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Themes & Learning outcomes

The following sections show the categories and the overarching learning objectives for the DID-ACT student curriculum and the train-the-trainer course (TTT).  References to published learning objectives are indicated by the numbers in brackets (see references).

Upon completion of the course:

(1) Theories of clinical reasoning

1.1 The student will have an understanding of key theoretical models related to clinical reasoning. (1,2,3,5)

(2) Gathering, interpreting, and synthesizing patient information

2.1 The student will be competent in gathering, interpreting, and synthesizing patient information. (1, 6, 10)

2.2 The student will be able to accurately and efficiently collect key clinical findings needed for the analysis of a patient’s problem. (11)

2.3 The student will be able to accurately and efficiently analyze and interpret the key clinical findings to plan patient treatment and care. (7)

(3) Generating differential diagnoses including defining and discriminating features

3.1 The student will be competent in generating differential diagnoses including defining and discriminating features. (1, 7, 9)

3.2 The student will be competent in identifying the most likely diagnoses/problems/treatments based on the interpretation and prioritization of different patient-relevant information. (1, 10, 11)

3.3 The student will know about benefits and risks of clinical decision support systems, including artificial intelligence, in clinical reasoning. (11)

(4) Developing a treatment/management plan

4.1 The student will be competent in developing treatment/management plans.

4.2 The student will be able to apply treatment, therapeutic and prophylactic procedures based on a holistic assessment of the patient, the diagnosis, the healthcare context, alongside with current best evidence.

4.3 The student will know how to set treatment goals together with the patient based on evidence, healthcare context and the patient’s needs and preferences. (6, 7)

(5) Aspects of patient participation in clinical reasoning

5.1 The student will be competent in involving the patient in clinical reasoning. (7)

5.2 The student will be able to engage and collaborate with patients and families, in accordance with their values and preferences in the diagnosis and analysis of a patient’s problems. (7, 11)

5.3 The student will be able to involve and support the patient in a shared decision-making process about the treatment/management plan. (1)

5.4 The learner will be able to appreciate the patient’s (including his/her relatives) roles in clinical reasoning.

(6) Collaborative aspects of clinical reasoning

6.1 The student will be competent in collaborating with others in the clinical reasoning process. (6)

6.2 The student will be able to make use of other team members’ (own and other professions) competencies regarding patient information, diagnostic and treatment/management. (4)

(7) Interprofessional aspects of clinical reasoning

7.1 The student will be competent in applying interprofessional aspects of clinical reasoning.

7.2 The student will be able to collaborate and communicate across professions in the clinical reasoning process to meet the needs of the patient. (4, 11)

7.3 The student will understand how personal, professional and interprofessional values affect interprofessional care. (1)

7.4 The student will understand similarities and differences between the clinical reasoning of health professions.

(8) (Interprofessional) Collaboration and exchange (TTT)

8.1 The learner will be competent in teaching about similarities, differences, and most common sources of errors and biases in the clinical reasoning process of health professions.

(9) Ethical aspects

9.1 The student will be able to take legal, moral, diversity, gender-related, and ethical aspects into account in the clinical reasoning process.

(10) Self-reflection on clinical reasoning performance and strategies for future improvement

10.1 The student will be competent in applying self-reflection on clinical reasoning performance and develop strategies for future improvement.

10.2 The student will know how to use self-reflection and clinical critical thinking to improve diagnostic, therapeutic and management performance. (11)

10.3 The student will be able to evaluate the outcomes of the clinical reasoning with patients and colleagues and plan for appropriate improvements together with patients and colleagues. 

(11) Errors in the clinical reasoning process and strategies to avoid them

11.1 The student will have an understanding of common cognitive errors and biases in the clinical reasoning process and be able to apply strategies to avoid them. (1, 2, 3, 5, 7, 8, 9, 12)

11.2 The student will have an understanding of the benefits of an open climate which allows sharing of errors for promoting continuous learning and patient safety. (11, 12)

11.3 The student will be able to explain the occurrence of uncertainty in the clinical reasoning process under different circumstances and how to deal with them in a safe manner. (1, 8)

11.4 The student will have an understanding of how cognitive biases, system issues, and emotions can influence clinical reasoning. (12)

11.5 The student will know how to overcome common challenges and errors during the clinical reasoning process. (1)

(12) Attitudes towards clinical reasoning teaching (TTT)

12.1 The learner will be able to critically reflect on the importance of clinical reasoning learning, teaching, and assessment.

12.2 The learner will develop an awareness and openness to share errors in the clinical reasoning teaching.

12.3 The learner will be motivated and inspired to teach and assess clinical reasoning

(13) Teaching, assessing, and evaluating clinical reasoning (TTT)

13.1 The learner will be able to choose appropriate teaching, assessment and evaluation methods for clinical reasoning and adapt these to the cultural context. (5)

13.2 The learner will be able to implement the DID-ACT clinical reasoning student curriculum into their teaching.

(14) Decision Making

14.1 Students will be competent in making diagnostic decisions based on hypotheses regarding the patient’s problem.

14.2 Students will be competent in making management decisions taking the patient’s goals and perceived situation into account.

14.3 Students will be competent in re-evaluating their decisions based on new information.

References

  1. O’Connor et al., Chapter 32 in book: Higgs, J. (2019) Clinical Reasoning in Health Professions
  2. Duca NS, Glod S. Bridging the gap between the classroom and the clerkship: a clinical reasoning curriculum for third-year medical students. MedEdPORTAL. 2019;15:10800.
  3. Weinstein A, Gupta S, Pinto-Powell R, et al. Diagnosing and remediating clinical reasoning difficulties: a faculty development workshop. MedEdPORTAL. 2017;13:10650.
  4. Stephenson, R. C. (2004). Using a complexity model of human behaviour to help interprofessional clinical reasoning. International Journal of Therapy and Rehabilitation, 11(4), 168-175.
  5. Iyer S, Goss E, Browder C, Paccione G, Arnsten J. Development and evaluation of a clinical reasoning curriculum as part of an Internal Medicine Residency Program. Diagnosis (Berl). 2019;6(2):115-119
  6. Liou SR, Liu HC, Tsai HM, et al. The development and psychometric testing of a theory-based instrument to evaluate nurses’ perception of clinical reasoning competence. J Adv Nurs. 2016;72(3):707-717. 
  7. Polish Ministry of Science and Higher Education Educational Outcomes for Medicine Catalogue (Directive 2019; 1573)
  8. Harendza S, Krenz I, Klinge A, Wendt U, Janneck M. Implementation of a Clinical Reasoning Course in the Internal Medicine trimester of the final year of undergraduate medical training and its effect on students’ case presentation and differential diagnostic skills. GMS J Med Educ. 2017;34(5):Doc66.
  9. NKLM (National competency-based learning objectives catalog, in German)
  10. PROFILES
  11. Olson A, Rencic J, Cosby K, Rusz D, Papa F, Croskerry P, et al. Competencies for improving diagnosis: an interprofessional framework for education and training in health care. Diagnosis. 2019;6(4):335–41.
  12. Kiesewetter J et al. The Learning Objective Catalogue for Patient Safety in Undergraduate Medical Education – A Position Statement of the Committee for Patient Safety and Error Management of the German Association for Medical Education. GMS J Med Educ. 2016; 33(1): Doc10
Previous Curricular Framework
Next Curricular Blueprint

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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