DID-ACT – Developing, implementing, and disseminating an adaptive clinical reasoning curriculum for healthcare students and educatorsDID-ACT

Project Overview

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. In the European Union the number of errors and adverse events in healthcare is estimated at 8-12% of hospitalizations (WHO). 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 – two priorities of the EU Health policy.

Project Objectives

The aim of the DID-ACT 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.

Target Groups


Our primary target groups are educators, healthcare professionals, students and faculty staff who can benefit from the clinical reasoning curriculum and the train-the-trainer course. For researchers the curriculum offers a great potential to address open research questions in clinical reasoning teaching.

The secondary target group includes patients and the public who can benefit from better educated students. Non-healthcare institutions can adopt parts of the curriculum relevant for their students.

Outline of the work

Publications & Resources

  • 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 Med Educ. 2024;24(1):622. (Full Text)
  • Our identified barriers on developing a longitudinal clinical reasoning curriculum has been published in BMC Med Ed
  • The general needs analysis, which was the basis for this project has been published in Medical Teacher
  • More than 60 open access virtual patients in English and German have been created as part of a previous Marie-Curie Global Fellowship. The courses are freely available at https://crt.casus.net (Login with EduGain account). Part of the virtual patients have been adapted to the current Covid-19 situation.
  • A series on short video clips about clinical reasoning and diagnostic errors is available as aplaylist on YouTube

More information

Contact

Please contact us at info@did-act.eu if you have any questions or comments concerning the project.

Project coordinator: Inga Hege

You can also follow DID-ACT updates on LinkedIn

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Virtual Patients (VPs)

The virtual patients integrated into the DID-ACT learning units are partly taken from the EU-funded project iCoViP and form the collection for deliberate practice. The virtual patients are freely accessible via the CASUS system at https://crt.casus.net and a description of available VPs with key symptoms and final diagnoses is available in this blueprint. Thus, you can choose VPs suitable for your students and also offer them the whole collection for longitudinal and deliberate practice.

Participants: Medical educators

Learning units: Person-centered approach and the role of patients
Level: Teacher

Description: Offered as part of the faculty development to faculty educators.
Mode: Part to the faculty development program with emphasize on the educational potential of clinical reasoning teaching techniques

Technical Integration: Access to the DID-ACT Moodle, synchronous sessions were held via the virtual platform NewRow.

Tips & Tricks:

Participants: Multi-professional educators (nurses, physicians, paramedics)

Learning units: What is Clinical Reasoning and Models
Level: Teacher

Description: Offered as additional faculty development opportunity to staff members of the Medical Education Department.
Mode: Option / additional part to the faculty development program with emphasize on the educational potential of clinical reasoning teaching techniques

Technical Integration: Access to the DID-ACT Moodle via EduGain, synchronous sessions were held face-to-face.

Tips & Tricks: Give participants time to familiarize themselves with the learning material between the sessions. Do not put too much in one day - better to meet twice for shorter sessions. Face-to-face sessions lead to more productive discussions than Zoom meetings. Focus on discussion with the audience and on examples from practical teaching to illustrate the learning objectives.

Participants: Multi-professional educators

Learning units: Differences and similarities in clinical reasoning among health professions
Level: Teacher

Description: Offered as part of the faculty development program, it was held as a blended learning course with the synchronous phase online.
Mode: Part of the faculty development program with certificate

Technical Integration: Access to the DID-ACT Moodle via EduGain, synchronous sessions were held online via Zoom.

Tips & Tricks: Give good practical information how Moodle works and how the participants can find and work with the different assigments of the learning unit. Emphasize the importance to the participants to work with the different individual tasks, as the discussions will be more interesting and fruitful. Also important that all the participants from different occupations feel comfortable to meet and that they all are a part of the discussion. This is an important and maybe the primary task for the facilitator!

Participants: Multi-professional and international educators

Learning units: Clinical Reasoning teaching and assessment & What is Clinical Reasoning and Models
Level: Teacher

Description: Offered as optional learning unit for participants of the Master of Medical Education (MME) program in Bern/Switzerland.
Mode: Part of the faculty development program with certificate

Technical Integration: Access to the DID-ACT Moodle via EduGain, synchronous sessions were held face-to-face.

