research Centre [CHRC], 1150-082 Lisbon, Portugal
| | - Ljubiša Pađen
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester M13 9PL, UK
| | - Małgorzata Stefaniak
- Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Ana Pérez-Perdomo
- Hospital Clinic of Barcelona, Fundacio Clinic per a la Recerca Biomedica, 08036 Barcelona, Spain;
| | - Lore Bangels
- University Colleges Leuven-Limburg, 3590 Diepenbeek, Belgium;
| | | | - Guida Amaral
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Campus do IPS—Estefanilha, 2910-470 Setúbal, Portugal; (A.P.); (D.A.M.); (N.B.); (H.F.); (L.N.); (F.M.)
- Comprehensive Health Research Centre [CHRC], 7002-554 Évora, Portugal
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Wagner FL, Sudacka M, Kononowicz AA, Elvén M, Durning SJ, Hege I, Huwendiek S. Current status and ongoing needs for the teaching and assessment of clinical reasoning - an international mixed-methods study from the students` and teachers` perspective. BMC MEDICAL EDUCATION 2024; 24:622. [PMID: 38840110 PMCID: PMC11151606 DOI: 10.1186/s12909-024-05518-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024]
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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Affiliation(s)
- F L Wagner
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland.
| | - M Sudacka
- Center of Innovative Medical Education, Department of Medical Education, Jagiellonian University, Kraków, Poland
| | - A A Kononowicz
- Faculty of Medicine, Department of Bioinformatics and Telemedicine, Jagiellonian University, Kraków, Poland
| | - M Elvén
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - S J Durning
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - I Hege
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - S Huwendiek
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
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Flores-Cohaila JA, Vizcarra-Jiménez SF, Bermúdez-Peláez MF, Vascones-Román FF, Rivarola-Hidalgo M, Taype-Rondan A. Effects of SNAPPS in clinical reasoning teaching: a systematic review with meta-analysis of randomized controlled trials. Diagnosis (Berl) 2024; 0:dx-2023-0149. [PMID: 38446132 DOI: 10.1515/dx-2023-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/09/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Clinical reasoning is crucial in medical practice, yet its teaching faces challenges due to varied clinical experiences, limited time, and absence from competency frameworks. Despite efforts, effective teaching methodologies remain elusive. Strategies like the One Minute Preceptor (OMP) and SNAPPS are proposed as solutions, particularly in workplace settings. SNAPPS, introduced in 2003, offers a structured approach but lacks comprehensive evidence of its effectiveness. Methodological shortcomings hinder discerning its specific effects. Therefore, a systematic review is proposed to evaluate SNAPPS' impact on clinical reasoning teaching. CONTENT We searched PubMed, EMBASE, and CINAHL for randomized controlled trials (RCTs) comparing SNAPPS against other methods. Data selection and extraction were performed in duplicate. Bias and certainty of evidence were evaluated using Cochrane RoB-2 and GRADE approach. SUMMARY We identified five RCTs performed on medical students and residents. Two compared SNAPPS with an active control such as One Minute Preceptor or training with feedback. None reported the effects of SNAPPS in workplace settings (Kirkpatrick Level 3) or patients (Kirkpatrick Level 4). Low to moderate certainty of evidence suggests that SNAPPS increases the total presentation length by increasing discussion length. Low to moderate certainty of evidence may increase the number of differential diagnoses and the expression of uncertainties. Low certainty of evidence suggests that SNAPPS may increase the odds of trainees initiating a management plan and seeking clarification. OUTLOOK Evidence from this systematic review suggests that SNAPPS has some advantages in terms of clinical reasoning, self-directed learning outcomes, and cost-effectiveness. Furthermore, it appears more beneficial when used by residents than medical students. However, future research should explore outcomes outside SNAPPS-related outcomes, such as workplace or patient-related outcomes.
