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Background: Assistant professors in the health sciences (108 participants from biomedicine, clinical medicine, dentistry,sports, nursing and public health) submitted their teaching portfolio as part of the requirement for a pedagogical course foruniversity teachers at Aarhus University, Denmark. The course introduced participants to concepts and methods to createconstructive alignment and activating teaching and to a teaching portfolio as a means of reflecting upon inquiry and teaching.Design: This study investigated assistant professors espoused beliefs about the role of scientific inquiry in teaching andsupervision of students. The study was a discourse analysis of participants’ written portfolios (each 1-10 pages).Results: Scientific inquiry was constructed by participants as a means to increase students’ motivation (e.g. to pursue ascientific career), emotions (e.g. curiosity) or as a mean to increase students’ deep learning. A large group of participants tooka disciplinary stand to inquiry: They saw the laboratory as an important site of learning inquiry in biomedicine or they taughtabout scientific findings in order to translate findings from biomedicine to clinical medicine. A small group of participantsexpressed the view that students need meta-cognitive skills to develop scientific inquiry. Furthermore, they subscribed to aminimally guided inquiry model whereby students should learn to question their own findings. Even fewer participantsperceived of scientific inquiry in terms of a more systematic approach to higher-level thinking. Thus although participants citedone or more constructivist educational theorists, they did not express a well-articulated notion of inquiry and they providedlimited concrete examples on how to design a conducive learning environment around inquiry or critical thinking.Discussion: The value of this study is that it might enable educational developers to give junior faculty better guidance onteaching and specific feedback on their teaching portfolio in particular in regards to the design of learning activities that mightuse scientific inquiry as means and end in higher education.

PurposeThis chapter aims to demonstrate how medical educators can use e-collaborative tools to collaborating internationally and cross-institutionally towards designing environmental sustainability and health (ESH) education. The main focus of the chapter is on sustainable medical curricula.MethodologyThe chapter uses a case-study approach to bridge these broader e-collaborative principles with the specifics of implementation driven and supported by e-collaboration.FindingsThe case study describes the evolution of the Sustainable Healthcare Education (SHE)-network into a network collaborative. Finally, the chapter discusses e-collaboration for education development through an illustrative case. The case concerns an UK-Greek University e-collaboration aimed at combating obesity and promoting climate literacy.Research implicationsE-collaboration is central at all levels of the ESH curriculum design process from forming a network collaborative around the curriculum process, alignment of assessment and learning activities with objectives, discussing and agreeing on a vision to the actual implementation plan.Practical implicationsE-collaboration aids the curriculum design process such that people feel that their participation and interests are valued, as well as providing resources and input to resource stressed academics and institutions. E-collaboration is not an end in itself, but a means of enabling a global network collaborative to address an issue that suits this type of collaboration towards sustainable healthcare education.OriginalityThis chapter is inventive in showing how the promotion of climate literacy can be a component of a sustainable medical curriculum and how this process is facilitated with e-collaborative tools. The chapter demonstrates how health education should educate climate literate health professionals who are able to address and reduce public health impacts of climate change.

Background: Despite the widespread implementation of competency-based education, evidence of ensuing enhancedpatient care and cost-benefit remains scarce. This narrative review uses the Kirkpatrick/Phillips model to investigate thepatient-related and organizational effects of graduate competency-based medical education for five basicanesthetic procedures.Methods: The MEDLINE, ERIC, CINAHL, and Embase databases were searched for papers reporting results inKirkpatrick/Phillips levels 3–5 from graduate competency-based education for five basic anesthetic procedures. A grayliterature search was conducted by reference search in Google Scholar.Results: In all, 38 studies were included, predominantly concerning central venous catheterization. Three studies reportedsignificant cost-effectiveness by reducing infection rates for central venous catheterization. Furthermore, the proceduralcompetency, retention of skills and patient care as evaluated by fewer complications improved in 20 of thereported studies.Conclusion: Evidence suggests that competency-based education with procedural central venous catheterizationcourses have positive effects on patient care and are both cost-effective. However, more rigorously controlled andreproducible studies are needed. Specifically, future studies could focus on organizational effects and the possibility oftransferability to other medical specialties and the broader healthcare system.Keywords: Anesthesia, Graduate medical education, Internship and residency, Catheterization, Central venous, Anesthesia,General, Anesthesia spinal, Anesthesia, Epidural, Airway management, Competency-based education, Mastery learning

