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Lee CY, Lai HY, Lee CH, Chen MM, Yau SY. Collaborative clinical reasoning: a scoping review. PeerJ 2024; 12:e17042. [PMID: 38464754 PMCID: PMC10924455 DOI: 10.7717/peerj.17042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Background Collaborative clinical reasoning (CCR) among healthcare professionals is crucial for maximizing clinical outcomes and patient safety. This scoping review explores CCR to address the gap in understanding its definition, structure, and implications. Methods A scoping review was undertaken to examine CCR related studies in healthcare. Medline, PsychInfo, SciVerse Scopus, and Web of Science were searched. Inclusion criteria included full-text articles published between 2011 to 2020. Search terms included cooperative, collaborative, shared, team, collective, reasoning, problem solving, decision making, combined with clinical or medicine or medical, but excluded shared decision making. Results A total of 24 articles were identified in the review. The review reveals a growing interest in CCR, with 14 articles emphasizing the decision-making process, five using Multidisciplinary Team-Metric for the Observation of Decision Making (MDTs-MODe), three exploring CCR theory, and two focusing on the problem-solving process. Communication, trust, and team dynamics emerge as key influencers in healthcare decision-making. Notably, only two articles provide specific CCR definitions. Conclusions While decision-making processes dominate CCR studies, a notable gap exists in defining and structuring CCR. Explicit theoretical frameworks, such as those proposed by Blondon et al. and Kiesewetter et al., are crucial for advancing research and understanding CCR dynamics within collaborative teams. This scoping review provides a comprehensive overview of CCR research, revealing a growing interest and diversity in the field. The review emphasizes the need for explicit theoretical frameworks, citing Blondon et al. and Kiesewetter et al. The broader landscape of interprofessional collaboration and clinical reasoning requires exploration.
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Affiliation(s)
- Ching-Yi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hung-Yi Lai
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Hsin Lee
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Mi-Mi Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Sze-Yuen Yau
- (CG-MERC) Chang Gung Medical Education Research Centre, Linkou, Taoyuan, Taiwan
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Chu M, Xu L, Liu Y, Ye H, Zhang Y, Xue Y, Li Y, Gao X, Hao J, Wang L, Guo Q, Wang Y. Interprofessional education in problem-based learning: A frontier form of PBL in medical education. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:376. [PMID: 38144018 PMCID: PMC10743944 DOI: 10.4103/jehp.jehp_62_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/07/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Interprofessional education (IPE) aims to educate healthcare students to improve collaboration and the quality of care. The delivery of IPE through a problem-based learning (PBL) setting appears to hold good validity. However, there are few studies that show the value of combining these two teaching modes. MATERIALS AND METHODS The research was a longitudinal intervention study. A total of 360 students were randomly divided into three interprofessional PBL (IPBL) groups that mixed nursing, pharmacy, and clinical medical students and three uniprofessional PBL (UPBL) groups that consisted of a single profession. An improved Attitude and Learning Ability Questionnaire (ALAQ) was used to measure the improvement in attitudes toward interprofessional cooperation and learning outcomes. The tutorial session and final examination grades were compared between IPBL and UPBL by Chi-square tests and Cochran-Mantel-Haenszel tests. Cronbach's α analysis was calculated to assess the validity and reliability. Cronbach's alpha coefficient of the questionnaire was 0.887, demonstrating high levels of reliability (95% confidence interval [CI]: 0.842 0.916). RESULTS According to Chi-square tests and Cochran-Mantel-Haenszel tests, we observed the student's positive attitudes toward interprofessional collaboration and the student's role awareness in the IPBL students was increased compared with UPBL students. In addition, a great majority of IPBL students felt that they had improved their self-learning ability and maintained a high enthusiasm for learning during the course. CONCLUSION Our study found that the IPBL teaching model was more effective than the UPBL teaching model in healthcare student's positive attitudes toward interprofessional collaboration and learning outcomes.