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Affiliation(s)
| | - Sonia F Vizcarra-Jiménez
- Escuela de Medicina Humana, Facultad de Ciencias de la Salud, 120782 Universidad Privada de Tacna , Tacna, Peru
| | | | | | - Marco Rivarola-Hidalgo
- Centro de Estudios e Investigación en Educación Médica y Bioética, 120782 Universidad Privada de Tacna , Tacna, Peru
| | - Alvaro Taype-Rondan
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, 33225 Universidad San Ignacio de Loyola , Lima, Peru
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Naya K, Sakuramoto H, Nojima K, Ouchi A, Okamoto S, Kawasaki T, Kitae M. Translation, Reliability, and Validity of the Japanese Clinical Reasoning Skills Self-Evaluation Scale: An Instrument Design Study. Cureus 2024; 16:e53177. [PMID: 38420045 PMCID: PMC10901550 DOI: 10.7759/cureus.53177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Currently, little evidence supports the notion that improved practical skills through simulation education are reflected in actual clinical practice and ultimately lead to positive outcomes for participants. However, by clarifying the relationship between the simulation foundation and its practicality, insights can be gained to develop educational programs to improve clinical reasoning skills. However, no clear scale is currently available in Japan. AIMS To create a valid Japanese version of the clinical reasoning skills self-evaluation scale and evaluate its reliability and validity. METHODS This instrument design study included 580 nursing students and nurses surveyed online from February to March 2023. The clinical reasoning skills self-evaluation scale was translated into Japanese using a back-translation method, and semantic equivalence and content validity were assessed. The content validity index was assessed using a pilot test involving 26 clinical nurses, 25 nursing students, and an expert panel. Validity and reliability were tested using a convenience sample of 580 nursing students and nurses. Reliability was assessed using internal consistency and test-retest reliability. Construct validity was assessed using confirmatory factor analysis. RESULTS Cronbach's alpha for all dimensions was >0.7, and the questionnaire showed acceptable internal consistency. Test-retest reliability was evaluated using the intraclass correlation coefficient (0.674-0.797, all dimensions); the lowest value at a 95% confidence interval was 0.504 (at least moderate reliability). CONCLUSION Our scale has acceptable validity and reliability. It may help in clinical reasoning skill assessment for nurses and nursing students and aid in examining and supporting these skills.
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Affiliation(s)
- Kazuaki Naya
- Nursing, Wakayama Faculty of Nursing, Tokyo Healthcare University, Wakayama, JPN
| | - Hideaki Sakuramoto
- Critical Care, Japanese Red Cross Kyushu International College of Nursing, Munakata, JPN
| | | | - Akira Ouchi
- Critical Care, Ibaraki Christian College, Hitachi, JPN
| | | | - Takeya Kawasaki
- Respiratory Medicine, Ibarakihigashi National Hospital, Tokai, JPN
| | - Misako Kitae
- Nursing, Wakayama Faculty of Nursing, Tokyo Healthcare University, Wakayama, JPN
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Boyle JG, Walters MR, Jamieson S, Durning SJ. Distributed cognition: Theoretical insights and practical applications to health professions education: AMEE Guide No. 159. MEDICAL TEACHER 2023; 45:1323-1333. [PMID: 37043405 DOI: 10.1080/0142159x.2023.2190479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Distributed cognition (DCog) is a member of the family of situativity theories that widens the lens of cognition from occurring solely inside the head to being socially, materially and temporally distributed within a dynamic system. The concept of extending the view of cognition to outside the head of a single health professional is relatively new in the healthcare system. DCog has been increasingly used by researchers to describe many ways in which health professionals perform in teams within structured clinical environments to deliver healthcare for patients. In this Guide, we expound ten central tenets of the macro (grand) theory of DCog (1. Cognition is decentralized in a system; 2. The unit of analysis is the system; 3. Cognitive processes are distributed; 4. Cognitive processes emerge from interactions; 5. Cognitive processes are interdependent; 6. Social organization is a cognitive architecture; 7. Division of labour; 8. Social organization is a system of communication; 9. Buffering and filtering; 10. Cognitive processes are encultured) to provide theoretical insights as well as practical applications to the field of health professions education.
