Author: Daniel Donath

From October 18th to November 30th 2022, we gathered data from a survey set out to evaluate various aspects of the DID-ACT clinical reasoning curriculum. These aspects included personal data, objectives, technology, impact, learning activities, and assessment/feedback.
A total of 32 reviewers participated in this External Quality Review. The survey was based on quantitative questions, however, reviewers were also asked to add comments in free-text boxes.

Overall, the feedback received was very positive. The majority of participants evaluated the objectives and expectations of the curriculum as being clearly stated and that sufficient instructions were provided to work with and through the learning units. Most participants were able to navigate through the website and viewed the technology and media provided as playing a supporting role to the learning units. A large number of respondents (n=19) agreed that these learning units will improve students’/learners’ clinical reasoning abilities. The same number of respondents also agreed that the learning units will improve the way educators teach clinical reasoning. The learning activities were seen as aiding in engaging in and achieving the objectives set forth in the learning units. The different forms of assessment and feedback were considered appropriate and allowed learners to assess their progress.

Some respondents provided comments with valuable feedback, such as

• Some reviewers found the interface a bit “old- fashioned” and would have preferred a more convenient, modern interface, but one also mentioned that they did not experience any technical issues and still managed to follow the learning units with interest.
• Reviewers found the platform to be interesting, and the virtual patients, which are part of the curriculum “entertaining”, which indicates that these educational resources are encouraged learner interaction. 
• Other reviewers commented on the excellent quality of the work created, and how important and novel the curriculum is to fill the gap of clinical reasoning knowledge in medical education. They also appealed to the importance of disseminating the curriculum, to both students and educators alike. 
• Comments about the objectives included that they were clear and indicated that there would be no issues in understanding the process of the learning units. 

Overall, we feel that we have gathered very positive feedback from our external reviewers in this survey, and are happy with its outcome. With all the reviews and feedback received, we will continue improving and sustaining the work that has been done in the DID-ACT project so far.

In fall 2022, we decided to pilot additional four learning units at EDU to test them after the refinement process, which occurred earlier in the year. We piloted the following learning units (see descriptions) and obtained qualitative feedback from facilitators and students.

Student Curriculum – Person Centred Approach to clinical reasoning

This learning unit was piloted in 2021, however, we wanted to re-evaluate it to assess the refinements with learners and facilitators. The learning unit was taught by the same facilitator as 2021 saw. After the session, the facilitator expressed that the structure of the session was more fluent and students were more happy to engange in the session. Moreover, students thought the real life example of a person-centred perspective had a real positive impact on their learning. 

Student Curriculum – Ethical aspects – patient management and treatment

This learning unit was piloted was previously not piloted by any partner.  Overall, both the facilitator and the learners found the learning unit useful and interesting, and commented that the interactive activities and case examples were very useful in delivering the content. Minor suggestions for improvements were recommended.

Train the Trainer – Information gathering, generating differential diagnoses, decision making and treatment planning

This learning unit was previously piloted by partners from Maribor, Bern, and Krakow, but not EDU. After the session and comparable to the earlier pilots, we received positive feedback from participants regarding the content and structure of the learning unit. Also, the need for such teaching was made clearer. 

Train the Trainer – Discussing and teaching about cognitive errors and biases.

This learning unit was previously not piloted by partners. Again, the structure and content of the learning unit were well received, and especially the fishbone diagram and wiki of this learning unit were appreicated by participants.

Overall, the additional pilots indicated that the refinements earlier on in the year were successful in improving the created DID-ACT curriculum and we are happy with the results we achieved. Prior to implement a learning unit, we recommend familiarizing oneself with the DID-ACT learning platform (Moodle), so teaching can run more smoothly. The additional pilots also reaffirm what we saw in our needs analysis, that there is a need for both teachers and learners to learn about clinical reasoning, and we hope that our curriculum can start filling this needs gap.

