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Curricular Blueprint

Explanation of the DID-ACT curricular blueprint

The table shows an overview about the DID-ACT student curriculum including learning units for the train-the-trainer course. The blueprint is based on the categories, themes, and learning outcomes that have been developed as part of WP2. Each cell represents one learning unit (LU) with one or more colored dots for the category/ies on the left-hand side indicating the level of ceompetency (see explanation below the table). To access more information on each LU, please click on the name or the i-symbol. 

ThemeNovice LevelIntermediate LevelAdvanced LevelVirtual patientsTeacher Level
What is Clinical Reasoning What is clinical reasoning and how can theories be put into practice What is Clinical Reasoning and Models - Theoretical / Background Knowledge Clinical Reasoning teaching and assessment Evaluation of Clinical Reasoning
Dual Process Theory
Using the Outcome Present State Test Model
Illness Scripts
Health profession roles in clinical reasoning Collaboration of health professions in Clinical Reasoning Collaborate with others in clinical reasoning Differences and similarities in clinical reasoning among health professions
Person-centered approach to clinical reasoning Shared Decision Making in Clinical Reasoning Person-centered approach and the role of patients
Biomedical Knowledge and Clinical Reasoning Information gathering, Generating differential diagnoses, Decision making, and Treatment planning
Collect and prioritize key clinical findings/problems
Generating differential diagnoses and deciding about final diagnosis Decision Support Systems Decision Support Systems
Developing a treatment plan Ethical aspects - patient management and treatment
Biases and cognitive errors - an Introduction Biases and cognitive errors Discussing and teaching about cognitive errors and biases
Uncertainty Uncertainty
Metacognition, reflection and models for reflection Metacognition, reflection and models for reflection
Analyzing and avoiding errors Analyzing and avoiding errors
DID-ACT clinical reasoning curriculum

Explanation

Theories of Clinical Reasoning
Self-Reflection & Attitudes
Errors & Biases
Gathering, interpreting & synthezising information

Decision Making
Generating dfferential diagnoses
Ethical Aspects
Teaching Clinical Reasoning

Developing a treatment plan
(Interprofessional) Collaboration
Patient Perspective

Previous Themes & Learning outcomes

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)

DID-ACT clinical reasoning curriculum

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

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:
Links: Student course - Facilitator resources

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. 60 min)
Links: Student course - Facilitator resources

Metacognition, reflection and models for reflection

todo

Theme(s): Errors & biases
Level: Advanced
Format:
Links: Student course - Facilitator resources

Metacognition, reflection and models for reflection

todo

Theme(s): Errors & biases
Level: Novice
Format:
Links: Student course - Facilitator resources

Uncertainty

Theme(s): Biases & errors
Level: Advanced
Format:
Links: Student course - Facilitator resources

Uncertainty

todo

Theme(s): Errors & biases
Level: Novice
Format:
Links: Student course - Facilitator resources

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 mins) followed by a synchronous meeting (ca. 60 - 90 min). Optional additional activities are provided for beginners.
Links: Participant 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.

Theme(s): Biases & errors, Ethical aspects, Theories of clinical reasoning
Level: Advanced
Format:
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.

Theme(s): Errors & biases, Theories of clinical reasoning, Ethical aspects
Level: Novice
Format: Asynchronous preparation (ca. 90 min) with a follow-up synchronous meeting (ca. 90 min)
Links: Student course - Facilitator resources

Ethical aspects - patient management and treatment

Theme(s): Ethical Aspects
Level: Intermediate
Format:
Links: Student course - Facilitator resources

Developing a treatment plan

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 (45-60 min) followed by a synchronous meeting (ca. 80 min)
Links: Student course - Facilitator resources

Decision Support Systems

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 a synchronous meeting (ca. 90 min)
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)
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. 45 min)
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)
Links: Student 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 mins) followed by a synchronous meeting (ca. 45 mins). Optional additional activities for beginners are available.
Links: Participant course - Facilitator resources

Biomedical Knowledge and Clinical Reasoning

This learning unit explains the interconnection of biomedical knowledge and differential diagnoses formulation and explores different techniques to visualize encapsulated knowledge.

Theme(s): Generating differential diagnoses
Level: Novice
Format: Two synchronous sessions (ca.60 min) with an asynchronous learning phase in between (ca. 45 min)
Links: Student 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. 45 mins), followed by a synchronous meeting (ca. 90 mins). Optional additional activites are available for beginners.
Links: Participant course - Facilitator resources

Shared Decision Making in Clinical Reasoning

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.

Theme(s): Patient Perspective, Decision Making
Level: Intermediate
Format:
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: Two synchronous meetings (90 min each), each with a preparatory asynchronous phase (15-30 min)
Links: Student 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

Theme(s): Teaching clinical reasoning, (Interprofessional) collaboration
Level: Educators
Format: Asynchronous preparation (ca. 60 mins) followed by a synchronous meeting (ca. 90 mins). Optional additional activities provided for beginner.
Links: Course,Facilitator resources

Collaborate with others in clinical reasoning

Todo

Theme(s): (Interprofessional) Collaboration
Level: Novice
Format:
Links: Student course - Facilitator resources

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:
Links: Student course - Facilitator resources

Health profession roles 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)
Links: Student course - Facilitator resources

Illness Scripts

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. 60 min each) with an asynchronous learning phase (ca. 60 min) in between
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.

Theme(s): Theories of Clinical Reasoning
Level: Novice
Format: Asynchronous preparation phase (ca. 60 min) with a follow-up synchronous meeting (ca. 90 min)
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 (60-90 min) followed by a synchronous meeting (ca. 90 min)
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.
Links: Course

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.
Links: Course

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.

What is Clinical Reasoning and Models

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 mins) with asynchronous phase (ca. 45 mins) in between
Links: 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)
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 (45 min)
Links: Student course - Facilitator resources

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