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Purpose: The study objective was to investigate how health care providers in stroke teams reason about their clinical reasoning process in collaboration with the patient and next of kin. Materials and methods: An explorative qualitative design using stimulated recall was employed. Audio-recordings from three rehabilitation dialogs were used as prompts in interviews with the involved staff about their clinical reasoning. A thematic analysis approach was employed. Results: A main finding was the apparent friction between profession-centered and person-centered clinical reasoning, which was salient in the data. Five themes were identified: the importance of different perspectives for a rich picture and well-informed decisions; shared understanding in analysis and decision-making - good intentions but difficult to achieve; the health care providers' expertise directs the dialog; the context's impact on the rehabilitation dialog; and insights about missed opportunities to grasp the patient perspective and arrive at decisions. Conclusions: Interprofessional stroke teams consider clinical reasoning as a process valuing patient and next of kin perspectives; however, their professional expertise risks preventing individual needs from surfacing. There is a discrepancy between professionals' intentions for person-centeredness and how clinical reasoning plays out. Stimulated recall can unveil person-centered practice and enhance professionals' awareness of their clinical reasoning.

Educating health care professionals for working in interprofessional teams is a key preparation for roles in modern healthcare. Interprofessional teams require members who are competent in their roles. Self-assessment instruments measuring interprofessional competence (IPC) are widely used in educational preparation, but their ability to accurately and reliably measure competence is unknown. We conducted a systematic review to identify variations in the characteristics and use of self-report instruments measuring IPC. Following a systematic search of electronic databases and after applying eligibility criteria, 38 articles were included that describe 8 IPC self-report instruments. A large variation was found in the extent of coverage of IPC core competencies as articulated by the Interprofessional Education Collaborative. Each instrument's strength of evidence, psychometric performance and uses varied. Rather than measuring competency as "behaviours", they measured indirect proxies for competence, such as attitudes towards core interprofessional competencies. Educators and researchers should identify the most appropriate and highest-performing IPC instruments according to the context in which they will be used.Systematic review registration: Open Science Framework (https://archive.org/details/osf-registrations-vrfjn-v1).

Bakgrund: Beslut och metoder inom hälso- och sjukvården bygger på vetenskaplig grund vilket förutsätter en forskningsbas. Inom detta område är svensk vetenskaplig produktion och tillämpning relativt stark, däremot ser vi inte motsvarande styrka i kunskapsbasen för utbildningsuppdraget. I diskussionen om utbildningens forskningsförankring är det vanligtvis innehållet som avses eller kontakt med aktiva forskare, mer sällan hur utbildningen bör utformas för att stödja lärande eller förutsättningarna för lärarskicklighet. Det saknas inte forskning inom området, på den internationella arenan ser vi en växande högskolepedagogisk forskningsproduktion med medicin och hälsa som kontext, sk. medicinsk pedagogik. Däremot finns anledning att uppmärksamma från vilken kontext forskningen kommer och förutsättningarna att omsätta den till kvalitet och innovation i utbildningarna. Merparten av fältets forskningsproduktion kommer från USA, UK, Canada och Australien (Thomas, 2019). Den internationella prägeln på kunskapsbasen är inte alltid optimal för implementering i svenska förhållanden då resultaten och slutsatser är dragna från en kontext som i flera avseenden skiljer sig från vår. Förutom tillgång till forskning behövs möjligheter att ta del av den och omsätta till godo för utbildningen. Europeiska lärare anser inte att ny forskning når deras arbetsgrupper i någon hög utsträckning (Thomas et al., 2019). Medicinskt skolade lärare är ofta ovana vid den högskolepedagogiska forskningsgenren som evidensgrund (Kneebone, 2002). Nederländerna, som är mer befolkat än Sverige men har snarligt antal läkarutbildningar samt likartade förhållanden för högre utbildning, har satsat på en medicinpedagogisk utveckling som givit avtryck i fältet. Syftet med denna studie är att undersöka svensk forskningsproduktion inom det medicinpedagogiska området samt att föreslå en förstärkning av förutsättningar för denna produktion och dess tillämpning i utbildningar för medicin och hälsa. Metod: Författarn