Tips & Tricks: To foster a valuable learning experience it is indispensible to provide good case examples that are tailored to the needs and experiences of the participants, so that they can relate to their prior knowledge. Thus, the provided examples in this learning units might need some adaptations for your target group of educators.

Participants: Multi-professional educators across German-speaking coutries

Learning units: Differences and similarities in clinical reasoning among health professions
Level: Teacher

Description: Offered as part of the faculty development program at the University of Augsburg, but open to participants from Germany, Austria, and Switzerland. It was held as a blended learning course with the synchronous phase online. Participants were eager to exchange their experience and disucss their views across institutions and professions.
Mode: Part of the faculty development program with certificate

Technical Integration: Access to the DID-ACT Moodle via EduGain, synchronous sessions were held online via Zoom.

Tips & Tricks: To foster a valuable interprofessional experience the participants should represent a balanced mix of professions and also ideally the facilitators should at least represent two different professions. This allows a good discussion and also guarantees that the small groups can work interprofessionally. Our experience with a less-balanced group composition was that the over-represented profession dominates the discussions and it was quite difficult to counter-balance this.

Target group: Medical students in year 2

Learning units: Person-centered approach to clinical reasoning
Level: Novice

Description:The Learning Unit was run as an extra-curricular session as a virtual class. The facilitators were trained on this topic by attending the Train-the-trainer learning unit on "Person-centered approach and the role of patients".
Mode: Extracurricular activity

Technical Integration: Access to the DID-ACT Moodle via EduGain, synchronous sessions were held online via NewRow.

Tips & Tricks: Learning objective cross-referencing with the existing curriculum helps identify the level of integration. Encouraging and helping students to get familiar with Moodle before the session facilitates a smooth integration of the asynchronous phases.

Target group: Medical students in year 4 and 5

Learning units: Generating differential diagnoses and deciding about final diagnoses
Level: Novice

Description: The learning unit was integrated into a pediatric emergency department clerkship with a relation to virtual patients already used in this clerkship. Facilitators were trained by attending the train-the-trainer unit on "Information gathering, Generating differential diagnoses, Decision making, and Treatment planning".
Mode: Part of a regular curricular activity

Technical Integration: Access to the DID-ACT Moodle via EduGain, synchronous sessions were held face-to-face.

Tips & Tricks: Integration into clerkships works well, especially with a relation to already used content.

Target group: Medical students in year 1-6

Learning units: All 25 learning units of the DID-ACT curriculum
Level: Novice - Advanced

Description:
Longitudinal integration of the DID-ACT learning units into a clinical skills & communication course with the following suggested distribution across years:
Year 1: What is Clinical Reasoning, Person-centered approach to clinical reasoning, Health profession roles in clinical reasoning, and Biomedical Knowledge & Clinical Reasoning. (Required time in curriculum ca. 5 hours / semester)
Year 2: Dual Process Theory, Illness scripts, Collect and prioritize key clinical findings/problems, and What is clinical reasoning and How can theories be put into practice (Intermediate). (Required time in curriculum: ca. 4 1/2 hours/semester)
Year 3: Generating differential diagnoses and deciding about final diagnosis, Biases and cognitive errors - an Introduction, Analyzing and avoiding errors. (Required time in curriculum: ca. 4 1/2 hours/semester)
Year 4: Using the Outcome Present State Test Model, Developing a treatment plan, Metacognition, reflection and models for reflection, Collaboration of health professions in Clinical Reasoning (Intermediate). (Required time in curriculum: ca. 6 hours/semester)
Year 5: All remaining intermediate learning units: Shared Decision Making in Clinical Reasoning, Decision Support Systems, Ethical aspects - patient management and treatment, Uncertainty. (Required time in curriculum: ca. 5 hours/semester)
Year 6: All 6 advanced learning units: Collaborate with others in clinical reasoning, Decision Support Systems, Biases and cognitive errors, Uncertainty, Metacognition, reflection and models for reflection, Analyzing and avoiding errors.
(Required time: ca. 6 hours / semester. Final year students often have a day/week off from clinical work so these days could be used for DID-ACT learning units and optional participation in the train-the-trainer units)
Years 1-5: Virtual Patients (VPs) as additional deliberate practice activities in increasing number and complexity (e.g. starting with 5 VPs (=ca. 1.5 hours)/semester) in Year 1 and increasing to 10 VPs/semester) in Year 3-5.
Mode: Integrated into a clinical longitudinal course that runs from year 1 to 6 resulting in a total of 2.4 ECTS.

