Search

Introduction: Although there is substantial evidence supporting the benefits of simulation-based education (SBE), its widespread and effective implementation remains challenging. The aim of this study was to explore the perceptions of top-level health care leaders regarding SBE and the barriers and facilitators that influence its wide implementation as part of the postgraduate surgical curricula in Denmark., Methods: We conducted semi-structured interviews with top-level health care leaders who were chosen based on their roles in ensuring high-quality patient care delivery and developing strategies to achieve the goals of the entire health care system. The interview transcripts were translated into English, and a thematic approach was used to code and inductively analyse the data. We used the Consolidated Framework for Implementation Research to identify and understand the determinants to a successful implementation of SBE., Results: We interviewed 13 participants from different political and administrative levels. We found that the participants had limited knowledge about SBE, which highlighted a disconnection between these leaders and the educational environment. This was further compounded by a lack of effective communication and inadequate information dissemination between simulation centres and higher-level organisations. While participants recognised the benefits of SBE for doctors in training, they expressed concerns about the implementation given the already strained health care system and limited resources. The need for evidence, particularly in the context of patient safety, was emphasised to facilitate SBE implementation. Although participants supported the implementation of SBE, it was unclear who should initiate action., Discussion: This study highlighted the perspectives of top-level health care leaders regarding SBE and identified the determinant factors for a successful implementation. Effective communication channels are crucial to enhance collaborations and reduce the disconnection between the different health care organisational levels. Strategic implementation processes, including the roles and responsibilities, should be defined and established. These will inform decisions regarding the implementation strategies to effectively integrate SBE into the residency training curricula., (© 2023 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

During the last decade, there has been a growing recognition that emotions can be of critical importance for students' learning and cognitive development. The aim of this study was to investigate the self-reported and the observed relationship of: activity-, outcome-, epistemic-, and social emotions' role in students' learning in a clinical interprofessional context. We conducted a focused ethnography study of medical and nursing students' clinical placement in an interprofessional orthopaedic outpatient clinic where the students performed consultations with patients, together. We used content analysis to analyse observational notes and interviews. Two themes were identified. First self-regulated learning with two sub-themes: unexpected incident and reflection . The second theme was cooperative learning with three sub-themes: equality, communication , and role distribution . Participants only reported activating emotions. Negative emotions often occurred when the students together experienced an incongruity between their cognitive capability and the type of task. However, because of the possibility for students to call for a supervisor, the negative activating emotions often, in connection with reflection on the incident, resulted in a positive emotion due to the students' awareness of having acquired new knowledge and capability, and thereby, learning. It is important to be aware of the close interplay between emotions and clinical learning in an interprofessional context. The learning environment must include easy access for supervision.

Clinical interprofessional education has traditionally taken place in hospital wards, but much diagnosis and treatment have shifted to the outpatient setting. The logical consequence is to shift more students' clinical placements from the "bedside" to outpatient settings. However, it is unclear how we ensure that this shift maximises learning. The purpose of this article is to understand the authentic learning experience in an interprofessional outpatient clinic setting. We performed an exploratory case study with interviews of four nursing students, 13 medical students, and six staff members who worked in an interprofessional outpatient orthopaedic clinic from March 2015 to January 2016. The interviews were transcribed and analysed using systematic text condensation. The students' self-reported learning experience in this outpatient clinic was characterised by direct patient contact and by authentic, interprofessional, task-based learning, and a preference for indirect supervision when conducting uncomplicated patient consultations. The supervisors intended to create this interprofessional outpatient clinic experience by having a clear teaching approach based on adult learning principles in a safe and challenging learning environment. The shift to the outpatient setting was strongly and practically supported by the management. This study indicates that student learning can be shifted to the outpatient clinic setting if there is supportive management and dedicated supervisors who establish a challenging yet safe interprofessional learning environment.

In this paper we describe and discuss communication skills training in Denmark - it has come a long way. After a short review of current research we outline the history of communication training in Denmark and describe the case of communication training at Aarhus University, which illustrates how the Danish universities have radically changed their communication training in the last decade. Finally, we discuss communication models and teaching methods and recommend an attempt to reach a national consensus on communication training.

Background: Patient-centered communication is a core competency in modern health care and associated with higher levels of patient satisfaction, improved patient health outcomes, and lower levels of burnout among physicians. The objective of the present study was to develop a questionnaire assessing medical student and physician self-efficacy in patient-centeredness (SEPCQ) and explore its psychometric properties., Methods: A preliminary 88-item questionnaire (SEPCQ-88) was developed based on a review of the literature and medical student portfolios and completed by 448 medical students from Aarhus University. Exploratory Principal Component analysis resulted in a 27-item version (SEPCQ-27) with three underlying self-efficacy factors: 1) Exploring the patient perspective, 2) Sharing information and power, and 3) Dealing with communicative challenges. The SEPCQ-27 was completed by an independent sample of 291 medical students from 2 medical schools and 101 hospital physicians., Results: Internal consistencies of total and subscales were acceptable for both students and physicians (Cronbach's alpha (range): 0.74-0.95). There were no overall indications of gender-related differential item function (DIF), and a Confirmatory Factor Analysis (CFA) indicated good fit (CFI = 0.98; NNFI = 0.98; RMSEA = 0.05; SRMR = 0.07). Responsiveness was indicated by increases in SEPCQ scores after a course in communication and peer-supervision (Cohen's d (range): 0.21 to 0.73; p: 0.053 to 0.001). Furthermore, positive associations were found between increases in SEPCQ-scores and course-related motivation to learn (medical students) and between SEPCQ scores and years of clinical experience (physicians)., Conclusions: The final SEPCQ-27 showed satisfactory psychometric properties, and preliminary support was found for its construct validity, indicating that the SEPCQ-27 may be a valuable measure in future patient centered communication training and research.