Scenario overview. (DOCX 36 kb)

Baggrund: Dette interventionsstudie har til formål at forbedre patientsikkerheden gennem design af in situ simulation. Undersøgelsen fandt sted på en akut medicinsk stue i den centrale region i Danmark. Forskning tyder på, at mangelfuld handover kommunikation kan øge sandsynligheden for kritiske hændelser men at simulationstræning kan være en effektiv strategi til at forbedrer kommunikation. Metoder: Dette er et prospektivt pre-post studie der undersøger virkningen af in situ simulation. Det bruges en trestrenget strategi: (1) tematisk analyse af data, der består af de indberettede kritiske hændelser, (2) en behovsanalyse baseret på korttids-etnografi, og (3) ændringer i holdninger til sikkerhed (SAQ) og tilfredshedsmål. Resultater: Seksten forskellige sundhedsfaglige teams deltog, bestående af 9 læger og 30 sygeplejersker. Deltagerne scorede deres sikkerhedsordninger (i SAQ’en) i forhold til seks kategorier. Der var signifikant forbedring i post-SAQ SAQ og teamsamarbejde (p

Calendar. (PDF 17.9 kb)

Handover and re-evaluation chart. (PDF 918 kb)

In situ plan. (PDF 1566 kb)

Observation chart. (PDF 1003 kb)

The idea of computational thinking (CT) has resulted in widespread action at all levels of the American educational system. Some action focuses on programming, some on cognition, and some on physical action that is seen as embodying computational thinking concepts. In a K–12 educational context, the observation that computing is usually about some non-computational thing can lead to an approach that integrates computational thinking instruction with existing core curricular classes. A social justice argument can be made for this approach, because all students take courses in the core curriculum.Utilizing university students in co-development activities with teachers, the current study located and implemented opportunities for integrated computational thinking in middle school in a large, suburban, mixed-socioeconomic standing (SES) , mixed-race district. The co-development strategy resulted in plausible theories of change and a number of different educational projects suitable for classroom instruction. However, a major outcome of the study was to advance the importance of proto-computational thinking (PCT). We argue that, in the absence of preexisting use of representational tools for thinking, proto-computational thinking may lead to enhanced facility in computational thinking per se. At the same time, the absence of opportunities for proto-computational thinking may leave students less open to acquiring sophisticated approaches to computational thinking itself. An approach that values proto-computational thinking may be uncomfortable because it calls attention to implicit ceilings in instruction, especially in low-SES circumstances. We argue for addressing those ceilings through proto-computational thinking.

Urosepsis scenario. (DOC 83 kb)

Paediatric education in a Danish context [ 36, 37 ]. (DOCX 86 kb)

Purpose: To examine philosophical stances underpinning medical identity and assess the conceptual relationship betweenphysician, medical practice and culture. Argument: Medical identity is about the ideals and moral positions that physicians take when justifying themselves.Medical identity is the study of the sociocultural paragons that conceptually underlie the phenomenology of physician’scoming to take themselves as autonomous social agents. The paper relies on Hegel’s Phenomenology of Spirit andinvestigates dilemmas pertaining to first objectivist versus subjectivist views and second hedonistic versus sentimentalistapproaches to medical identity. The sociocultural philosophical analysis of medical identity can shed light on what it meansconceptually for a physician to harbor beliefs associated with him/her being taken to be an autonomous professional. It isimportant because it touches on the meaning of being a compassionate, good and skilled physician, making its relevance toperson-centered medicine self-evident. Conclusion: Medical identity should be analyzed with reference to literature, philosophy and medical practice in order forthe physician to exercise a reflective position in the care of the individual patient which is both scientifically rational andsubjectively meaningful.