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Affiliation(s)
- Ming Chu
- Department of Immunology, School of Basic Medical Sciences, Peking University, NHC Key Laboratory of Medical Immunology (Peking University), Beijing, China
| | - Lan Xu
- Department of Immunology, School of Basic Medical Sciences, Peking University, NHC Key Laboratory of Medical Immunology (Peking University), Beijing, China
| | - Yuan Liu
- Department of Immunology, School of Basic Medical Sciences, Peking University, NHC Key Laboratory of Medical Immunology (Peking University), Beijing, China
| | - Huihui Ye
- Department of Immunology, Hunan Polytechnic of Environment and Biology, Hengyang, China
| | - Yan Zhang
- Teaching Office, School of Basic Medical Sciences, Department of Immunology, Peking University Health Science Center, Beijing, China
| | - Yintong Xue
- Department of Immunology, School of Basic Medical Sciences, Peking University, NHC Key Laboratory of Medical Immunology (Peking University), Beijing, China
| | - Yan Li
- Department of Immunology, School of Basic Medical Sciences, Peking University, NHC Key Laboratory of Medical Immunology (Peking University), Beijing, China
| | - Xiang Gao
- Department of Immunology, School of Basic Medical Sciences, Peking University, NHC Key Laboratory of Medical Immunology (Peking University), Beijing, China
| | - Jie Hao
- Department of Immunology, School of Basic Medical Sciences, Peking University, NHC Key Laboratory of Medical Immunology (Peking University), Beijing, China
| | - Lijun Wang
- Department of Immunology, School of Basic Medical Sciences, Peking University, NHC Key Laboratory of Medical Immunology (Peking University), Beijing, China
| | - Qi Guo
- Student Office, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Yuedan Wang
- Department of Immunology, School of Basic Medical Sciences, Peking University, NHC Key Laboratory of Medical Immunology (Peking University), Beijing, China
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Vreugdenhil J, Somra S, Ket H, Custers EJFM, Reinders ME, Dobber J, Kusurkar RA. Reasoning like a doctor or like a nurse? A systematic integrative review. Front Med (Lausanne) 2023; 10:1017783. [PMID: 36936242 PMCID: PMC10020202 DOI: 10.3389/fmed.2023.1017783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
When physicians and nurses are looking at the same patient, they may not see the same picture. If assuming that the clinical reasoning of both professions is alike and ignoring possible differences, aspects essential for care can be overlooked. Understanding the multifaceted concept of clinical reasoning of both professions may provide insight into the nature and purpose of their practices and benefit patient care, education and research. We aimed to identify, compare and contrast the documented features of clinical reasoning of physicians and nurses through the lens of layered analysis and to conduct a simultaneous concept analysis. The protocol of this systematic integrative review was published doi: 10.1136/bmjopen-2021-049862. A comprehensive search was performed in four databases (PubMed, CINAHL, Psychinfo, and Web of Science) from 30th March 2020 to 27th May 2020. A total of 69 Empirical and theoretical journal articles about clinical reasoning of practitioners were included: 27 nursing, 37 medical, and five combining both perspectives. Two reviewers screened the identified papers for eligibility and assessed the quality of the methodologically diverse articles. We used an onion model, based on three layers: Philosophy, Principles, and Techniques to extract and organize the data. Commonalities and differences were identified on professional paradigms, theories, intentions, content, antecedents, attributes, outcomes, and contextual factors. The detected philosophical differences were located on a care-cure and subjective-objective continuum. We observed four principle contrasts: a broad or narrow focus, consideration of the patient as such or of the patient and his relatives, hypotheses to explain or to understand, and argumentation based on causality or association. In the technical layer a difference in the professional concepts of diagnosis and the degree of patient involvement in the reasoning process were perceived. Clinical reasoning can be analysed by breaking it down into layers, and the onion model resulted in detailed features. Subsequently insight was obtained in the differences between nursing and medical reasoning. The origin of these differences is in the philosophical layer (professional paradigms, intentions). This review can be used as a first step toward gaining a better understanding and collaboration in patient care, education and research across the nursing and medical professions.
