DID-ACT Integration Guide

With Q1 rapidly coming to a close, we are racing through our final year of the DID-ACT Project with excitement and fervor. We have created so much over the past 2 years and have solidified a place to clearly consolidate the knowledge we have created and amassed. We therefore created the DID-ACT integration guide. We will continue to update it in an ongoing manner as we develop our integration guideline. 

DID-ACT’s Integration Guide

The DID-ACT Integration Guide is found under our Curriculum heading and is broken into 5 categories. The goal of this resource is to provide an overview of the curriculum in its entirety, a guide to getting started for both educators and students, as well as our additional resources and FAQ about the curriculum. 

Curricular blueprint 

The DID-ACT curriculum is incredibly succinct and provides content for both educators and students. In order to effectively maneuver through the learning units, we put together the curricular blueprint earlier in the project. This page provides this blueprint in the form of an interactive table where you can view all of the learning units, broken down by level, audience, and theme. Using this table will help you best organize your learning and facilitate finding specific learning opportunities either as a student or educator.

Clinical reasoning learning outcomes

Building from the blueprint, learners and facilitators are able to explore the themes and overarching learning objectives we have defined as a basis for our curriculum. There are 14 themes in our curriculum, ranging from topics like decision-making and attitudes toward clinical reasoning, to the basic theories around clinical reasoning. 

How to use the DID-ACT curriculum

For students, there are 25 learning units to navigate from novice to advanced-level students in health professions. This page holds many functions, one of them being the provision of the who, why, what and how around making this curriculum be all it can be. 

For educators, there are 8 train-the-trainer learning units. The content includes multiple aspects of how to teach clinical reasoning to students including models and theories, cognitive errors and biases, as well as differences and similarities within different health professions. To support all of this learning are virtual patients, group work, and facilitator guides. 

Clinical reasoning integration guideline

Our Integration Guide is still currently growing. The integral guideline provides insight on how institutions and educators can easily integrate content from the curriculum into their pre-existing learning structure. Coupled with examples from our pilots but also from interactions with associate partners and external stakeholders  that highlight real-world experience and application, this guideline is a key to the successful adoption of the DID-ACT clinical reasoning curriculum. 

If you have used our resources successfully, we would love to hear from you as your input and experience would be very valuable. Just leave a comment!

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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)

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