Technical Integration: Access to the DID-ACT Moodle via EduGain, synchronous sessions face-to-face or online.

Tips & Tricks:
Alining a longitudinal curriculum with curricula of other health professions remains a challenge and requires careful and early planning, but the asynchronous phases might be a good starting point for interprofessional teaching sessions. The VPs can be quite easily aligned with other curricular courses e.g., based on key symptoms.

Target group: Medical students in year 3

Learning units: Person-centered approach to clinical reasoning
Level: Novice

Description: The learning unit was integrated into the Laboratory Training of Clinical Skills. This course consists of six face-to-face meetings for groups of around 10 students. Within the meetings the students discuss various topics related to communication skills and person-centered approach. The fifth of the six meetings of the course was replaced by the DID-ACT learning unit. Students could then refer back to this learning unit during final session of the course.
Mode: Part of a regular curricular activity

Technical Integration: Access to the DID-ACT Moodle via EduGain, synchronous sessions were held face-to-face. If possible, a uniform technology to provide access to the online resources in the class (using university tablets in our case) and support of the technical staff on-site was helpful to lower the technical barrier.

Tips & Tricks: Changing of the standard format of classes is interesting and motivating for the students. Virtual patients are a tool to present authentic clinical scenarios which are appreciated by the students. A blend of role-play and virtual patients allows students to take advantages of the two methods to reach the learning objectives.

Target group: Medical students in year 2 and nursing students in year 3 across Europe

Learning units: Collaboration of Health Professions in Clinical Reasoning
Level: Intermediate

Description:
This learning unit was implemented with , aside from clinical reasoning, tow additional objectives: 1) providing internationalization experience for students without traveling. 2) Deepening the knowledge of one's own professional roles and responsibilities and knowledge of another profession .
Mode: Extra-curricular interprofessional learning session with international participants

Technical Integration: Self-registration on DID-ACT Moodle, synchronous sessions via zoom.

Tips & Tricks: Facilitators running this course and supporting the discussions should be careful about supporting and encouraging all the participating professions' perspectives.

Target group: Medical students in year 1 and 2 (preclinical) across Europe

Learning units: Introduction into Clinical Reasoning & Health profession roles in clinical reasoning
Level: Novice

Description: The course was offered as a blended learning module to students from different medical schools in Europe as an international elective. Synchronous phases were held online via Zoom. The international aspect was very motivating for students and they learnt a lot from each other by exchanging their perspectives and how they are taught clinical reasoning vaspects. This teaching mode could also be implemented as an activity to welcome or prepare new Erasmus students. Facilitairs were trained by attending the train-the-trainer learning unit on "Differences and similarities in clinical reasoning among health professions".
Mode: Elective course

Technical Integration: Self-registration on DID-ACT Moodle, synchronous sessions via zoom and use of Padlet for interactivities.

Tips & Tricks: The organization with the registration of students was a bit complex, so, we suggest just setting dates and let students book. Allow enough (more time) for discussion and introduction rounds as participants do not know each other and are eager to hear and learn from peers at other schools and countries. Ideally, this session could also be held interprofessionally, however, it makes the finding of suitable dates even more complex.

How to teach synchronously in a virtual setting

  • You need a reliable camera, microphone, and virtual platform and be familiar with its features, such as whiteboard, chat, polling, breakout rooms, etc.
  • At the beginning establish communication rules, e.g. whether participants should raise their (virtual) hand, use the chat, and/or just speak. Also, we recommend asking participants to turn on their camera
  • For small group work break out rooms work very well, just be clear about the tasks the groups should work on prior to dividing them into the groups.
  • For collaboration the use of integrated virtual whiteboards or other platforms such as Padlet are very useful. Just make sure prior to the session that you have everything setup and the links at hand, e.g. to post them in the chat.
  • Allow a bit more time for starting the session and the group works as there might be participants who are not familiar with the platform or technical problems might occur.

