Project Meeting in Maribor on May 30th 2022

On May 30th the DID-ACT team met for our third hybrid project meeting in the beautiful city of Maribor in Slovenia.

We started the day by celebrating our achievements so far, which include the completing of our learning units including piloting and evaluation, a wide range of dissemination activities, and the expansion of our network.

We then discussed the remaining deliverables for the upcoming seven months including the refinement of the student courses, the development of a certificate for the train-the-trainer courses, the finalization of the integration guideline, and the development of a sustainability model and long-term integration plans at our institutions.  

To further work on the integration guideline, we split into three small groups and discussed recommendations for three main challenges we came across during our pilot implementations:

  • How to teach in an interprofessional setting
  • How to address potential overlaps of the DID-ACT courses with the local curriculum
  • How to deal with different levels of experience of participants

We summarized our results on Padlet and will integrate these recommendations into the guideline. Similarly, we worked in smaller groups on the development of a business canvas as part of the DID-ACT sustainability model. We will continue our work on this during our next planned project meeting in Kraków, Poland.

We concluded the day with a wonderful dinner at a local restaurant in the center of Maribor.

A big thank you to our Slovenian hosts!

Gender Disparities and Biases in Healthcare – still not a topic from the past

While developing the DID-ACT learning unit about cognitive errors and biases, we came across the this great video on YouTube by Dr. Joanna Kempner about gender biases and the underrepresentation of especially women of color in healthcare. Stereotypes are still deeply incorporated into our culture and as Dr. Kempner illustrates they are still visible in (medical) advertisement, healthcare institutions, or workplaces. Although women have finally been included into clinical trials in the 1990s in the US, funding for diseaseas that are more prevalent in women is still very low, which also results in less or lower quality treatment. For more information and details, we highly recommend the video by Dr. Kempner:

The aforementioned learning unit for students is publicly available in our learning managment system: Biases and cognitive errors – an introduction.

Wrap-up of 2021

Just before the holiday season, we finalized a couple of interesting deliverables, reports, and updates.

Most importantly we completed the development of the DID-ACT train-the-trainer courses on clinical reasoning. Overall, eight learning units are available in our learning platform moodle including comprehensive information and documents for future course facilitators. The course development was accompanied with pilot testing of learning units with participants from partner-, associate-, and external institutions. On our website we provide a summary of these pilots and the extensive results of the evaluation activities. These results will inform the refinements of the train-the-trainer courses we will start implementing in January 2022.

We also repeated our Social Network Analysis and published the results including our website and learning management platform hits in this updated summary.

We wish you all peaceful holidays and a happy New Year!

More about virtual patients ….

In this blog post we would like to point another Erasmus+ funded project “iCoViP” – International collection of virtual patients. This strategic partnership with participants from Poland, Germany, France, Spain, and Portugal aims to create a well-designed high-quality collection of virtual patients to train clinical reasoning. Other than DID-ACT, iCoViP focuses specifically on the training of medical students by providing opportunities to identify symtpoms and findings, develop differential diagnoses, document tests and treatment options, and decide about the final diagnosis.

Screenshot of a virtual patient in CASUS

The project started in April 2021 and continues until March 2023. As a first stept the consortium develops a blueprint that describes the virtual patients based on key symptoms, final diagnosis, and (virtual) patient-related data, such as age, sexual orientation, disability, profession, etc. This approach ensures that the collection is a realistic representation of a real-world patient collective.

More information about the project can be found at icovip.eu

Developing a longitudinal clinical reasoning curriculum

Curriculum Development Process

For the development of  the DID-ACT’s online clinical reasoning curriculum we will be following the six step Kern cycle for curriculum development. Kicking off our third and fourth work package in January 2021 signalled the start for detailed planning and development of learning units. As of now, we have started with 4 units, but based on our curricular framework, we will be developing a total of 40 learning units. These units will be aligned with a collection of case scenarios and virtual patients. Together, these will allow for interprofessional and deliberate practice of clinical reasoning.

We started this process by providing an exemplary learning unit (“What is clinical reasoning – an introduction”) and a template for describing a learning unit. We then divided into smaller teams to develop the first four learning units on different clinical reasoning-related theories in parallel. Each team includes partners from different health professions across Europe. Each team has varying levels of expertise, ranging from students to experienced clinicians or educators. The diversity of knowledge and experience are key elements for developing a clinical reasoning curriculum that reflects the various needs of health professions across Europe and beyond.

Upon completion of each learning unit, each unit will be reviewed within our team and by associate partners. The units will then be revised accordingly and implemented into Moodle, our learning management system, using available OERs. We will create new resources ourselves, if needed. After a final review, all learning units will be made publicly available to be freely used by students and educators.

Pilot implementations

We will pilot selected learning units from the student curriculum and the train-the-trainer course within our partner institutions during the summer and fall 2021. The evaluation results of course participants and facilitators will be the basis for further refinements of our clinical reasoning curriculum. For that purpose, we aim to include at least 500 students and 50 educators.

Barriers for a clinical reasoning curriculum

As part of the DID-ACT project we conducted over 40 interviews with educators, students and clinical reasoning experts asking them among other questions, what barriers they see for developing a clinical reasoning curriculum for students and a train-the-trainer course for teachers. Interestingly, one of the most important barriers mentioned by the interviewees were cultural barriers. This includes aspects such as a lack of collaboration among educators, no culture of reflection, no culture of dealing with errors, and a resistance to change. A second category of barriers was related to the teaching process. Interviewees identified obstacles such as a lack of awareness that clinical reasoning can be taught, a lack of qualified educators to teach students, and also a lack of guidance and standards on how to teach clinical reasoning.

The results of the interviews can be found in the D1.1b report.

As already started in our ideation workshop we are now discussing solutions to overcoming these barriers – the results will be published by the end of June!

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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