Introduction: The dropout level from the Danish medical schools is high, but we have only little insight into this problem. The purpose of this study was to qualify the ongoing discussions concerning dropout., Material and Methods: In this retrospective cohort study, relevant variables were extracted from the established database of Aarhus University for the 639 students initiating medicine studies between 1 January 1999 and 31 December 2000. A multivariate pre-admission and post-admission model was examined., Results: Of the 639 medical students, 20% dropped out. Most students dropped out during their first year. The type of admission exam was a strong predictor of dropout in the pre-admission model, whereas previous higher education protected against dropout. Obtaining leave was a very strong predictor of dropout in the post-admission model, whereas high grades protected against dropout., Conclusion: The dropout rate has been decreasing during the past decade. Young people considering studying medicine could be advised to choose natural science subjects in high school, and a number of research questions concerning preparedness for medical school are worth pursuing. Leave or very low grades during the first and second study years might serve as red flags to supervisors., Funding: Study research was funded by Aarhus University., Trial Registration: Not relevant, register-based research with no biological human material cannot be notified to the Danish Committee System. The Danish Data Protection Agency allows schools to conduct anonymized, non-sensitive, educational analyses without notification.

Introduction: The purpose of this study was to assess the coherence between the undergraduate medical program at Aarhus University and the foundation year., Material and Methods: This cross-sectional questionnaire survey included 503 doctors graduated from Aarhus University from the winter of 2007/2008 to the summer of 2009., Results: The response rate was 73%. Approximately 73% of the respondents were in their foundation year or their first year of specialist training and 83% generally felt well-prepared. Respondents found that most of the learning outcomes of the undergraduate medical curriculum at Aarhus University are important for junior doctors. More than 90% of the respondents estimated that they were sufficiently prepared when it came to core outcomes such as history taking and physical examination. Five issues diverged considerably in importance stated and preparedness experienced: suggestion of diagnoses, initiation of treatment, pharmacotherapy, handling of own emotions and structuring of own learning. Also, 40% stated that their clerkships had only had little value in preparing them for their foundation year., Conclusion: Overall, graduates felt well-prepared and characterized the education coherent. However, the study raises major questions concerning clerkships and competence in treatments, pharmacotherapy and the more personal aspects of professionalism., Funding: not relevant., Trial Registration: not relevant.

In this paper we describe the first four phases of a curriculum reform covering the three clinical years of medical school at Aarhus University. The reform intends to ease students' transition from medical school to the foundation year, increase focus on communication, create more coherence between subjects, increase students' active participation, and align learning outcomes and assessments. More than 80 stakeholders participated in the first phases and five task forces gave their recommendations on how to achieve the intentions. The next phases are initiated on the basis of this solid work.

Purpose: To enhance the recognition of educational effort and thereby support faculty vitality, the authors aimed to identify essential categories of educational effort from the perspective of clinical faculty and determine whether the emerging categories were in concordance with an organizational perspective., Method: The authors performed nominal group processes in four groups in 2008, with the participation of 24 clinical faculty members, 6 in each group, representing 18 (medical, surgical, paraclinical, and psychiatric) specialties at 14 hospitals in Denmark. Subsequently, the authors performed a comparative analysis of the emerging essential categories and the organizational work by the national panel on medical education, appointed by the Association of American Medical Colleges (AAMC)., Results: The four groups of clinical faculty members agreed on categories of educational effort. This quantitative consistency in prioritization was supported by qualitative consistency, as the authors observed similar uses of words and phrases among all four groups. The top priority in essential categories of educational effort was "Visibility of planned educational activities on the work schedule," which received 39% of all votes. The comparative analysis showed that the essential categories of educational effort suggested by clinical faculty were in concordance with the steps developed by the AAMC., Conclusions: The high degree of consistency among clinical faculty from different locations and specialties and the high concordance with the organizational work of the AAMC suggest that it is possible to develop standardized measurements of educational effort. Clinical faculty emphasized that a good starting point for educational measurements is the work schedule.

Lecturing is one of the oldest forms of teaching. The lecture is as effective as other teaching formats for transmitting information. One of the major defects of the lecture method is that it tends to induce passive learning. In order to lecture effectively, the lecturer must gain and hold the attention of the audience. Also, the audience should be given a chance to elaborate on the information presented. The list of expedient lecturing skills is long. In this paper we focus on how to effectively open and close a lecture. In addition, we give suggestions to how an audience may be actively engaged.