How to motivate unprepared participants

  • Make clear that the asynchronous assignments are a core part of the course and that its content will not be repeated. Even if it is difficult, stick to that when starting the synchronous teaching session.
  • If you expect unprepared participants, you can start the session with a student-centered group exercise mixing prepared and unprepared students to increase peer-pressure and make them realize that being unprepared does not feel good.  
  • Use the introductory or closing quizzes / tests so that participants can self- assess whether they have the required knowledge and you as a facilitator can see the level of knowledge and preparation of your participants.

Further recommended reading:

How to involve participants with different levels of experience

  • To account for such different levels, we recommend making use of the asynchronous preparatory phases which also include introductory quizzes in which participants can self-assess their prior knowledge and you as a facilitator can assess the differences within your group. Participants with less prior experience can also be guided to additional preparatory resources.
  • Encourage participants to work in pairs or small groups when preparing so that they can help and learn from each other. You could even facilitate this by dividing them into groups with different levels of experience.
  • Similarly, during the synchronous phases, we recommend forming groups with participants different levels of experience and emphasize the peer support aspects of such group activities.
  • We also recommend starting with rather smaller groups and allow more time than stated in the course outlines, if you expect a heterogenous level of experience. This way you can better manage this challenge.
  • Encourage your participants to ask questions, emphasizing that nobody knows everything and that it is important for learning to ask questions.  
  • Especially in the train-the-trainer course you might have to deal with over-confident participants, who especially in an interprofessional setting can dominate the group. This is a complex cultural challenge, but you could try to establish (and follow) communication rules at the beginning of a session.  

How to address potential overlaps or redundancies

  • Identify what is already included and what is missing in your curriculum related to clinical reasoning outcomes and compare it to the DID-ACT blueprint. Prioritize learning outcomes that are not yet covered but regarded as important.
  • Identify activities, resources, or teaching sessions with similar learning outcomes that might be in need for change anyway because of low evaluation results, teachers or students struggle with it. These could be suitable for adding or replacing parts with DID-ACT activities.
  • Ask teachers and students about overlaps and gaps they see in their teaching / learning of clinical reasoning and where they struggle. This could also be done by a reflection round after related teaching activities in the curriculum
  • Although ideally a longitudinal integration is aimed at, we recommend to starting small with a pilot implementation to gain experience and develop a show case.

How to teach in an interprofessional setting

  • Allow for enough time prior to the teaching for the organization and motivation / encouragement of stakeholders and participants
  • Allow for enough time and guidance during the course so that the participants from the different professions can get to know each other and their professions and discuss their different perspectives. This might mean that you need to calculate some extra time in addition to the suggested duration of the learning unit.
  • There may be a different understanding of clinical reasoning in the different health professions, so we recommend making participants aware of this. You could for example use and adapt activities from the learning units on the health profession roles to facilitate this.
  • Courses in an interprofessional setting should not come too early in the curriculum (not before professions have formed their own professional identity - however, this also depends on the aim of the course). 
  • Make sure you have enough participants from different professions. If possible, the facilitator could divide the participants in smaller groups with an equal distribution of professions. 
  • Similarly, you need an equal distribution of facilitators / facilitators from different professions.
  • Develop customized learning materials considering the different professions. If needed you can adapt the material and activities provided in the DID-ACT curriculum.

Further recommended reading:

van Diggele, C., Roberts, C., Burgess, A. et al. Interprofessional education: tips for design and implementation. BMC Med Educ 20, 455 (2020). (Link)

Theoretical / Background Knowledge

These resources and activities summarize all topics from the student learning units to introduce educators to these concepts. These resources are part of the train-the-trainer courses and marked as "optional" . Thus, they can be used optionally by course facilitators if participants are not yet familiar with basic concepts.

Theme(s): All basic concepts of clinical reasoning
Level: Educators
Format: Additional resources and material provided for each train-the-trainer learning unit that can be integrated if needed, e.g. if participants are quite new to the topic. These resources cover the basic concepts of a topic without going into the teaching aspects, so they can be used as preparatory steps.

