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

by Inga Hege

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.

A look back on an eventful first half year

by Felicitas Wagner & Sören Huwendiek, Universität Bern

The first phase of the DID-ACT project (January – June 2020) was a very intense and insightful time. The main goal of the first project phase was to conduct a needs assessment among different stakeholder groups regarding a longitudinal clinical reasoning curriculum for students and a train-the-trainer course for teachers. Also, barriers for the implementation for such a curriculum and course as well as potential solutions were investigated.

At the first meeting of the project-team in Augsburg in January, the foundations were laid for the following work. In the next months, we carried out surveys and interviews. The data collection unfortunately collided with the onset of the Corona crisis, which made it a challenging task to recruit participants in the health sector. Nevertheless, we were able to conduct a considerable number of interviews and almost 200 people took part in the survey. During these difficult times, our bi-weekly online-meetings were especially valuable to keep the project on track, coordinate and support each other with the ongoing tasks.

DID-ACT team meeting in zoom

The analysis of the needs for the student curriculum showed that cases and simulations are seen as especially important in the teaching of clinical reasoning while oral and written exams are seen as most useful to assess clinical reasoning. For the train-the-trainer course, a blended-learning approach is favored. Results on barriers are described in our blog entry “Barriers for a clinical reasoning curriculum“. More detailed results can be found in the D1.1a report and the D1.1b report.

After finishing the data analysis regarding needs and barriers for the planned longitudinal clinical reasoning curriculum and the train-the-trainer course, solutions to overcome the identified barriers were sought. We analyzed the answers from our interview partners and conducted an online ideation workshop with the team members to develop further solutions (described in our blog entry “Online ideation workshop”). More details on solutions are described in the D1.2 report.

After this exciting first phase of the project, we are now looking forward to the next months where a curricular framework with learning goals and educational methods for the student curriculum and the train-the-trainer course will be developed.

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!

Online ideation workshop

In our specific needs analysis we have identified a wide range of barriers and needs for the implementation of a clinical reasoning curriculum in a survey and semi-structured interviews. As a next step we had planned a face-to-face design thinking workshop on May 5th in Krakow, Poland, to develop solutions to overcoming these barriers and addressing the needs. Due to the travel restrictions we decided to try something new and do the workshop in a synchronous online meeting after an asynchronous individual preparation phase.

For the preparation phase we setp up a course in our learning management system and the team members had time to familiarize themselves with the identified barriers and needs. They were asked to submit at least five (better ten) ideas on how these needs and barriers could be addressed including at least one crazy/absurd idea.

In our online meeting on May 5th we divided the 18 participants into four small groups (using the zoom break out rooms) in which they had to present their ideas and clarify any questions. After 20 minutes we met in the plenary in which each group presented their ideas and we documented and clustered those (using the integrated whiteboard). Finally, each particpant was asked to identify three solutions that are easy to do / hard to do / have a high impact.

Overall, the online workshop worked very well, only the simultaneous presentation of ideas and clustering on the whiteboard was tough, and could be better done in two phases with first collecting the ideas and then clustering them.

During the next weeks we will continue the discussion and refinement of the solutions and publish a final version as D1.2 report by the end of June.