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Affiliation(s)
- James G Boyle
- Undergraduate Medical School, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Matthew R Walters
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Susan Jamieson
- Health Professions Education Programme, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Steven J Durning
- Center for Health Professions Education, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Pađen L, Pajnič M, Vettorazzi R, Pérez-Perdomo A, Stefaniak M, Claes N, Franco H, Vandervoort A, Ravljen M. "Learning a Way of Thinking"-World Café on Clinical Reasoning in Nursing and Midwifery Education and Practice across Five European Union Countries. Healthcare (Basel) 2023; 11:2969. [PMID: 37998462 PMCID: PMC10671496 DOI: 10.3390/healthcare11222969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/29/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
Clinical reasoning is a key attribute of nursing and midwifery professionals. As a part of the Erasmus plus project, we designed a study with the aim of exploring the understanding of clinical reasoning as a concept, experiences of teaching clinical reasoning and practices related to using clinical reasoning in nursing and midwifery. A qualitative study was carried out using the World Café method, involving 44 participants from five European countries. The participants represented diverse professional backgrounds, including nurses, midwives and lecturers. Our analytical approach was based on a thematic analysis. We categorized the data into three main categories, namely, "Spiral of thinking", "The learning and teaching of a way of thinking" and "Clinical reasoning in real life", all under an overarching theme, "Learning a way of thinking". This study highlighted areas of learning and teaching which can be improved in current nursing and midwifery education. Furthermore, it identified barriers, facilitators and practices from five European countries which can be used in the further development of nursing and midwifery curricula and courses with the aim of enhancing clinical reasoning competence and ultimately improving patient care.
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Affiliation(s)
- Ljubiša Pađen
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia; (L.P.); (M.P.); (R.V.)
| | - Manca Pajnič
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia; (L.P.); (M.P.); (R.V.)
| | - Renata Vettorazzi
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia; (L.P.); (M.P.); (R.V.)
| | | | - Małgorzata Stefaniak
- Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Nele Claes
- HBO Verpleegkunde Genk, 3600 Genk, Belgium;
| | - Hugo Franco
- School of Health Setúbal, Setúbal Polytechnic University, 2910-761 Setúbal, Portugal;
| | | | - Mirjam Ravljen
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia; (L.P.); (M.P.); (R.V.)
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Huesmann L, Sudacka M, Durning SJ, Georg C, Huwendiek S, Kononowicz AA, Schlegel C, Hege I. Clinical reasoning: What do nurses, physicians, and students reason about. J Interprof Care 2023; 37:990-998. [PMID: 37190790 DOI: 10.1080/13561820.2023.2208605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/17/2023]
Abstract
Clinical reasoning is a core ability in the health professions, but the term is conceptualised in multiple ways within and across professions. For interprofessional teamwork it is indispensable to recognise the differences in understanding between professions. Therefore, our aim was to investigate how nurses, physicians, and medical and nursing students define clinical reasoning. We conducted 43 semi-structured interviews with an interprofessional group from six countries and qualitatively analysed their definitions of clinical reasoning based on a coding guide. Our results showed similarities across professions, such as the emphasis on clinical skills as part of clinical reasoning. But we also revealed differences, such as a more patient-centered view and a broader understanding of the clinical reasoning concept in nurses and nursing students. The explicit sharing and discussion of differences in the understanding of clinical reasoning across health professions can provide valuable insights into the perspectives of different team members on clinical practice and education. This understanding may lead to improved interprofessional collaboration, and our study's categories and themes can serve as a basis for such discussions.