Metacognition, reflection and models for reflection

Similar to the novice learning unit learners are asked to complete a reflective diary for five days. However, in this learning unit they should focus on critical or difficult situations in the clinical context.

Theme(s): Errors & biases
Level: Advanced
Format: Asynchronous online preparatory phase (ca. 60 min) with a synchronous follow-up meeting (ca. 60 min)
Recommended ECTS: 0.07
Links: Student course - Facilitator resources

Ethical aspects - patient management and treatment

his learning unit provides an introduction into bioethical principles, consent, capacity, and ethical clinical reasoning.

Theme(s): Ethical Aspects
Level: Intermediate
Format: Asynchronous online preparatory phase (ca. 60 min) with a synchronous follow-up meeting (ca. 90 min)
Recommended ECTS: 0.08
Links: Student course - Facilitator resources

Decision Support Systems

The learning unit includes the generation of a decision tree based on a breast cancer data set from radiology department using the RapidMiner software package and an elaboration of the concepts of sensitivity and specificity. Furthermore, we will apply Bayesian reasoning and give an opportunity to discuss the base rate fallacy problem and the use of electronic calculators to judge the risk. The learning unit is finished with a discussion of the barriers/facilitators of using computers/AI in hospitals to support clinical reasoning.

Theme(s): Gathering, interpreting, and synthesizing information, Decision making
Level: Advanced
Format: Synchronous meeting (ca. 90 min) followed by an asynchronous phase (ca. 90 min)
Recommended ECTS: 0.1
Links: Student course - Facilitator resources

Uncertainty

In this learning unit, the approach of practice inquiry will be introduced and applied.

Theme(s): Biases & errors
Level: Advanced
Format: Asynchronous online preparation (ca. 60 min) followed by a synchronous meeting (ca. 60 min)
Recommended ECTS: 0.07
Links: Student course - Facilitator resources

Analyzing and avoiding errors

This learning unit will provide general and specific aspects of a morbidity and mortality conference and apply the knowlege by working through a case report.

Theme(s): Biases & errors
Level: Advanced
Format: Asynchronous online preparation (ca. 60 min) followed by a synchronous meeting (ca. 90 min)
Recommended ECTS: 0.08
Links: Student course - Facilitator resources

Biases and cognitive errors

This learning unit introduces additional errors and biases and your will have the opportunity to work on virtual patients to identify error-prone situations.

Theme(s): Biases & errors, Ethical aspects, Theories of clinical reasoning
Level: Advanced
Format: Asynchronous online preparataion (ca. 60 min) for a follow-up synchronous meeting (ca. 90 min)
Recommended ECTS: 0.08
Links: Student course - Facilitator resources

Shared Decision Making in Clinical Reasoning

In this learning unit, learners will be familiarized or re-familiarized with the basic concept of shared decision-making (SDM) in a way that serves as a steping stone for how to implement key concepts and models into practice. A job aid on shared decision-making will be a takeaway from this learning unit.

Theme(s): Patient Perspective, Decision Making
Level: Intermediate
Format: Asynchronous online preparation (ca. 60 min) with a follow-up synchronous meeting (ca. 90 min)
Recommended ECTS: 0.08
Links: Student course - Facilitator resources

Collaboration of health professions in clinical reasoning

In this learning unit you will be able to apply interprofessional aspects of clinical reasoning and understand similarities and differences between the clinical reasoning of health professions. This facilitates a better communicate across professions in the clinical reasoning process to meet the needs of the patient.

Theme(s): (Interprofessional) Collaboration
Level: Intermediate
Format: Starting with two synchronous meetings (each 60 min or combined) followed by an asynchronous follow-up (ca. 60 min)
Recommended ECTS: 0.1
Links: Student course - Facilitator resources

Decision Support Systems

The aim of this learning unit is to facilitate a discussion about which aspects of clinical reasoning can be supported by artificial intelligence and what the limitations of machines in clinical reasoning are.

Theme(s): Gathering, interpreting, and synthesizing information, Decision making
Level: Intermediate
Format: Synchronous meeting (ca. 90 min) with a follow-up asynchronous phase (ca. 90 min)
Recommended ECTS: 0.1
Links: Student course - Facilitator resources

Evaluation of Clinical Reasoning

This learning unit provides an overview about surveys and questions suitable to evaluate clinical reasoning teaching. It also introduces the relevance of learning analytics.