We present a case study of the outpatient consultation in oncology. We explore and highlight the social positions available to the doctor and patient in conversation. Our reflections are drawn from qualitative interviews and observations. We apply positioning theory, a dynamic alternative to role theory, to investigate how oncological residents and patients strive to position themselves as persons with rights and duties. Our focus is on how: (a) relational shift in authority depend on the situation and the participants present; (b) storylines establish acts and positions and narratively frame what participants can expect from the medical consultation viewed as a social episode; (c) positioning of rights and duties can lead to misunderstandings and frustrations. We conclude that doctors and patients locate themselves in outpatient conversations as participants who jointly produce and are produced by story lines about who should take responsibility for treatment. In this article, we present a case study of residents’ clinical experiences and communication in outpatient oncology consultations. We apply positioning theory, a dynamic alternative to role theory, to investigate how oncology residents and patients situate themselves as persons with rights and duties. Drawing from seven qualitative interviews and six days of observation, we investigate the residents’ social positioning and their conversations with patients or supervisors. Our focus is on how (a) relational shifts in authority depend on each situation and its participants; (b) storylines establish acts and positions and narratively frame what participants can expect from a medical consultation viewed as a social episode; and (c) the positioning of rights and duties can lead to misunderstandings and frustrations. We conclude that residents and patients locate themselves in outpatient conversations as participants who jointly produce and are produced by patients’ and nurses’ storylines about who should take responsibility for treatment.

IntroductionIn situ simulation is characterized by being situated inthe clinical environment as opposed to the simulationlaboratory. But in situ simulation bears a familyresemblance to other types of on the job training. Weexplore a typology of in situ simulation and suggest thatthere are four fruitful approaches to in situ simulation: (1)In situ simulation informed by reported critical incidentsand adverse events from emergency departments (ED)in which team training is about to be conducted to writescenarios. (2) In situ simulation through ethnographicstudies at the ED. (3) Using prewritten scenarios from thesimulation lab and transferring them to in situ simulation.(4) Action research – insider or participant action researchto obtain in-depth understanding of team processes toguide scenario design.We evaluate the approach relying on Marks’ et al.taxonomy that posits the following processes: Transitionprocesses, Action processes and Interpersonal processes.Design and purposeThis abstract suggests four approaches to in situsimulation. A pilot study will evaluate the differentapproaches in two emergency departments in the CentralRegion of Denmark.MethodsThe typology will be illustrated with reference to anempirical pilot project, which has a triple strategy:1) Literature study 2) Patient safety data analysis 3)Observational study on interprofessional emergencyteams, and 4) In situ simulation intervention study withevaluation of interprofessional team training.Perspective and relevanceEmpirical and theoretical research is needed to developin situ simulation and to theorize and experiment withhow we best take reported critical incidents and adverseevents back to the clinic. In situ simulation offers a uniqueway to study team interactions there are widely differentapproaches to team intervention and philosophiesinforming what good situated learning research is. Thisstudy generates system knowledge that might informscenario development for in situ simulation.

High-reliability teams have high levels of training, and their members come from different disciplines, such as medicine, nursing, or military science. Team reason, therefore, is likely to bear the mark of a formal knowledge repertoire or tool kit. This knowledge is associated with a socially valued social practice that embodies a range of cultural traditions that can be classified as, for instance, natural scientific, legal, religious, or artistic and that might influence how the team reasons. Thus, how the team makes sense of the dynamic environment depends on how the team reasons with tools and ideas formed within cultural traditions developed through societal history. Cultural-historical practices form, as argued in social philosophy for centuries (Hegel, 1807/1977), the backdrop for reason; in other words, there is an inherent, deep-seated sociality behind any kind of cognition and reason. Therefore, individual cognition, macrocognition, and team cognition are social phenomena, not primarily because knowledge is shared and can be made public but because team cognition is unthinkable without social practices such as natural science or art that provide means for team members to think and reason with. Thus, what members of society take to be rational, that is to say, mediated by societal institutions and with goals, norms, and underlying assumptions amenable to critical scrutiny, might shape what a high-reliability team takes to be worth pursuing. Thus, the notion of team reason aims to describe how societal institutions validate and shape knowledge, goals, tools, and ideas relevant to high-reliability team problem solving.