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Affiliation(s)
- Lukas Huesmann
- Medical Education Sciences, University of Augsburg, Augsburg, Germany
| | - Małgorzata Sudacka
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Steven J Durning
- Department of Medicine, Center for Health Professions Education, Uniformed Services University, Bethesda, Maryland, USA
| | - Carina Georg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Andrzej A Kononowicz
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Kraków, Poland
| | - Claudia Schlegel
- Department Learning, Training & Transfer, Bern, College of Higher Education of Nursing, Bern, Switzerland
| | - Inga Hege
- Medical Education Sciences, University of Augsburg, Augsburg, Germany
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Isbej L, Fuentes-Cimma J, Véliz Paiva C, Valladares-Pérez S, Riquelme A. A comprehensive approach to identify challenges for clinical reasoning development in undergraduate dental students and their potential solutions. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2023; 27:859-868. [PMID: 36458893 DOI: 10.1111/eje.12876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/05/2022] [Accepted: 10/30/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Clinical reasoning is a core competence in health professions that impacts the ability to solve patients' health problems. Due to its relevance, it is necessary to identify difficulties arising from different sources that affect clinical reasoning development in students. The aim of this study was to explore a comprehensive approach to identify challenges for clinical reasoning development in undergraduate dental students and their potential solutions. METHODS Mixed methods were used in four stages: (1) students and clinical teachers focus groups to identify challenges to clinical reasoning development; (2) literature review to explore potential solutions for these challenges; (3) Delphi technique for teacher consensus on pertinence and feasibility of solutions (1-5 scale); and (4) teachers' self-perception of their ability to implement the solutions. RESULTS Three categories and seven subcategories of challenges were identified: (I) educational context factors influencing the clinical reasoning process; (II) teacher's role in clinical reasoning development; and (III) student factors influencing the clinical reasoning process. From 134 publications identified, 53 were selected for review, resulting in 10 potential solutions. Through two Delphi rounds, teachers rated the potential solutions very highly in terms of relevance (4.50-4.85) and feasibility (3.50-4.29). Finally, a prioritisation ranking of these solutions was generated using their scores for relevance, feasibility, and teachers' self-perception of their ability to implement them. CONCLUSIONS The present comprehensive approach identified challenges for clinical reasoning development in dental students and their potential solutions, perceived as relevant and feasible by teachers, requiring further research and follow-up actions to address them.
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Affiliation(s)
- Lorena Isbej
- Faculty of Medicine, School of Dentistry, Pontificia Universidad Católica de Chile, Santiago, Chile
- Pharmacology and Toxicology Programme, Faculty of Medicine Pontificia Universidad Católica de Chile, Santiago, Chile
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Javiera Fuentes-Cimma
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
- Department of Health Sciences, Faculty of Medicine Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Véliz Paiva
- Faculty of Medicine, School of Dentistry, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Arnoldo Riquelme
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centre of Medical Education and Health Sciences, Faculty of Medicine Pontificia Universidad Católica de Chile, Santiago, Chile
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Murillo Chavez FA, Araujo de Oliveira Santana M, Yildirim S, Alemán MJ, Nematollahi S. Geographic Diversity in Clinical Problem-Solving Exercises. J Gen Intern Med 2023; 38:2841-2842. [PMID: 36973574 PMCID: PMC10506961 DOI: 10.1007/s11606-023-08180-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Franco A Murillo Chavez
- Sinai Hospital of Baltimore, Baltimore, MD, USA.
- Facultad de Ciencias de La Salud, Carrera de Medicina Humana, Universidad Científica del Sur, Lima, Peru.