Theme(s): Teaching clinical reasoning
Level: Educators
Format: Self-guided on-demand course with different material on clinical reasoning evaluation (ca. 60 min)
Recommended ECTS: 0.03
Links: Course

Discussing and teaching about cognitive errors and biases

In this learning unit participating educators and clinicians will have the opportunity to share ideas on how a culture for discussing errors should look like. They will also learn more about most common errors and biases in clinical resoning and (teaching) strategies on how to avoid these. This learning unit supports educators in teaching the student courses on the novice level: Biases and cognitive errors, Uncertainty, and Analyzing & avoiding errors

Theme(s): Teaching clinical reasoning, Errors & biases, Theories of clinical reasoning, Ethical aspects
Level: Educators
Format: Asynchronous preparation (ca. 60 min) followed by a synchronous meeting (ca. 90 min). Optional additional activities are provided for beginners (ca. 80 min).
Recommended ECTS: 0.08 (including optional phase: 0.13)
Links: Participant course - Facilitator resources

Information gathering, Generating differential diagonses, Decision making, and Treatment planning

This learning unit is designed to support educators in implementing the student courses on Collect and prioritize key clinical findings/problems, Generating differential diagnoses and deciding about final diagnosis, Developing a treatment plan, and Biomedical Knowledge and Clinical Reasoning

Theme(s): Teaching clinical reasoning, Gathering, interpreting & synthesizing information, Generating differential diagnoses, Developing a treatment / management plan, Decision making, Ethical aspects
Level: Educators
Format: Asynchronous preparation (ca. 60 min) followed by a synchronous meeting (ca. 60 min). Optional additional activities for beginners are available (ca. 60 min).
Recommended ECTS: 0.07 (including optional phase: 0.1)
Links: Participant course - Facilitator resources

Person-centred approach and the role of patients

This learning unit prepares educators to comprehensively and confidently teach the the learning unit on Person-centred approach to clinical reasoning. This unit will take educators through the learning content provided in the learning unit, as well as supports them in familiarizing themselves with the resources and exercises. Educators will have the opportunity to create their own teaching notes as part of this learning unit.

Theme(s): Teaching clinical reasoning, Patient perspective
Level: Educators
Format: Asynchronous preparation (ca. 60 min), followed by a synchronous meeting (ca. 90 min). Optional additional activites are available for beginners (ca. 100 min).
Recommended ECTS: 0.08 (including optional phases: 0.14)
Links: Participant course - Facilitator resources

Differences and similarities in clinical reasoning among health professions

This learning unit introduces teaching methods for clinical reasoning in different healthcare professions and prepares educators to teach the learning units on Health profession roles in clinical reasoning

Theme(s): Teaching clinical reasoning, (Interprofessional) collaboration
Level: Educators
Format: Asynchronous preparation (ca. 60 min) followed by a synchronous meeting (ca. 70 min). Optional additional activities provided for beginners (ca. 120 min).
Recommended ECTS: 0.07 (including optional phases: 0.14)
Links: Course,Facilitator resources

What is Clinical Reasoning and Models

This learning unit familiarizes healthcare profession educators on teaching aspects related to the clinical reasoning process and terminology of the different health professions. This includes how to explain the importance of clinical reasoning in the different health professions to students and how to support students in reflecting on clinical reasoning theories. The learning unit prepares you for teaching the novice courses on What is clinical reasoning, Dual Process Theory, Outcome Present State model, and Illness scripts.

Theme(s): Teaching clinical reasoning, Theories of clinical reasoning
Level: Educators
Format: Two synchronous meetings (ca. 60 and 45 min) with asynchronous phase (ca. 45 min) in between. Optional additional phase with ca. 45 min.
Recommended ECTS: 0.08 (including optional phase: 0.11)
Links: Course, Facilitator resources

Clinical Reasoning teaching and assessment

This learning unit provides and overview about teaching and assessment methods for clinical reasoning. It also highlights some general apsects, such as the importance of constructive alignment or how to organize group discussions.