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Affiliation(s)
- Jettie Vreugdenhil
- Research in Education, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- VUmc Amstel Academie, Institute for Education and Training, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Faculty of Psychology and Education, LEARN! Research Institute for Learning and Education, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Hans Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Marcel E. Reinders
- Family Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jos Dobber
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam School of Nursing, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Rashmi A. Kusurkar
- Research in Education, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Faculty of Psychology and Education, LEARN! Research Institute for Learning and Education, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
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Hanum C, Findyartini A, Soemantri D. Collaborative clinical reasoning learning using an integrated care pathway in undergraduate interprofessional education: An explorative study. J Interprof Care 2022; 37:438-447. [PMID: 35880761 DOI: 10.1080/13561820.2022.2086221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Collaborative clinical reasoning (CCR) is part of interprofessional collaborative practice and aims to negotiate and manage patient problems. An integrated care pathway (ICP) can be used as a framework for developing comprehensive patient care, typically in a clinical setting. This study aims to explore the CCR process in undergraduate interprofessional teams and the use of ICP as guidance in discussing a patient's problem and its comprehensive management. This is a qualitative study following phenomenology and was performed in an interprofessional education (IPE) program held by Health Science Cluster Universitas Indonesia. A total of four observations involving 40 students and four focus-group discussions involving 18 students from different health professions backgrounds were conducted to explore the CCR process using the ICP framework. In-depth interviews with four tutors from different health professions backgrounds and document analysis were also conducted as triangulation processes. This study shows that CCR was held in two stages - individual and group. The ICP framework could be used as a guiding tool in the CCR process to discuss the patient's management and discharge plan. This study also demonstrates that there are several challenges in this learning process, including the clinical case used in the discussion, the need for prior knowledge and previous exposure to IPE and the ICP framework, and health professions' dominance during the discussion. This study provides evidence on learning of CCR using the ICP framework as a guiding tool in a pre-licensure IPE program. This approach is useful for preparing students to develop an interprofessional, comprehensive, and holistic health care plan and to help them understand the roles of each profession.
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Affiliation(s)
- Chaina Hanum
- Master Program in Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ardi Findyartini
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Faculty of Medicine, Medical Education Center, Indonesia Medical Education & Research Institute (IMERI), Universitas Indonesia, Jakarta, Indonesia
| | - Diantha Soemantri
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Faculty of Medicine, Medical Education Center, Indonesia Medical Education & Research Institute (IMERI), Universitas Indonesia, Jakarta, Indonesia
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Blondon K, Chenaud C. Using an Interprofessional Lens to Analyze Serious Adverse Events in a Teaching Hospital: An Analysis with the TeamSTEPPS<sup>&reg;</sup> Framework. Health (London) 2022. [DOI: 10.4236/health.2022.1412085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Gleason KT, Commodore-Mensah Y, Wu AW, Kearns R, Pronovost P, Aboumatar H, Dennison Himmelfarb CR. Massive open online course (MOOC) learning builds capacity and improves competence for patient safety among global learners: A prospective cohort study. NURSE EDUCATION TODAY 2021; 104:104984. [PMID: 34058646 PMCID: PMC8316390 DOI: 10.1016/j.nedt.2021.104984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/23/2021] [Accepted: 05/17/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Education about patient safety has historically been limited in health professionals curricula and largely inaccessible to the general public. We developed a massive open online course (MOOC), The Science of Safety in Healthcare, to present the foundational patient safety principles to a broad global audience of health professionals, learners, and patients interested in patient safety. OBJECTIVES To describe the Science of Safety in Healthcare MOOC, its effects on patient safety competence, and the satisfaction of course participants. METHODS The five-week video-based course was delivered in 2013 and 2014, and was organized in five modules: 1) overview of science of safety and safety culture, 2) enabling and contextual factors that influence patient safety and quality, 3) methods to improve safety and quality, 4) translating evidence intro practice and leading change, and 5) summary and opportunities for capacity building. Each module had three or four segments. Participants were introduced to key concepts, and tools and skills to promote patient safety. Participants completed the Health Professional Education in Patient Safety Survey (H-PEPSS), which measures patient safety competence, and a course satisfaction survey. Pre- and post- course H-PEPSS scores were compared using paired t-tests. Course satisfaction surveys were administered at the completion of the course and six months later. RESULTS A total of 20,957, and 9679 participants enrolled in the course in 2013 and 2014, respectively. About half of participants were 25-44 years old (57%), and female (54%). Participants joined from over 100 countries. The majority were health professionals (61%) or health professionals in training (7%). Mean H-PEPSS scores improved after course completion, with significant increases on all survey domains in both years (p < 0.01). Mean score differences were: Teamwork 0.68 (95% CI: 0.64, 0.71), Communication 0.70 (95% CI: 0.66, 0.73), Managing Risk 0.79 (95% CI: 0.76, 0.82), Human Environment 0.64 (95% CI: 0.61, 0.68), Recognizing and Responding 0.64 (95% CI: 0.61, 0.68), and Culture 0.72 (95% CI: 0.68, 0.75). About 8% of participants in each cohort earned a certificate of completion. At 6-months post-course, the majority of the participants agreed or agreed strongly that the course content was useful (93%) and that the course positively influenced their clinical practice (69%) and communication (84%). CONCLUSIONS The MOOC course allowed educators to reach a large, diverse audience. The course was well-received and participants reported a significant increase in patient safety competence. As with most MOOCs, rates of completion were low.