Introduction/Background: Acute critical situations and emergencies are among the most challenging situations in medicine where acute care teams are often constituted on an ad hoc basis. In such types of teams, it is obvious that excellent performance depends on the ability of the team to function in a coordinated, effective matter. In this regard, interprofessional team communication plays a pivotal role for patient safety. In social psychological or organizational studies, communication is often oversimplified and treated statistically or mechanistically and often represented by simple communication events like closed-loop communication.1 A more nuanced understanding of team communication has the potential to enhance scholarship in interprofessional endeavours. In high risk environments, team performance depends on the ability of teams to quickly alter actions in response to rapidly changing conditions.2,3 However, research on team adaptation in healthcare is scarce.4 In this study, team adaptation in medical emergency teams was explored through the quality and content of updates. Updating is an ongoing process of incorporating interpretations based on new information with current beliefs.5 Research on how teams adapt to unforeseen changes or non-routine events supports the idea that updating is somehow difficult to accomplish.6,7Methods: Thirty emergency physicians and nurses participated in a Simulator Instructor Course at SkejSim Medical Simulation and Skills Training, Aarhus, Denmark in May-June 2012. The study was exempted from approval from the Danish National Committee of Health Research. The study has been reported to the Danish Data Protection Agency. All participants volunteered and written informed consent was obtained. Twenty nine simulation scenarios were recorded and reviewed. The research design used an explorative case study methodology to answer the research question: Which factors most strongly mediate adaptive team performance?Results: Through an iterative, inductive process, data supported the building of the Team Adaptation Tool (TATool) that captures and conceptualizes team processes through recursive cycles of updates. In the 29 simulation scenarios, 94 updates were recorded. There were between 0 and 8 updates per scenario (mean 3,2). Level five was achieved in 13 scenarios, level four in 8 scenarios and finally, level two and three were achieved in four scenarios. Level one was not achieved as the highest level in any scenario. Teams were found to differ in ability to develop and perform updating processes, in their ability to adapt to unforeseen changes and adjust courses of action. These differences could be explained using the five-level TATool.Conclusion: The trend in the literature is towards studying teamwork as a cluster of behaviours. However, we argue that communication between team members is the core concept in patient safety discourse to keep the team coordinated and at the right track. We found that those teams that were able to recognize changes, adjust priorities and implement adjusted strategies were more likely to perform successfully in environments with unforeseen changes, in other words adaptability is the generalization of trained knowledge and skills to new, more difficult and more complex tasks. An interpretative approach is required to meaningfully account for communication exchanges in context. As such, this theoretical framework might provide a vocabulary for operationalizing the differences between "effective and ineffective" communication. Moving beyond counting communication events or the frequency of certain communications, the empirical metric moves from how much communication to what messages are communicated and how are these messages interpreted.1 Despite the complexity of interprofessional team communication, the TATool might provide a significant framework for the construct of adaptive team performance. Further, the TATool can be applied as a team training tool to help practitioners develop effective team performance skills based on metacognition of adaptive team performance through effective team communication.