Theme(s): Teaching clinical reasoning
Level: Educators
Format: Self-guided on-demand course with different material on clinical reasoning teaching and assessment.
Recommended ECTS: 0.03
Links: Course

DID-ACT clinical reasoning curriculum

This learning unit provides an overview about the DID-ACT student curriculum including all course outlines and resources neede to implement these learning units. It also introduces a tutorial on how to read the course outlines and use the provided resources.

Theme(s): Teaching clinical reasoning
Level: Educators
Format: Self-guided on-demand course with different material on our DID-ACT curriculum including all course outlines for student learning units and material needed.
Links: Course

Analyzing and avoiding errors

Along a case report this learning unit introduces the root cause analysis (RCA) to analyze errors and start to find ways for preventing / avoiding errors.

Theme(s): Errors & Biases
Level: Novice
Format: Asynchronous preparation (ca. 90 min) followed by a synchronous meeting (ca. 70 min)
Recommended ECTS: 0.09
Links: Student course - Facilitator resources

Metacognition, reflection and models for reflection

In this learning unit reflection models will be introduced and self-reflection will be applied on form of a reflective diary.

Theme(s): Errors & biases
Level: Novice
Format: Synchronous meeting (ca. 60 min), followed by an asynchronous online phase (ca. 80 min) and a concluding synchronous meeting (ca. 80 min)
Recommended ECTS: 0.12
Links: Student course - Facilitator resources

Uncertainty

The aim of this learning unit is to introduce situations of uncertainty and strategies that can be applied in such situations to avoid errors.

Theme(s): Errors & biases
Level: Intermediate
Format: Asynchronous preparation (ca. 60 min) followed by a synchronous session (ca. 90 min)
Recommended ECTS: 0.08
Links: Student course - Facilitator resources

Biases and cognitive errors - an Introduction

This learning unit provides a basic introduction into the topic of biases and cognitive errors. It introduces a selection of common biases, such as premature closure or confirmation bias with providing the opportunity to elaborate on these biases with case vignettes.

Theme(s): Errors & biases, Theories of clinical reasoning, Ethical aspects
Level: Novice
Format: Asynchronous preparation (ca. 70 min) with a follow-up synchronous meeting (ca. 90 min)
Recommended ECTS: 0.09
Links: Student course - Facilitator resources

Developing a treatment plan

This learning unit provides an introduction into the topics "EBM in the context of clinical reasoning" and "developing a treatment/management plan" for students with no or some prior clinical experience.

Theme(s): Developing a treatment / management plan, Ethical aspects, Patient perspective
Level: Novice
Format: Asynchronous preparation (ca. 45 min) followed by a synchronous meeting (ca. 80 min)
Recommended ECTS: 0.08
Links: Student course - Facilitator resources

Generating differential diagnoses and deciding about final diagnosis

This learning unit introduces different methods of creating and organizing differential diagnoses. There is also opportunity to practice the finding of differential diagnoses as well as discriminating and confining features on a prototypical case.

Theme(s): Generating differential diagnoses, Decision Making
Level: Novice
Format: Two synchronous meetings (ca. 90 min each) with an asynchronous phase in between (ca. 60 min)
Recommended ECTS: 0.13
Links: Student course - Facilitator resources

Collect and prioritize key clinical findings/problems

This learning unit highlights how to collect and prioritize key clinical findings using case examples.

Theme(s): Gathering, interpreting & synthesizing information
Level: Novice
Format: Asynchronous preparatory phase (ca. 45 min) followed by a synchronous meeting (ca. 60 min)
Recommended ECTS: 0.06
Links: Student course - Facilitator resources

Biomedical Knowledge and Clinical Reasoning - Knowledge Encapsulation

This learning unit explains the interconnection of biomedical knowledge and differential diagnoses formulation and explores different techniques to visualize encapsulated knowledge.