Clinical reasoning is a complex and crucial ability health professions students need to acquire during their education. Despite its importance, explicit clinical reasoning teaching is not yet implemented in most health professions educational programs. Therefore, we carried out an international and interprofessional project to plan and develop a clinical reasoning curriculum with a train-the-trainer course to support educators in teaching this curriculum to students. We developed a framework and curricular blueprint. Then we created 25 student and 7 train-the-trainer learning units and we piloted 11 of these learning units at our institutions. Learners and faculty reported high satisfaction and they also provided helpful suggestions for improvements. One of the main challenges we faced was the heterogeneous understanding of clinical reasoning within and across professions. However, we learned from each other while discussing these different views and perspectives on clinical reasoning and were able to come to a shared understanding as the basis for developing the curriculum. Our curriculum fills an important gap in the availability of explicit clinical reasoning educational materials both for students and faculty and is unique with having specialists from different countries, schools, and professions. Faculty time and time for teaching clinical reasoning in existing curricula remain important barriers for implementation of clinical reasoning teaching.

OBJECTIVES: This scoping review aimed to explore and synthesize current literature to advance the understanding of how to design clinical reasoning (CR) curricula for students in health professions education. METHODS: Arksey and O'Malley's 6-stage framework was applied. Peer-reviewed articles were searched in PubMed, Web of Science, CINAHL, and manual searches, resulting in the identification of 2932 studies. RESULTS: Twenty-six articles were included on CR in medical, nursing, physical therapy, occupational therapy, midwifery, dentistry, and speech language therapy education. The results describe: features of CR curriculum design; CR theories, models, and frameworks that inform curricula; and teaching content, methods, and assessments that inform CR curricula. CONCLUSIONS: Several CR theories, teaching, and assessment methods are integrated into CR curricula, reflecting the multidimensionality of CR among professions. Specific CR elements are addressed in several curricula; however, no all-encompassing CR curriculum design has been identified. These findings offer useful insights for educators into how CR can be taught and assessed, but they also suggest the need for further guidance on educational strategies and assessments while learners progress through an educational program., Funding Agency:Erasmus+ Knowledge Alliance project DID-ACT

Background: Although person-centered care is prioritized in healthcare, challenges remain before such care is integrated in everyday communication and practice. One way to strengthen person-centered care is that health professionals’ clinical reasoning (i.e., assessment and management) is pervaded by patient participation and individualized to patient needs. Interprofessional team meetings, focusing on goals and management planning, is an opportunityt o improve person-centeredness. However, there is a lack of understanding of how person-centeredness is created in the clinical reasoning of teams. This study aims to explore how clinical reasoning is performed from a person-centered perspective in team meetings with patients with stroke and next of kin. Methods: Explorative qualitative design employing a thematic analysis of audio recorded communication at three team meetings. In total, three patients, two next of kin, and 15 professionals representing eight health professions, participated in the meetings. Findings: Four themes and eight subthemes were established: a) Emphasizing the patient’s resources; b) Struggling to find a common understanding, including subthemes: Unite the person’s narrative, the relative’s view, and the expertise of the interprofessional team, missed opportunities to clarify patient needs and wishes, and active listening and receptiveness; c) Balancing the patient’s goals and professionals’ goals, including subthemes: Shared goals, the professionals’ view of appropriate goals, and the professionals’ assessment governs achievement of goals; d) Ambiguity in decisions about the management plan, including subthemes: Initiating shared decision making and lack of clarity and consensus. Discussion: This study reveals how the patient, next of kin and team contribute to shared understanding of the patient’s problem. Goals were guided by the patient’s and professionals’ expertise. To improve person-centeredness in clinical reasoning, the team need to fu

Introduction Entry-level students conceptualizations of clinical reasoning can provide a starting point for program planning related to clinical reasoning development with a focus on patient-centered care Objective The aim of the study is to explore how physiotherapy students understand clinical reasoning midway through their education. Nine physiotherapy students were interviewed at the end of their third semester Methods Semi-structured individual interviews were conducted, recorded and transcribed verbatim. A phenomenographic approach to qualitative data analysis, seeking to explore variations in students conceptions was applied Results The students ways of understanding clinical reasoning could be described as: 1) the cognitive process of the physiotherapist; and 2) the relational process of the collaborative partnership between the physiotherapist and the patient. A contrastive analysis shows how the cognitive and relational perspectives are developed through the relationships among three dimensions of clinical reasoning: 1) problem-solving; 2) context of working; and 3) own learning Conclusion By identifying the critical variation in students conceptions of clinical reasoning, focus can be placed on pedagogical arrangements to facilitate students progression toward a person-centered approach.