University students learning of scientific concepts can be described as a process of semiosis at three different levels: Ontogenetic, whereby students over time actively acquire signs that represent new meaning to themselves; mesogenetic, whereby a teacher through teaching an dialogue activities together with students build conceptual understanding; sociogenetic, whereby the scientific achievements of a science disseminate into the classroom. Semiotic processes have been investigated in educational semiotics (Cunningham, 1992), sociocultural psychology (Valsiner, 2007) and research on math and science students diagrammatic reasoning (Hoffmann et al, 2005; Radford, 2000). This study builds on these traditions in order to explain students learning of biochemical concepts and specifically the mediating role of threshold concepts in students learning over time. Threshold concepts are concepts that are central to a subject and subsequently to persons grasping of a scientific subject (Meyer et al, 2006). Because threshold concepts are thought (metaphorically speaking) to form a portal through which the student steps once these concepts are mastered, they have begun to be used in planning university teaching includingbiochemistry teaching (Loertscher, 2011). The study seeks an answer to the problem of emergence in science students acquisition of concepts, not only how students form new sign hierarchies over time, but how say easy concepts suddenly change into a hard concepts(or vice versa) as new signs are appropriated by students? Why are biochemical structures easier to grasp than processes?Illustrations are provided from a case deriving from a mixed-methods longitudinal study of odontology university students (N=50) biochemical conceptual understanding. Students ratings (on visual analogue scales) of biochemical concepts were collected every week during a university semester. Archival data (e.g. biochemistry textbooks), diaries and a qualitative interviewwere collected with a biochemistry teacher. Methodological challenges are identified in studying conceptual change and the applicability of semiotics is discussed.

Aim: This study aims to systematically review the qualitative research studying Emergency Medicine (EM) physicians in Emergency Departments (ED).Background: Qualitative research aims to study complex social phenomena. EM is a highly complex medical and social environment that can be investigated with qualitative research. Methods: Electronic databases of English peer-reviewed articles were searched from 1971 to 2012 using Medline through PubMed and PsychINFO. This search was supplemented with hand-searches of Academic Emergency Medicine and Emergency Medicine Journal from 1999 to 2012 and cross references were reviewed. The key words used were emergency medicine, qualitative, ethnography, observation, interview, video, anthropology, simulation, and simulation-based.Results: 820 papers were identified and 46 studies were included in this review. This literature review found that the reviewed qualitative studies on EM physicians were designed using the following strategies of inquiry: Ethnography, mixed methods, action research, grounded theory, phenomenology, content analysis, discourse analysis, and critical incident analysis. The reviewed studies were categorized into four main themes: Education and training, communication, professional roles, and organizational factors, and into 12 sub-themes.Conclusion: The strength of qualitative research is its ability to grasp and operationalize complex relations within EM. Although qualitative research methodologies have gained in rigour in recent years and few researchers would question their value in studying complex social phenomena and settings such as EM and ED, more rigorous design in qualitative studies are needed. A stricter adherence to one strategy of inquiry would yield more valid studies in qualitative terms concerning validity, reliability and transferability.

In this paper, we follow Averill, who tells us that emotions reflect “the thought of an epoch, the secret of a civilization”. In this light, to understand the meaning of an emotion is to understand the relevant aspects of the sociocultural systems of which the emotion is a part. We argue that a number of the most central emotions in human lives are identified with reference to the moral order of the sociocultural system rather than with reference to physiological conditions or body states. We present a normative theory of emotions and refer to research on “emotionologies” of different cultures to demonstrate that specific moral orders are associated with specific forms of emotionality. If properly cultivated, moral emotions become “orientation guides” that enable persons to respond adequately to what happens in their local, moral worlds, and, as researchers, we can only grasp what such emotions are if we recognize that they are always already conceptualized as normative responses to moral properties of social events.

Kapitlet konfronterer normen om deltager observation som langvarig og viser, hvordan deltager observation fejlagtigt er forbundet med legenden om det langvarige eksil. Argumentet er at det kortere feltophold hverken bør forstås ud fra en metafor om blitzkrig eller langvarigt eksil. Dernæst argumentes for, at psykologisk deltager observation ofte har et kortere tidsperspektiv kombineret med et mere intervenerende sigte i forhold til det naturalistiske og beskrivende sigte i klassisk etnografi. Så beskrives et casestudie af mesterlære i to guldsmede-værksteder. Casen bruges til at uddybe, hvilke grunde der kan være til at vælge kortids deltagende observation. Endelig konkluderes, at der er betydelige overlap mellem klassisk etnografi og klassisk psykologi og at der ikke er et skarpt skel mellem korttids og langtids feltforskning.