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Affiliation(s)
- Kelly T Gleason
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
| | | | - Albert W Wu
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Robert Kearns
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Hanan Aboumatar
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Cheryl R Dennison Himmelfarb
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA; School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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7
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Vreugdenhil J, Döpp D, Custers EJFM, Reinders ME, Dobber J, Kusukar RA. Illness scripts in nursing: Directed content analysis. J Adv Nurs 2021; 78:201-210. [PMID: 34378221 PMCID: PMC9290845 DOI: 10.1111/jan.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/21/2021] [Accepted: 07/09/2021] [Indexed: 12/01/2022]
Abstract
Aims To explore the possible extension of the illness script theory used in medicine to the nursing context. Design A qualitative interview study. Methods The study was conducted between September 2019 and March 2020. Expert nurses were asked to think aloud about 20 patient problems in nursing. A directed content analysis approach including quantitative data processing was used to analyse the transcribed data. Results Through the analysis of 3912 statements, scripts were identified and a nursing script model is proposed; the medical illness script, including enabling conditions, fault and consequences, is extended with management, boundary, impact, occurrence and explicative statements. Nurses often used explicative statements when pathophysiological causes are absent or unknown. To explore the applicability of Illness script theory we analysed scripts’ richness and maturity with descriptive statistics. Expert nurses, like medical experts, had rich knowledge of consequences, explicative statements and management of familiar patient problems. Conclusion The knowledge of expert nurses about patient problems can be described in scripts; the components of medical illness scripts are also relevant in nursing. We propose to extend the original illness script concept with management, explicative statements, boundary, impact and occurrence, to enlarge the applicability of illness scripts in the nursing domain. Impact Illness scripts guide clinical reasoning in patient care. Insights into illness scripts of nursing experts is a necessary first step to develop goals or guidelines for student nurses’ development of clinical reasoning. It might lay the groundwork for future educational strategies.
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Affiliation(s)
- Jettie Vreugdenhil
- Amsterdam UMC, LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit, Amsterdam, the Netherlands
| | - Donna Döpp
- Amstel Academie, Amsterdam UMC, Amsterdam, the Netherlands
| | - Eugène J F M Custers
- Centre for Research and Development of Education, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marcel E Reinders
- Department of Family Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jos Dobber
- Amsterdam School of Nursing, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Rashmi A Kusukar
- Amsterdam UMC Faculty of Medicine, Faculty of Psychology and Education, LEARN! Research Institute for learning and education, Vrije Universiteit, Amsterdam, the Netherlands
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Gleason K, Harkless G, Stanley J, Olson APJ, Graber ML. The critical need for nursing education to address the diagnostic process. Nurs Outlook 2021; 69:362-369. [PMID: 33455815 PMCID: PMC8178169 DOI: 10.1016/j.outlook.2020.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/10/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
Diagnostic errors are among the most common medical errors and the deadliest. The National Academy of Medicine recently concluded that diagnostic errors represent an urgent national concern. Their first recommendation to address this issue called for promoting the key role of the nurse in the diagnostic process. Registered nurses across clinical settings significantly contribute to the medical diagnostic process, though their role in diagnosis has historically gone unacknowledged. In this paper, we review the history and current state of diagnostic education in pre-licensure registered nurse preparation, introduce interprofessional individual- and team-based competencies to improve diagnostic safety, and discuss the next steps for nursing education. Nurses educated and empowered to fully participate in the diagnostic process are essential for achieving better, safer patient outcomes.