Phenomenon This study aimed to investigate how students can develop their understanding of trauma biomechanics by means of technology-enhanced learning-an interactive visualization tool developed to enhance understanding of the biomechanics underlying an injury via dynamic imaging sequences. Approach: Students were invited to explore the content as a learning resource during an interprofessional clinical placement on an orthopedic ward. Thirty volunteer medical, nursing, and physiotherapy/occupational therapy students participated in 10 interprofessional groups of three participants. They were video recorded while interacting with learning software that was divided into five sections: Work Up, General Information, Biomechanical Case Study, Biomechanical Risk Assessment, and Treatment. Investigators probed students learning experiences via four focus group discussions. A sociomaterial perspective was adopted, directing the analytical focus to how students made use of talk, gestures, bodies, and material objects to understand the visualized phenomena. Findings: When connecting the visualization to a patient case, certain features of the technology stood out as important for promoting engagement and understanding trauma mechanisms. Decreased tempo, showing the directions and dynamics of trauma biomechanics in slow-motion, and color coding of the strain on the affected structures were especially important for evoking the emotional responses. The visualization tool also supported students explorations of causal relationships between external forces and their biomedical effects. These features emphasize the sociomaterial relation between the design of the technology and the student activities. Insights: Dynamic visualization of biomechanical events has the potential to improve the understanding of injury mechanisms and specifically to identify anatomical structures at high risk of injury. Dynamic visualizations for educational purposes seem to promote possibilities for le, Funding Agencies|Marcus and Amalia Wallenberg Foundation, Sweden [MAW2014-0103]; Stockholm County CouncilStockholm County Council [20150760]

Background: Although person-centered care is prioritized in healthcare, challenges remain before such care is integrated in everyday communication and practice. One way to strengthen person-centered care is that health professionals’ clinical reasoning (i.e., assessment and management) is pervaded by patient participation and individualized to patient needs. Interprofessional team meetings, focusing on goals and management planning, is an opportunity to improve person-centeredness. However, there is a lack of understanding of how person-centeredness is created in the clinical reasoning of teams. This study aims to explore how clinical reasoning is performed from a person-centered perspective in team meetings with patients with stroke and next of kin. Methods: Explorative qualitative design employing a thematic analysis of audio recorded communication at three team meetings. In total, three patients, two next of kin, and 15 professionals representing eight health professions, participated in the meetings. Findings: Four themes and eight subthemes were established: a) Emphasizing the patient’s resources; b) Struggling to find a common understanding, including subthemes: Unite the person’s narrative, the relative’s view, and the expertise of the interprofessional team, missed opportunities to clarify patient needs and wishes, and active listening and receptiveness; c) Balancing the patient’s goals and professionals’ goals, including subthemes: Shared goals, the professionals’ view of appropriate goals, and the professionals’ assessment governs achievement of goals; d) Ambiguity in decisions about the management plan, including subthemes: Initiating shared decision making and lack of clarity and consensus. Discussion: This study reveals how the patient, next of kin and team contribute to shared understanding of the patient’s problem. Goals were guided by the patient’s and professionals’ expertise. To improve person- centeredness in clinical reasoning, the team need to f