| | | | | | - María Jimena Alemán
- School of Medicine, Universidad Francisco Marroquín, Guatemala City, Guatemala
| | - Saman Nematollahi
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
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Hege I, Adler M, Donath D, Durning SJ, Edelbring S, Elvén M, Bogusz A, Georg C, Huwendiek S, Körner M, Kononowicz AA, Parodis I, Södergren U, Wagner FL, Wiegleb Edström D. Developing a European longitudinal and interprofessional curriculum for clinical reasoning. Diagnosis (Berl) 2023; 10:218-224. [PMID: 36800998 DOI: 10.1515/dx-2022-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/24/2023] [Indexed: 02/19/2023]
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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Affiliation(s)
- Inga Hege
- Medical Education Sciences, University of Augsburg, Augsburg, Germany
| | | | - Daniel Donath
- Faculty of Medicine and Health, EDU Higher Education Institute, Kalkara, Malta
| | - Steven J Durning
- Uniformed Services University of the Health Sciences, Bethesda, USA
| | | | - Maria Elvén
- School of Health Sciences, Örebro University, Örebro, Sweden
- School of Health, Care and Social Welfare, Mälardalen University, Örebro, Sweden
| | - Ada Bogusz
- Jagiellonian University Medical College, Kraków, Poland
| | - Carina Georg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, Bern, Switzerland
| | - Melina Körner
- Medical Education Sciences, University of Augsburg, Augsburg, Germany
| | | | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Felicitas L Wagner
- Department for Assessment and Evaluation, Institute for Medical Education, Bern, Switzerland
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13
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Harendza S, Bußenius L, Gärtner J, Heuser M, Ahles J, Prediger S. "Fit for the finals" - project report on a telemedical training with simulated patients, peers, and assessors for the licensing exam. GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc17. [PMID: 37361248 PMCID: PMC10285374 DOI: 10.3205/zma001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/11/2023] [Accepted: 02/06/2023] [Indexed: 06/28/2023]
Abstract
Background Undergraduate medical students take the licensing exam (M3) as a two-day oral-practical examination. The main requirements are to demonstrate history taking skills and coherent case presentations. The aim of this project was to establish a training in which students can test their communication skills during history taking and their clinical reasoning skills in focused case presentations. Methods In the newly developed training, final-year students took four telemedical histories in the role of physicians from simulated patients (SP). They received further findings for two SPs and presented these in a handover, in which they also received a handover of two SPs which they had not seen themselves. Each student presented one of the two received SPs in a case discussion with a senior physician. Feedback was given to the participants on their communication and interpersonal skills by the SPs with the ComCare questionnaire and on the case presentation by the senior physician. Sixty-two students from the universities of Hamburg and Freiburg in their final year participated in September 2022 and evaluated the training. Results Participants felt that the training was very appropriate for exam preparation. The SPs' feedback on communication and the senior physician's feedback on clinical reasoning skills received the highest ratings in importance to the students. Participants highly valued the practice opportunity for structured history taking and case presentation and would like to have more such opportunities in the curriculum. Conclusion Essential elements of the medical licensing exam can be represented, including feedback, in this telemedical training and it can be offered independent of location.
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Affiliation(s)
- Sigrid Harendza
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
| | - Lisa Bußenius
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
| | - Julia Gärtner
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
| | - Miriam Heuser
- Albert-Ludwigs-Universität Freiburg, Medizinische Fakultät, Studiendekanat, Freiburg, Germany
| | - Jonathan Ahles
- Albert-Ludwigs-Universität Freiburg, Medizinische Fakultät, Studiendekanat, Freiburg, Germany
| | - Sarah Prediger
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
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Elvén M, Welin E, Wiegleb Edström D, Petreski T, Szopa M, Durning SJ, Edelbring S. Clinical Reasoning Curricula in Health Professions Education: A Scoping Review. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231209093. [PMID: 37900617 PMCID: PMC10605682 DOI: 10.1177/23821205231209093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/09/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVES This scoping review aimed to explore and synthesize current literature to advance the understanding of how to design clinical reasoning (CR) curricula for students in health professions education. METHODS Arksey and O'Malley's 6-stage framework was applied. Peer-reviewed articles were searched in PubMed, Web of Science, CINAHL, and manual searches, resulting in the identification of 2932 studies. RESULTS Twenty-six articles were included on CR in medical, nursing, physical therapy, occupational therapy, midwifery, dentistry, and speech language therapy education. The results describe: features of CR curriculum design; CR theories, models, and frameworks that inform curricula; and teaching content, methods, and assessments that inform CR curricula. CONCLUSIONS Several CR theories, teaching, and assessment methods are integrated into CR curricula, reflecting the multidimensionality of CR among professions. Specific CR elements are addressed in several curricula; however, no all-encompassing CR curriculum design has been identified. These findings offer useful insights for educators into how CR can be taught and assessed, but they also suggest the need for further guidance on educational strategies and assessments while learners progress through an educational program.
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Affiliation(s)
- Maria Elvén
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Elisabet Welin
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Desiree Wiegleb Edström
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Tadej Petreski
- Institute for Biomedical Sciences, Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Magdalena Szopa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Steven J. Durning
- Department of Medicine, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Samuel Edelbring
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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