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Affiliation(s)
| | | | - Joan Stanley
- American Association of Colleges of Nursing, Washington, DC
| | | | - Mark L Graber
- Society to Improve Diagnosis in Medicine, Chicago, IL
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Rogers BA, Franklin AE. Cognitive load experienced by nurses in simulation-based learning experiences: An integrative review. NURSE EDUCATION TODAY 2021; 99:104815. [PMID: 33640776 DOI: 10.1016/j.nedt.2021.104815] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 01/11/2021] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Simulation based learning experiences help nurses gain skills necessary for independent practice. However, increased cognitive load placed on learners in simulation may affect learning outcomes. OBJECTIVES The purpose of this integrative review was to synthesize what is known about nurses' cognitive load in simulation and summarize measurement approaches. DATA SOURCES A search of CINAHL, Medline, ProQuest Nursing and Allied Health, and ERIC databases was limited to peer-reviewed studies published after 2006 in the English language, using the key words nurse, simulation, and cognitive load. REVIEW METHODS Whittemore and Knafl's (2005) integrative review method was used. Studies investigating advanced practice nurses or interprofessional teams were excluded. RESULTS Database and reference lists searches identified a total of 3077 records, and 20 met inclusion criteria. Simulation fidelity, time pressure, dual-tasking, interruptions, task complexity, distractions, and mismatched simulation objectives to learner ability increase nurses' cognitive load. However, past experience, pre-briefing, repeated scenarios, and worked-out modeling optimize cognitive load. Subjective and objective cognitive load measures help researchers understand cognitive load and define its relationship with other variables. CONCLUSIONS Simulation impacts nurses' cognitive load. Varying simulation designs to optimize cognitive load will improve learning outcomes. Future nursing simulation research should utilize well-validated cognitive load measures and measure cognitive load alongside other variables to further understand how cognitive load affects simulation outcomes.
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Affiliation(s)
- Beth A Rogers
- Texas Christian University, Fort Worth, TX, United States of America.
| | - Ashley E Franklin
- Texas Christian University, Fort Worth, TX, United States of America.
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Coolen E, Engbers R, Draaisma J, Heinen M, Fluit C. The use of SBAR as a structured communication tool in the pediatric non-acute care setting: bridge or barrier for interprofessional collaboration? J Interprof Care 2020:1-10. [PMID: 33190546 DOI: 10.1080/13561820.2020.1816936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
SBAR (Situation, Background, Assessment and Recommendation) is a structured method developed for communicating critical information that requires immediate action. In 2016 the SBAR tool was introduced at the Amalia Children's Hospital in the Netherlands to improve communication between healthcare workers. Despite formal training and the introduction of aids to facilitate implementation, observed adherence to the tool was low. A qualitative study was undertaken to study the use of SBAR by pediatric residents and nurses in the non-acute clinical care setting of an academic children's hospital. Semi-structured focus group sessions were conducted and qualitatively analyzed using a constructed coding template to search for facilitators and barriers in the use of SBAR by different professionals. We found professionals' use of SBAR was influenced by departmental, cultural, and individual factors. Important themes for effective implementation and use of SBAR in an interprofessional setting, like situation dependency, learning climate and professional identity had not been addressed during the initial implementation. To facilitate SBAR's use it is important to identify professionals' needs to use the tool effectively, to take into account how tasks and responsibilities are perceived by different professions, and to stimulate interprofessional feedback and role modeling.
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Affiliation(s)
- Ester Coolen
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Rik Engbers
- Radboud Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos Draaisma
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Maud Heinen
- IQ Health Care, Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Cornelia Fluit
- Radboud Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
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Olson A, Rencic J, Cosby K, Rusz D, Papa F, Croskerry P, Zierler B, Harkless G, Giuliano MA, Schoenbaum S, Colford C, Cahill M, Gerstner L, Grice GR, Graber ML. Competencies for improving diagnosis: an interprofessional framework for education and training in health care. ACTA ACUST UNITED AC 2020; 6:335-341. [PMID: 31271549 DOI: 10.1515/dx-2018-0107] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 05/05/2019] [Indexed: 01/06/2023]
Abstract
Background Given an unacceptably high incidence of diagnostic errors, we sought to identify the key competencies that should be considered for inclusion in health professions education programs to improve the quality and safety of diagnosis in clinical practice. Methods An interprofessional group reviewed existing competency expectations for multiple health professions, and conducted a search that explored quality, safety, and competency in diagnosis. An iterative series of group discussions and concept prioritization was used to derive a final set of competencies. Results Twelve competencies were identified: Six of these are individual competencies: The first four (#1-#4) focus on acquiring the key information needed for diagnosis and formulating an appropriate, prioritized differential diagnosis; individual competency #5 is taking advantage of second opinions, decision support, and checklists; and #6 is using reflection and critical thinking to improve diagnostic performance. Three competencies focus on teamwork: Involving the patient and family (#1) and all relevant health professionals (#2) in the diagnostic process; and (#3) ensuring safe transitions of care and handoffs, and "closing the loop" on test result communication. The final three competencies emphasize system-related aspects of care: (#1) Understanding how human-factor elements influence the diagnostic process; (#2) developing a supportive culture; and (#3) reporting and disclosing diagnostic errors that are recognized, and learning from both successful diagnosis and from diagnostic errors. Conclusions These newly defined competencies are relevant to all health professions education programs and should be incorporated into educational programs.
