We are very excited about our different activities planned for the upcoming AMEE conference in Lyon (and also online) from August 27th – 31st 2022.
DID-ACT partners from Poland, Sweden, Slovenia, USA, Germany, and Switzerland will be present and the AMEE program includes the following topics and slots related to the DID-ACT project:
Topic
Time
Presenter
Session
Teaching clinical reasoning toolkit: Understanding, developing and implementing a clinical reasoning curriculum
Saturday Aug 27th 9:30 - 12:30
Monika Sobocan and DID-ACT partners
Pre-conference workshop (PCW L1)
Pilot implementation and evaluation of clinical reasoning train-the-trainer courses by the European project DID-ACT
Monday Aug 29th 8:00 - 9:30
Andrzej Kononowicz
Short communication
Developing a virtual patient collection to train clinical reasoning
Monday Aug 29th 8:00 - 9:30
Inga Hege
Short communication
Needs regarding teaching and assessment of clinical reasoning: An international mixed-methods study
Monday Aug 29th 18:30 - 20:00
Felicitas Wagner
Short communication (online)
Teaching methods for clinical reasoning - an overview for clinicians and educators
Tuesday Aug 30th 14:30 - 16:00
Melina Körner
EPoster
Comparison of person’s perspective attitudes after a virtual patient activity and role-plays of students - a prospective control-group randomized study
TDB
Michał Pers
Short Communication
You can find more information about AMEE including the program at the AMEE website
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.
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.
celebrating our achievementsVisit to the simulation center
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.
Elisa is a sustainable design student studying in Cologne and has been active in the DID-ACT Project since May 2021! Even though it is her first experience in medical education, Elisa easily managed to help various members of our team by creating storyboards, videos, audio recordings and animations based on summaries given to her in the curriculum development process. She works on a piece approximately every month, and has worked on over 12 pieces in total, each of which can take her days to create. Needless to say, Elisas’ contribution to the project has been essential. A big thank you to Elisa for her contribution to the DID-ACTProject and to @Daniel Donath from EDU-A Degree Smarter for the blog post!
Exemplary videos from Elisa include:
To see all of her videos, please visit the DID-ACT YouTube channel
After we had tested the train-the-trainer courses of the DID-ACT curriculum, it was time to evaluate the quality of learning units for students. We have conducted a series of pilot studies that validated five different learning units in eight evaluation events across all partner institutions including also associate partners. We have recorded student activities in the virtual patient collection connected with the DID-ACT curriculum available for deliberate practice. In addition, we evaluated the usability of the project’s learning management system in several test scenarios.
Overview about student activities in piloted learning units
Overall, students agreed to a large extent that the piloted DID-ACT learning units improved their clinical reasoning skills (average 5.75 in 7-point Likert scale). As a special strength of the curriculum students frequently named the benefit of virtual patients integrated with the learning units. Another highlight were small-group group discussions, often conducted in multinational teams which broadened their views on clinical reasoning. However, a challenge in the tested version of the curriculum implementation was navigation in the learning management system (Moodle). As a consequence, we have further analyzed these data and, furthermore, conducted a series of usability tests. These analyses and tests led to a process to address the issues wherever it is possible. We have also received several requests for modifications of the developed learning material that we will address in the next deliverable, in which we refine courses based on pilot implementation.
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!
An important part of our project is the testing of the developed learning units for students of the healthcare professions. With such pilot implementations we receive valuable feedback from the course participants, which will help us to further improve the learning units. Thus, each medical school in our consortium planned such a pilot implementation during fall/winter 2021.
Planning Pilot Implementations
Planning for the student units began in parallel to the train-the-trainer (TTT) units. This was done intentionally as it allowed for us to coordinate the trainers to be trained during the TTT pilots, ready for the student pilots later in the year. The consortium coordinated together in a document and focused on the following data:
Topic of the course
Piloting institution
Dates of asynchronous phases and synchronous meetings
Anticipated number of participants
Professions of participants, i.e. whether the pilot was conducted in a mono-, multi-, or interprofessional setting
Continuing with our regular meeting pace, if not adding in a few more, we continued to meet consistently to work out any questions and support each other while we prepared. We also sought advice from our associate partners in Sweden, Switzerland, and the US in order to have a strong variety of opinions and input. Some of the pilots were also open to external participants so that we could also test outside our immediate consortium.
Implementing the pilots
Overall, we conducted 9 courses covering five different clinical reasoning topics until the end of January 2022.
While course registration and invitations were handled locally, all technical support was handled in collaboration with Instruct. Having a central partner leading this was very helpful as they explained course access, structure of pilots, and any facilitator resources needed for each pilot. Instruct also created a specific roadmap document for each partner alongside a more general short manual for how to register and access the DID-ACT Moodle platform.
We managed to recruit 188 medical and nursing students from partner-, associate partner-, and external institutions. In addition, we piloted our virtual patient units with a total of 618 students.
Pilot Implementation Results
Overall, the feedback from the facilitators and the interest of students participating in our courses especially in international and interprofessional settings was very positive. The facilitators highlighted the discussion among participants, but in some units more time than anticipated was required. Similar to the train-the-trainer courses technical challenges were reported by participants due to their unfamiliarity with our learning platform. The collected feedback together with the participant questionnaires will provide the basis for improving the courses.