Artiklen argumenterer for, at følelser i arbejdsgrupper bør studeres kvalitativt og at følelser fungerer som moralske orienteringsguides for teamet. Argumentet er for det første, at normativitet i social praksis er på spil i enhver rationel empiriske undersøgelser af følelser i arbejdsteams og for det andet at moralske værdier bør undersøges for at forstå emotioner i arbejdsgrupper We argue that emotions in groups can best be studied qualitatively and act as moral orientation guides. This article argues first that the normativity of particular practices is at play in any rational empirical investigation of emotions in workgroups and second that moral values must be studied in order to understand emotions in work groups

Tillid og teams er begge blevet behandlet særdeles indgående i organisationslitteraturen. Men der er brug for studier af teamtillid. Denne artikel argumenterer for, at teamtillid kan defineres som teamet og teamindividernes forventning om, at man kan placere ressourcer eller sit helbred eller liv i en anden parts varetægt – eller i en ting eller en relation – hermed refleksivt anerkendende, at man løber en risiko i forhold til andre individer, grupper eller ting.. Denne artikel handler om tillid i arbejdsteams og beskriver fire dimensioner ved teamtillid: Fortrolighed, personlig tillid og systemtillid (Luhmann) samt psykologisk sikkerhed (Edmondson). Til sammen giver begreberne et bud på, hvordan teamtillid kan forstås.

Team læring er sjældent blevet studeret fra et sociokulturelt perspektiv (vygotskiansk). Denne poster er et teoretisk bidrag til team læring, der fokuserer på dialog, tegn-mediering og kulturel historisk praksis for at udvikle en forståelse af team læring som mere end forøgelse i adfærd, viden og færdigheder.

Der er kun få sociokulturelle studier af terapi. Denne præsentation har til formål at bidrage med en sociokulturel forståelse af motivation og socioemotionelle problemer blandt børn og familier i familieterapi. Undersøgelsen var designet som et case studie anvendende semistrukturerede interviews med 15 familier der fik familieterapi via en familiebehandling i Danmark. En model af konflikt, vold, læring og motivation i familieterapi er skitseret ved hjælp af begreber omkring kriser koblet til institutioner og hverdagsliv (Hedegaard) rammesat af historiske, spændingsfyldte kampe (Holland og Lave). Der argumenteres for vigtigheden af en holistisk, ikke-mekanistisk (Valsiner) tilgang til motivation for forandring samt til at forstå, hvordan "børn og unge i risiko" (som eksempelvis skulker fra skole eller oplever vold i hjemmet) oplever familieterapi. Endelig giver præsentationen en kritik af familieterapeutisk praksis ved fjernelse af privilegier som en form for negativ reinforcering og i forhold til magtfordeling mellem familiemedlemmers interesseproblemer samt afstraffelse som pædagogisk værktøj (Vygotsky; Ananjew). Given the relative lack of sociocultural approaches to therapy, this presentation aims to contribute to a sociocultural understanding of motivation and socio-emotional problems in children and families undergoing family therapy. The study was designed as a case study using semi structured interviews with 15 families undergoing family therapy delivered by a communal agency in Denmark. Using notions of crisis interlinked with institutions and everyday lives (Hedegaard) framed by historical, contentious struggles (Holland and Lave), a model of conflict, violence, learning and motivation will be sketched pertaining to the area of family therapy. The study argues for the importance of a holistic, non-mechanical (Valsiner) approach to motivation for change in understanding how "at risk" or "problematic" children and youth (who are for instance experiencing school absenteeism, domestic violence) experience family therapy. Finally the presentation offers a critique of the family therapeutic practice of removing children's privileges as a form of negative reinforcement in terms of power distribution between family members and children and adolescents' "problem of interests" and punishment as an educational tool (Vygotsky; Ananjew).