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Affiliation(s)
- Andrew Olson
- Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Joseph Rencic
- Internal Medicine Residency Program, Tufts University School of Medicine, Boston, MA, USA
| | | | - Diana Rusz
- Society to Improve Diagnosis in Medicine, Chicago, IL, USA
| | - Frank Papa
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Pat Croskerry
- Department of Emergency Medicine, Dalhousie University Medical School, Halifax, Nova Scotia, Canada
| | - Brenda Zierler
- University of Washington School of Nursing, Seattle, WA, USA
| | | | - Michael A Giuliano
- Hackensack Meridian School of Medicine at Seton Hall, South Orange, NJ, USA
| | | | - Cristin Colford
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Maureen Cahill
- National Council State Boards of Nursing, Chicago, IL, USA
| | - Laura Gerstner
- Campbell University Physician Assistant Program, Buies Creek, NC, USA
| | | | - Mark L Graber
- Chief Medical Officer, Society to Improve Diagnosis in Medicine, New York, NY, USA
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12
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Galland J, Martis N, Levraut M, Hani H, Baumann C, Fournier JP, Braun M. Impact of Simulation-Based Learning on National Ranking Medical Examination Results in France. ACTA ACUST UNITED AC 2020; 15:259-265. [DOI: 10.1097/sih.0000000000000431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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13
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Visser CLF, Wouters A, Croiset G, Kusurkar RA. Scaffolding Clinical Reasoning of Health Care Students: A Qualitative Exploration of Clinicians' Perceptions on an Interprofessional Obstetric Ward. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520907915. [PMID: 32133416 PMCID: PMC7040925 DOI: 10.1177/2382120520907915] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/29/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE Interprofessional education (IPE) on a ward supports students to generate interprofessional patient care plans as a means to learn about the roles, responsibilities, and clinical reasoning of other professions. We investigated how clinicians guide the clinical reasoning of students from their own and other professions and whether clinicians from nursing, midwifery, and medicine could scaffold students from all professions, that is, by providing just-in-time and tailored support. METHODS Nine supervising clinicians from medicine, nursing, and midwifery were interviewed and a repeat interview held 3 to 15 weeks later; one nurse supervisor was interviewed only once. Using conventional content analysis, themes were identified inductively. Next, we applied an existing scaffolding framework to conceptualise how clinicians supported the clinical reasoning in an IPE setting. RESULTS Themes were clinicians' interventions and intentions, results of interventions and of IPE, characteristics of students and clinicians, interactions between clinicians and students, and logistics. Clinicians applied various interventions and expressed several intentions to guide the learning of students from all professions. Clinicians stimulated students' clinical reasoning by structuring meetings, asking students to explain their thoughts to each other and through giving group assignments. Thus, clinicians used peer-assisted learning for the students. By collaborating with other supervising clinicians regarding the form and amount of guidance to give to the students, clinicians applied peer-assisted learning for themselves as well. CONCLUSION Clinicians can learn to scaffold the clinical reasoning of students from different professions, when they are provided with training, good examples, and structures. An existing scaffolding framework can serve as an overview of aims and interventions to provide just-in-time guidance to students from all professions. The scaffolding framework is useful for training clinicians and for depicting the pedagogical approach for IPE wards.