It is hard to believe our clinical reasoning project is already ⅔ complete. Being the final year of the project, we look back at our learning units, pilots, and evaluations with appreciation for how they bring us into the project’s next phase.
Curriculum Refinements
The DID-ACT project team is currently full speed toward our next round of project deliverables. Building from last year’s pilots implementations, we are taking our curriculums into their refinement stages. We will be working on the train-the-trainer (TTT) course’s refinements (D3.3), which we aim to have ready by May. Alongside this, we are finalising the student curriculum (D 4.1), which we will have ready by the end of March.
Upcoming Student Clinical Reasoning Curriculum
Happening simultaneously is the evaluation and analysis of learner activities for the student curriculum (D5.3). Our results, retrieved from the pilot implementations of the student curriculum, are being sorted and reported on under the leadership of Dr A. Kononowicz (Jagiellonian University). We look forward to these results as they will be implemented as refinements for the student course, which is planned to start in April 2022.
Curriculum Integration Guideline
Apart from the curriculum, the curriculum integration guideline is being prepared. This document will serve as a guide for various institutions aiming to integrate the curriculum into their own institutions. While it is currently being drafted as part of WP7, led by EDU and supported by Instruct, it will need to be refined after the curriculum is completed. This will go hand in hand with the sustainability model, which is due at the end of the project.
Dissemination of the results of the project and research done by partners surrounding the project will also continue; results will be shown at medical education conferences, including the AMEE. Time speeds forward as we are working to bring this project to life and help support educators and students develop their clinical reasoning skills. Here’s to the DID-ACT project starting off 2022!
To ensure the quality of our curriculum’s development, our pilots accompanied a questionnaire for participants and facilitators. We are using this feedback to create necessary emphasis and/ or create a clearer final product for our learners. These responses were coupled with monitoring our chosen learning management system (LMS), Moodle, and virtual patient system, CASUS. DID-ACT’s six institutional partners took part in the evaluation by facilitating 9 pilot courses across Europe. In brief, approximately 100 teachers participated in the 5 clinical reasoning teaching topics in the train-the-trainer course pilots. Approximately half of the participants returned their evaluation questionnaires alongside 12 responses from facilitators. The results, discussed further here, coding was double-checked and disagreements were solved by consensus.
Survey tools for clinical reasoning curriculum assessment
In our pilots we made the decision to use survey-based tools for measuring the train-the-trainer (TTT) and students courses. Our goal was to capture responses using fewer questions in a way that allowed for comparison between piloted units. In the end, we used Evaluation of Technology-Enhanced Learning Materials (ETELM). This tool, developed by David Cook and Rachel Ellaway, gave us our launch pad to have questionnaires be our standard evaluation tool. This was attractive for many reasons, including facilitating implementation into our learning unit template within our LMS.
Lessons learned around evaluations for our pilot implementation
Through iteration and collaboration with a psychologist, experienced educators, and researchers, we found the following pertinent for our project and beyond:
Ensure you are using consistent language; i.e use either ‘course’ or ‘learning unit’, as pertinent to your project
Be mindful of using the word ‘practice’ as it can be interpreted many ways; i.e in DID-ACT’s case, we changed, “This learning unit will change my practice” to “This learning unit will improve my clinical reasoning”
Providing participants an option to write free-text in their native language, as a project allows
Avoid too many questions that may lead to overloading participants
Asking about years in a profession versus age provides more succinct answers for what we needed.
TTT Pilot Implementation Survey Results
We set up our questionnaires using a scale of 1 (definitely agree) to 7 (definitely disagree). The average score of responses was 5.8 when prompted with the question about whether the courses would improve the teaching of clinical reasoning. The pilots excelled in the areas of selection of topics, small group discussions, the facilitators, and inter-professional learning opportunities. Growth was suggested in the areas of technical navigation of the LMS, assessment and feedback on process, and content that was tailored more to professions other than physicians.
Analysis of Pilot Implementations
The survey questionnaires were analyzed on Microsoft Excel where, using quantitative methodology, we calculated the descriptive statistics. In contrast, for open-ended responses, we performed a content analysis. Participant utterances were coded with the categories proposed in D3.2 (Didactical, Content, Technical, Interaction/ Collaboration, Implementation/ Time, Implementation /Facilitators). As well, we extended by adding three more categories (Content/Assessment, Overall and Others). All data was processed anonymously with each statement being set as positive, negative, or neutral.
Overall, the TTT pilot implementations were a success as well as were our efforts in evaluating them. We will implement constructive feedback applicable to other learning units as we continue to develop them. Alongside this, we will return to the original pilot implementations and amend what needs to be improved. You can read a more detailed overview of D5.2 Evaluation and analysis of learner activities during these TTT pilot implementations here.
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 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.
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:
Hege I, Tolks D, Adler M, Härtl A. Blended learning: ten tips on how to implement it into a curriculum in healthcare education. GMS J Med Educ. 2020;37(5):Doc45. (Article)
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.
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.
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.
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
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
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.
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.
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.
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) RecommendedECTS: 0.07 Links: Student course - Facilitator resources