In 2007 the Faculty of Health Sciences, Aarhus University, took a first step towards outcome-based education. During an educational development process, all courses developed clear, consistent descriptions of learning outcomes and extensive, template-based course descriptions. This enabled the Faculty to implement a new national grading system and to prepare for Aarhus University's application for an ECTS label. Furthermore, the process created the basis for alignment of outcomes, assessment and teaching. In this paper, we share results, problems encountered and lessons learned.

Introduction: The medical profession and hospital practice have changed over the last decades without a concomitant change in Danish clerkships. Therefore, the aim of this study was to analyze learning and supervision in clerkships and to discuss how traditional clerkship learning matches a modern effective hospital environment., Material and Methods: A qualitative field study based on 38 days of observations ( asymptotically equal to 135 hours) with 6 students in 8th Semester in 2 internal medical and 3 surgical wards at 2 teaching hospitals in Aarhus County during 2003. The 6 students were interviewed prior to and following clerkship. Data were coded using Ethnograph and analyzed qualitatively., Results: The students typically participated in 6 learning activities: morning reports, ward rounds, out-patient clinics, on call, clerking, and operating theatres. A common feature for the first 3 activities was the students' observational role in contrast to their more active role in the latter 3 activities. Supervision was primarily indirect as the doctors worked and thereby served as tacit role models. When direct, the supervision was didactic and characterized by information transfer., Conclusion: A clerkship offers important learning opportunities for students. They are exposed to many patients and faced with various clinical problems. However, the benefit of students learning in authentic environments is not fully utilized, and the didactic supervision used by doctors hardly matches the learning conditions in a busy hospital. Consequently, we need to reassess the students' roles and doctors' supervisory methods.

Background: The purpose of this study was to test whether focus groups involving medical students, house officers, senior doctors, and nurses could identify an undergraduate emergency medicine core curriculum., Method: From May 2001 to January 2002, we interviewed 12 homogeneous focus groups within all 88 participants. Three focus groups were composed of medical students; three of house officers, three of senior doctors, and three focus groups were composed of nurses. Each interview lasted 2 h. Interviews were recorded, transcribed, and analysed using qualitative methods., Results: The focus groups suggested and discussed in all 196 objectives. Students, physicians, and nurses agreed that newly graduated physicians should master history taking, 21 clinical disorders, 15 practical skills, interpretation of two diagnostic tests, two general diagnostic skills, and two leadership skills. Apart from these 43 core objectives, disagreement was substantial. Participants gave very different priorities to communication, knowledge about clinical disorders, practical clinical skills, leadership, and "the art of medicine"., Conclusion: In conclusion, focus groups could identify an emergency medicine core curriculum. However, participants had very different perspectives on the curriculum. Focus groups could be one very practicable part of seeking consensus on what is core and securing local roots and ownership to an undergraduate emergency medicine curriculum before and during implementation.

Introduction: We compared and contrasted the learned and intended practical clinical skills of the three Danish medical schools., Material and Methods: An anonymous questionnaire listing 210 practical clinical skills was posted to 226 newly qualified Danish physicians. They were asked if they could meet the minimum level for each of the skills, which had earlier been identified by a Delphi study., Results: The response rate was 80%. None of the responders met the minimum of all the 210 skills. Only 8% (14) met the minimum level for at least 90% (189) of the skills. On average, the responders met the minimum for 74% (155) of the skills. More than 90% of the responders could take medical histories and carry out examinations. The responders did not meet 28 medical emergency procedures., Discussion: We found that the clinical skills learned constituted 75% of those intended. Those responsible for pre- and postgraduate medical training should be aware of the discrepancy between expected and learned skills. We discuss the role of experts in the process of defining the core curriculum.

Introduction: The aim of the present study was to use the Delphi technique to identify standards of quality for the curriculum of basic clinical skills in the pre-registration internship., Method: The Delphi method was used with a selected panel of 52 experts to set a level of competence for 213 practical clinical skills in a series of three questionnaires., Results: For the pre-registration internship, the panel reached a 75% level of consensus for 80% of the basic clinical skills. A total of 47 basic clinical skills were identified (97% level of consensus) as core skills that should be mastered by the time of registration., Discussion: The study suggests that further investigations should be performed to identify a core curriculum of basic clinical skills common to all pre-registration internists. In addition, a curriculum of electives should be based on the special characteristics of each training department.

Introduction: The necessity of defining standards in medical education is increasingly recognised. The aim of the present study was to adapt the Delphi method in establishing a consensus about competence levels of basic clinical skills in the undergraduate medical curriculum., Method: We used a Delphi design with two postal rounds. An expert panel of 52 physicians was selected on the criteria of knowledge and practical engagement in medical education. Questionnaires were set up with lists of 213 practical skills based on literature studies. Six levels of competence were identified. The task of the panel was to select the competence level for each skill., Results: The panel reached a 75% level of consensus in 212 of the 213 skills. A core curriculum of basic clinical skills in the medical education of Danish undergraduates is proposed., Discussion: The Delphi method was found applicable to qualify the process of identifying goals in a medical curriculum design.