Theme(s): Theories of Clinical Reasoning
Level: Novice
Format: Two synchronous sessions (ca. 60 min each) with an asynchronous learning phase in between (ca. 45 min)
Recommended ECTS: 0.09
Links: Student course - Facilitator resources

Person-centered approach to clinical reasoning

The goal of this learning unit is to define what a 'person perspective' is in the context of healthcare provision and highlight why it is important when providing a quality healthcare experience. Learners will also visit the definitions of biomedical information as well as recite the terminology "diagnostic and analysis" in a way that helps patients and their families understand this stage in healthcare provision. Lastly, learners will combine the above into practical ability using questions that promote support for families and patients using terminology that facilitates mutual understanding.

Theme(s): Patient perspective
Level: Novice
Format: A synchronous meetings (ca. 90 min), with a preparatory and a follow-up asynchronous phase (ca. 90 and 45 min)
Recommended ECTS: 0.13
Links: Student course - Facilitator resources

Collaborate with others in clinical reasoning

This learning unit provides basic knowledge within different healthcare professions or across medical specialisations e.g. surgery, internal medicine and their collaboration with others in clinical reasoning.

Theme(s): (Interprofessional) Collaboration
Level: Advanced
Format: Asynchronous online preparation (ca. 60mins) for a follow-up synchronous meeting (ca. 90 mins)
Recommended ECTS: 0.08
Links: Student course - Facilitator resources

Health profession roles in clinical reasoning

This learning unit provides an introduction to the various health professions involved in health care on the subject of clinical reasoning. The unit has been developed for beginner and novice learners, and is appropriate for those who have and have not yet had extensive clinical experience due to the team aspect of the assessments. The learning unit will highlight varied professions ranging between physiotherapy, medicine, nursing, and occupational therapy and learners will be able to compare and contrast the definitions of clinical reasoning within said professions, as well as relate how this team-understanding fits into the broader picture of healthcare, with a goal to establish a common understanding and definition of 'clinical reasoning'.

Theme(s): (Interprofessional) Collaboration
Level: Novice
Format: Asynchronous preparatory phase (ca 45 min) followed by a synchronous meeting (ca. 90min)
Recommended ECTS: 0.08
Links: Student course - Facilitator resources

Using the Outcome Present State Test Model

This learning unit provides an introduction into the the Outcome-Presenter-State model for clinical reasoning, which is applied especially in nursing. The learning unit is designed for novices of all health professions who are at the beginning of their education.

Theme(s): Theories of Clinical Reasoning
Level: Novice
Format: Asynchronous preparation phase (ca. 80 min) with a follow-up synchronous meeting (ca. 90 min)
Recommended ECTS: 0.09
Links: Student course - Facilitator resources

Illness Scripts

This learning unit provides an introduction into scripts in general and more specifically into llness scripts for novices who are at the beginning of their education and do not have any prior knowledge or experience with illness scripts.

Theme(s): Theories of Clinical Reasoning
Level: Novice
Format: Two synchronous sessions (ca. 160 min) with an asynchronous learning phase (ca. 60 min) in between
Recommended ECTS: 0.12
Links: Student course - Facilitator resources

Dual Process Theory

This learning unit provides an introduction into the dual processing theory amd highlights the differences between system 1 and system 2 reasoning.

Theme(s): Theories of Clinical Reasoning
Level: Novice
Format: Asynchronous preparation phase (ca. 90 min) followed by a synchronous meeting (ca. 90 min)
Recommended ECTS: 0.1
Links: Student course - Facilitator resources

What is clinical reasoning and how can theories be put into practice

This learning unit covers how clinical reasoning theories can be used/applied during beside teaching, internships or other patient-centered situations and why it is important to know these theories. It deepens the differences and similarities of clinical reasoning in the health professions, terminology used and importance of clinical reasoning.

Theme(s): Theories of Clinical Reasoning
Level: Intermediate
Format: Asynchronous preparation (ca. 45 min) for a follow-up synchronous meeting (ca. 60 min)
Recommended ECTS: 0.07
Links: Student course - Facilitator resources

What is Clinical Reasoning - An Introduction

This learning unit provides an introduction into the topic for novices who are at the beginning of their education and do not have any prior knowledge or experiences with clinical reasoning.

Theme(s): Theories of Clinical Reasoning
Level: Novice
Format: Synchronous meeting (60 min) followed by asynchronous follow-up (60 min)
Recommended ECTS: 0.07
Links: Student course - Facilitator resources

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