On September 26th and 27th 2022, our Polish project partners hosted our final face to face project meeting in the beautiful city of Kraków, Poland. 
There were feelings of melancholy since we all really enjoy working together on this project which is soon coming to an end. However, there was also optimism for future collaborations, along with the remaining work and the online meetings.

In Kraków we had many inspiring discussions relating to the sustainability plans for the project, along with discussions about dissemination and our long-term integration plans.

On the first day, we presented the different approaches to integrating the clinical reasoning curricula at our institutions, including some discussion about the bottom up and top down integration approaches, and the pros and cons of each. The results and outcomes of the project were also discussed, as well as some specifics about the finalization of the project. On the second day, we focused on the sustainability plans and further research to be published, and agreed on some dissemination activities.
We all learned a lot from each other’s fruitful ideas and the team spirit was strong!

AMEE 2022, with more than 2400 international attendee, was big this year for the DID-ACT project! We were happily surprised by the interest shown to the project in our presentations and E-poster over the days, but we were especially surprised by the pre-conference workshop on “Teaching clinical reasoning toolkit”, during which we had more attendees (from all over the world) than registered. At the beginning of this workshop we introduced participants into the DID-ACT curriculum, which was followed by a small group work on three selected learning units, which participants should discuss in their group and develop ideas for integrating them into their curriculum.

Another highlight was the E-Poster from one of our medical students, Melina Körner (University of Augsburg), who presented the two videos she created together with Ada Frankowska from Kraków and Elisa Schneider from Augsburg. The videos are designed to support educators in selecting clinical reasoning teaching methods.

Overall, we received a lot of positive feedback on the DID-ACT curriculum and the integration guide, and educators were particularly happy about the fact that the material is under a creative commons license, and can therefore be used freely in clinical reasoning education.

The feedback we received at the AMEE 2022 will be included in the final work on the integration guideline and also into our sustainability model.

We are excited to announce that members of DID-ACT will be presenting research from the project alongside other great work at the Medical Education Forum (MEF) 2022 from the 28th-29th of September! DID-ACT partners from Poland, Germany, and the US will be present. The MEF program includes the following topics and slots related to clinical reasoning research:

Topic	Date	Presenter
Teaching clinical reasoning: four key lessons from the literature	28/9/22 11:40-12:00	Steven Durning, Uniformed Services University of the Health Sciences, Bethesda, USA
Building a European collection of virtual patients for clinical reasoning training within the iCoViP project	28/9/22 12:00–12:20	Inga Hege University of Augsburg, Germany
Developing, implementing, and disseminating an adaptive clinical reasoning curriculum for healthcare students and educators: the outcomes of a European project	28/9/22 12:20-12:40	Andrzej A. Kononowicz, Jagiellonian University, Poland
Workshop: Tips and tricks on how to teach clinical reasoning effectively supported by virtual patients	29/9/22 11:30-13:45	Inga Hege, Małgorzata Sudacka, Andrzej A. Kononowicz, Steven Durning

For more information regarding the program that includes a whole session about clinical reasoning, please see the program.
For more information regarding registration, please go to registration

We would be very excited to see you in person or virtually at the MEF2022 and talk about clinical reasoning in healthcare education!

With much work currently still being done to refine the student curriculum and the integration guideline, we already have a lot of additional resources which may be useful for both students and educators available freely on our site!

On our website you can find information about how to get started using DID-ACT resourcesfor students, educators. The recommended literature section includes literature regarding various aspects of clinical reasoning within medical education, including barriers, longitudinal teaching, interprofessional teaching, blended learning techniques and faculty development. Our open educational resources include various resources and also a link to a pool of 200 multilingual virtual patients created by another Erasmus+ funden project iCoViP. Other information regarding the curriculum, integration and some FAQs are also available on the DID-ACT Curriculum page.

Links to DID-ACT videos about the project are also available, including videos about clinical reasoning, and diagnostic errors. These videos are also available as a playlist on YouTube and most of them are integrated into the DID-ACT curriculum.

If you have any suggestions or would like to send us feedback, please just leave us a comment.