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Affiliation(s)
- Cora LF Visser
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amstel Academy, VU University Medical Center, Amsterdam, The Netherlands
| | - Anouk Wouters
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - Gerda Croiset
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - Rashmi A Kusurkar
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
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Ng CH, Ong ZH, Koh JWH, Ang RZE, Tan LHS, Tay KT, Chin AMC, Toh YP, Zhou JX, Krishna LKR. Enhancing Interprofessional Communications Training in Internal Medicine. Lessons Drawn From a Systematic Scoping Review From 2000 to 2018. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:27-35. [PMID: 32149946 DOI: 10.1097/ceh.0000000000000278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Interprofessional communication (IPC) enhances patient experiences and outcomes and improves well-being and satisfaction among health care professionals. This scoping review seeks to guide design of IPC training in internal medicine. METHODS The framework of Arksey and O'Malley (2005) guided this systematic scoping review in internal medicine across PubMed, Embase, CINAHL, Scopus, PsycINFO, ERIC, JSTOR, and Google Scholar databases for publications from the years 2000 to 2018. RESULTS Twenty-two thousand eight hundred seventy-four abstracts were retrieved, 326 full-text articles were reviewed, and 32 articles were included. The themes identified using directed content analysis were indications for an IPC program, training stages, and obstacles. The rationale for IPC programs was to improve interprofessional teamwork and enhance patient care. IPC training occurs in five stages beginning with instilling the role, value, and skills behind IPC and gradually practicing these skills within the clinical setting. The challenges to IPC highlight the need to confront workplace hierarchies and the lack of resources. DISCUSSION The findings of this systematic scoping review also serve to underscore the importance of understanding, evaluating, and influencing the clinical environment and the work environment and the need for new assessment tools that will guide the individualized, longitudinal, competency-based learning process that underpins IPC training.
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Affiliation(s)
- Cheng Han Ng
- Mr. Ng: Second Year Medical Student, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Mr. Ong: Third Year Medical Student, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Mr. Koh: Third Year Pharmacy Student, Faculty of Science, National University of Singapore, Singapore.Ms. Ang: Second Year Nursing Student, Alice Tan Centre of Nursing Studies, National University of Singapore, Singapore.Ms. Tan: Fifth Year Medical Student, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Mr. Tay: Fifth Year Medical Student, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Ms. Chin: Senior Librarian, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Dr. Toh: Family Medicine Resident, National University Health System, Singapore. Dr. Zhou: Consultant, Division of Supportive and Palliative Care, National Cancer Centre Singapore, and Education Faculty, Lien Centre for Palliative Care, Singapore. Dr. Krishna: Senior Consultant, Division of Supportive and Palliative Care, National Cancer Centre Singapore; Course Director, (phase 2) Duke NUS Medical School and Course Director, (phase 4 and 5) the Centre for Biomedical Ethics, National University of Singapore, Singapore
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A Scoping Review of Physicians' Clinical Reasoning in Emergency Departments. Ann Emerg Med 2019; 75:206-217. [PMID: 31474478 DOI: 10.1016/j.annemergmed.2019.06.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE Clinical reasoning is considered a core competency of physicians. Yet there is a paucity of research on clinical reasoning specifically in emergency medicine, as highlighted in the literature. METHODS We conducted a scoping review to examine the state of research on clinical reasoning in this specialty. Our team, composed of content and methodological experts, identified 3,763 articles in the literature, 95 of which were included. RESULTS Most studies were published after 2000. Few studies focused on the cognitive processes involved in decisionmaking (ie, clinical reasoning). Of these, many confirmed findings from the general literature on clinical reasoning; specifically, the role of both intuitive and analytic processes. We categorized factors that influence decisionmaking into contextual, patient, and physician factors. Many studies focused on decisions in regard to investigations and admission. Test ordering is influenced by physicians' experience, fear of litigation, and concerns about malpractice. Fear of litigation and malpractice also increases physicians' propensity to admit patients. Context influences reasoning but findings pertaining to specific factors, such as patient flow and workload, were inconsistent. CONCLUSION Many studies used designs such as descriptive or correlational methods, limiting the strength of findings. Many gray areas persist, in which studies are either scarce or yield conflicting results. The findings of this scoping review should encourage us to intensify research in the field of emergency physicians' clinical reasoning, particularly on the cognitive processes at play and the factors influencing them, using appropriate theoretical frameworks and more robust methods.
