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!
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.
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!
The DID-ACT project’s in-person September meeting in Bern, Switzerland, brought forward many interesting insights and opportunities for streamlining tasks. Aspects of effective project management in our development of a clinical reasoning curriculum were brought up a few times. Some key takeaways were small, like how to more clearly manage our folders using the feedback from the interim report. Larger topics, like tools for effectively writing blog posts and reports, were also brought up. These tools help to ensure the language of posts are at an appropriate audience level. One of our largest takeaways was how to streamline the review process for our learning units (LU) in a way that was more time-efficient and thorough.
Streamlining the curriculum review process
Our previous process for reviewing the learning units developed was to set up a small working group. Groups would be given a week or two for review, then come together to discuss our thoughts using a standardized review template. The team who developed the learning unit would then implement the necessary implementations based on feedback. Following this, there was a final review opened to the group. We noticed a few downfalls to this method:
It took many weeks to get the review done due to requiring a sync between the entire team;
Things slipped through the cracks upon the more scrutinized review that the Moodle implementation required;
By not being as high a stakeholder as, for example, someone who was testing the learning unit themselves, reviewers were not as engaged as needed for proper scrutiny.
This third point was the experience of one of the EDU teammates when preparing to implement the Person-Centred Care learning unit for trainers.
New review process for clinical reasoning learning units
omething many of us know about preparing anything is that running through it in detail, as close to how it will be used in real life, is a key part of ensuring you are producing a quality item. This is exactly the circumstance Jennifer and Daniel found themselves in when preparing their PCC learning unit pilot. Despite having made it through the pre-described learning unit review process, tiny errors slipped through. Ideas around how to more effectively use time, adequate prep for an activity, and Moodle implementation itself were all aspects of the curriculum we could streamline before the actual pilot. The EDU team brought this experience forward to the consortium at the Bern meeting and from this fruitful discussion came the following modified review process:
LU’s are to be completed in batches
When a working group has their LU prepared for review, they email the consortium and a review group of 2-3 people, including 2 of the authors, is formed using a Google doc sign up sheet
A review date is agreed on
At this point, the team is to review the learning unit asynchronously
Upon meeting synchronously, one of the authors is to proceed to run through the learning unit as if they were piloting it. The second is to take notes of their own as well as marking the reflections of the ‘learners’
Amendments are to be made and when completed go through a final review before being added to Moodle.
This modified review process helps to ensure that there is a stronger stakeholder in the review, the person who has to actually teach it to their teammates. We will keep you posted on how it goes!
For any questions regarding this process, please contact us!
Time has flown by quickly and the DID-ACT project, which began in January 2020. The project’s kick off began with the analysis of specific learner and educator needs for the development of a curriculum. We developed, in the beginning, a structured analysis of the needs and from that a set of learning goals and objectives on what a clinical reasoning curriculum should cover. Previous group work demonstrated that in medical education, explicit clinical reasoning curricula is needed, but not many health care institutions currently teach it explicitly. The project was therefore a welcome stepping stone to the development of the needed curricula. A big effort of our project is therefore to incorporate all needs identified through the survey prior to the project, and the in-depth needs for a clinical reasoning curriculum developed through the needs analysis, within the DID-ACT project.
The year 2021 marked an important step in the development of our clinical reasoning curriculum: Initiating the development of our first learning units. The learning units are the building blocks for our curriculum. The project intends to build 40 learning units for students and educators in total that educators can use, according to their needs, to implement either the whole curriculum or parts of it in their home institutions. The learning units focus on aspects such as theories of clinical reasoning, collaboration and interprofessional learning, or errors and biases in clinical reasoning (see Deliverable 2.1).
Our development groups spent and continue to spend time on developing and refining the learning units for both applicability and adaptability so that educators can use teaching content to their fullest potential. The learning units also include specific teaching methods and thus can be adapted to a particular institution’s framework. Reviewing the learning units is an integral part of this process. Upon initial completion, all learning units are further refined by a collaborative peer review done asynchronously followed by a synchronous session during a team DID-ACT meeting by multiple health professionals, learning designers, and other educational experience providers. Once the review process and revision following feedback is done, the learning units are implemented on our chosen learning management system.
The learning units are publicly available at with your institutional credentials or after registering with any email address :
For the development of the DID-ACT’s online clinical reasoning curriculum we will be following the six step Kern cycle for curriculum development. Kicking off our third and fourth work package in January 2021 signalled the start for detailed planning and development of learning units. As of now, we have started with 4 units, but based on our curricular framework, we will be developing a total of 40 learning units. These units will be aligned with a collection of case scenarios and virtual patients. Together, these will allow for interprofessional and deliberate practice of clinical reasoning.
We started this process by providing an exemplary learning unit (“What is clinical reasoning – an introduction”) and a template for describing a learning unit. We then divided into smaller teams to develop the first four learning units on different clinical reasoning-related theories in parallel. Each team includes partners from different health professions across Europe. Each team has varying levels of expertise, ranging from students to experienced clinicians or educators. The diversity of knowledge and experience are key elements for developing a clinical reasoning curriculum that reflects the various needs of health professions across Europe and beyond.
Upon completion of each learning unit, each unit will be reviewed within our team and by associate partners. The units will then be revised accordingly and implemented into Moodle, our learning management system, using available OERs. We will create new resources ourselves, if needed. After a final review, all learning units will be made publicly available to be freely used by students and educators.
We will pilot selected learning units from the student curriculum and the train-the-trainer course within our partner institutions during the summer and fall 2021. The evaluation results of course participants and facilitators will be the basis for further refinements of our clinical reasoning curriculum. For that purpose, we aim to include at least 500 students and 50 educators.
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)