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Fürstenberg S, Oubaid V, Berberat PO, Kadmon M, Harendza S. Medical knowledge and teamwork predict the quality of case summary statements as an indicator of clinical reasoning in undergraduate medical students. GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc83. [PMID: 31844655 PMCID: PMC6905359 DOI: 10.3205/zma001291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 09/08/2019] [Accepted: 09/26/2019] [Indexed: 05/21/2023]
Abstract
Background: Clinical reasoning refers to a thinking process including medical problem solving and medical decision making skills. Several studies have shown that the clinical reasoning process can be influenced by a number of factors, e.g. context or personality traits, and the results of this thinking process are expressed in case presentation. The aim of this study was to identify factors, which predict the quality of case summary statements as an indicator of clinical reasoning of undergraduate medical students in an assessment simulating the first day of residency. Methods: To investigate factors predicting aspects of clinical reasoning 67 advanced undergraduate medical students participated in the role of a beginning resident in our competence-based assessment, which included a consultation hour, a patient management phase, and a handover. Participants filled out a Post Encounter Form (PEF) to document their case summary statements and other aspects of clinical reasoning. After each phase, they filled out the Strain Perception Questionnaire (STRAIPER) to measure their situation dependent mental strain. To assess medical knowledge the participants completed a 100 questions multiple choice test. To measure stress resistance, adherence to procedures, and teamwork students took part in the Group Assessment of Performance (GAP) test for flight school applicants. These factors were included in a multiple linear regression analysis. Results: Medical knowledge and teamwork predicted the quality of case summary statements as an indicator of clinical reasoning of undergraduate medical students and explained approximately 20.3% of the variance. Neither age, gender, undergraduate curriculum, academic advancement nor high school grade point average of the medical students of our sample had an effect on their clinical reasoning skills. Conclusion: The quality of case summary statements as an indicator of clinical reasoning can be predicted in undergraduate medical students by their medical knowledge and teamwork. Students should be supported in developing abilities to work in a team and to acquire long term knowledge for good case summary statements as an important aspect of clinical reasoning.
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Affiliation(s)
- Sophie Fürstenberg
- University Medical Center Hamburg-Eppendorf, III. Department of Internal Medicine, Hamburg Germany
| | | | - Pascal O. Berberat
- Technical University of Munich, TUM Medical Education Center, School of Medicine, Munich, Germany
| | - Martina Kadmon
- University of Augsburg, Faculty of Medicine, Deanery, Augsburg, Germany
| | - Sigrid Harendza
- University Medical Center Hamburg-Eppendorf, III. Department of Internal Medicine, Hamburg Germany
- *To whom correspondence should be addressed: Sigrid Harendza, University Medical Center Hamburg-Eppendorf, III. Department of Internal Medicine, Martinistr. 52, D-20246 Hamburg, Germany, Phone: +49 (0)40/7410-53908, Fax: +49 (0)40/7410-40218, E-mail:
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Visser CLF, Kusurkar RA, Croiset G, Ten Cate O, Westerveld HE. Students' motivation for interprofessional collaboration after their experience on an IPE ward: A qualitative analysis framed by self-determination theory. MEDICAL TEACHER 2019; 41:44-52. [PMID: 29490575 DOI: 10.1080/0142159x.2018.1436759] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Interprofessional Education (IPE) may depend for its success not only on cognitive gains of learners, but also on affective and motivational benefits. According to Self-Determination Theory (SDT), a major motivation theory, autonomy (feeling of choice), competence (feeling of capability), and relatedness (feeling of belonging) drive motivation in a way that can improve performance. We investigated which elements of IPE in a clinical ward potentially influence students' feelings in these three areas. METHODS We conducted semi-structured interviews with 21 students from medicine, nursing, pharmacy, and physical therapy attending a three-week IPE ward and analyzed the data using a realist approach. Two researchers independently identified meaning units using open coding. Thirteen themes were synthesized. Next, meaning units, expressing autonomy, competence, or relatedness were discerned. RESULTS Students appeared motivated for an IPE ward, with its authentic situations making them feel responsible to actively contribute to care plans, by understanding how professions differ in their contributions and analytic approach and by informal contact with other professions, enhanced by a dedicated physical space for team meetings. CONCLUSION Students valued the IPE ward experience and autonomous motivation for IPE was triggered. They mentioned practical ways to incorporate what they learned in future interprofessional collaboration, e.g. in next placements.
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Affiliation(s)
- Cora L F Visser
- a VUmc School of Medical Sciences & VUmc Amstel Academy , VU University Medical Center , Amsterdam , The Netherlands
| | - Rashmi A Kusurkar
- b VUmc School of Medical Sciences, LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education , VU University Medical Center , Amsterdam , The Netherlands
| | - Gerda Croiset
- b VUmc School of Medical Sciences, LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education , VU University Medical Center , Amsterdam , The Netherlands
| | - Olle Ten Cate
- c Center for Research & Development of Education , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Hendrika E Westerveld
- d Department of Internal Medicine , University Medical Center Utrecht , Utrecht , The Netherlands
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