Introduction Clinical reasoning (CR) is scarcely explicitly taught in health profes- sions education. Barriers to teach CR include lack of awareness of teaching methods and a change-resistant teaching culture. Thus, CR often becomes a ‘black-box phenomenon’ that students need to develop informally. To advance our understanding of structured CR curriculum design in health professions education a scoping review was conducted. Methodology Arksey and O’Malley’s six-stage framework (1) was applied. Peer- reviewed articles were searched in PubMed, Web of Science, CINAHL, and manual searches, resulting in the identification of 2932 studies, which were screened by the team. Results Twenty-six articles were selected from medical, nursing, physical ther- apy, occupational therapy, midwifery, dentistry, and speech language therapy education. The analysis identified three themes: Features of CR curriculum design; CR theories informing curricula; and CR teaching content and methods. Discussion No all-encompassing CR curriculum design was identified. However, several theories and specific methods were described supporting CR development. Dual-process theory was the most prevalent theory and active learning approaches were emphasized. Patient centeredness in CR teaching was scarcely described. The diversity of methods stresses that educators need to make the intended meaning of CR explicit in their curricular work. Conclusion Specific theories and teaching methods can support curriculum devel- opment. Lack of overall CR curriculum strategy in the literature stresses further guidance on a longitudinal CR curriculum that support stu- dents’ CR progression throughout study programs.

It is challenging to organize interprofessional activities in terms of coordinating students' various schedules. These challenges can be overcome by providing flexible online opportunities based on virtual patients (VPs). This study set out to study feasibility of using a blended approach based on virtual patients and a flexible interprofessional student encounter. The encounter was arranged in pairs or triads between nursing and medical students from two separate courses. Data were gathered through a questionnaire and followed up with group interviews. Reflective texts from the interprofessional encounters were analyzed in relation to descriptions of interprofessional competence. The great majority (86%) chose to meet online due to its flexibility. The participants gained an understanding of the other profession's roles and competences and a holistic patient awareness. Given its flexible and scalable opportunities, the blended online virtual patient approach provides a valuable contribution to an interprofessional programme.

Objective: To explore the relationship between preparations and real-life experiences among prehospital major incident commanders. Design: An explorative, qualitative design was used. Setting: Prehospital major incidents in Sweden. Data were collected between December 2019 and August 2020. Participants: Prehospital major incident commanders (n=15) with real-life experiences from major events, such as fires, bus accidents, a bridge collapse and terrorist attacks, were included. All but one had participated in 2-day training focusing on the prehospital management of major incidents. In addition, about half of the participants had participated in simulation exercises, academic courses and other training in the management of major incidents. Methods: Data from two-session individual interviews were analysed using inductive thematic analysis. Results: The conformity between real-life major incidents and preparations was good regarding prehospital major incident commanders' knowledge of the operational procedures applied in major incidents. However, the preparations did not allow for the complexities and endurance strategies required in real-life incidents. Personal preparations, such as mental preparedness or stress management, were not sufficiently covered in the preparations. To some extent, professional experience (such as training) could compensate for the lack of formal preparations. Conclusions: This study identified perceived gaps between preparations and real-life experiences of being a prehospital major incident commander. To minimise the gaps between demands and expectations on perceived control and to better prepare individuals for being prehospital major incident commanders, the training and other preparations should reflect complexities of real-life incidents. Preparations should develop both technical skills required, such as principles and methodology used, and personal preparedness. Personal preparations should include improving one's mental preparedness

Background: Despite clinical reasoning standing at the core of health professions practice, it is often taught implicitly and informally within the health professions and there is a lack of its structured education. Multiple professions can gain from a supportive framework with explicit learning objectives and expressed key educational aspects. Our aim was to develop such a framework to support development of a longitudinal and adaptive clinical reasoning curriculum for students and teachers in health professions education.Summary of Work: Educators and researchers from several universities and learning institutions across Europe and the USA gathered to strengthen clinical reasoning education (DID-ACT consortium). As a part of a greater Kern-cycle of curriculum-development, participants worked in multiprofessional groups to identify resources, learning activities and assessments addressing target areas derived from a needs analysis.Summary of Results: The DID-ACT framework is based on a learner-centered and active learning pedagogical approach using contextualized patient-scenarios as point of departure. Thirty-five learning objectives were formulated regarding clinical reasoning theories, cognitive biases, about gathering, interpreting and synthesizing patient information and participation, as well as collaborative aspects of clinical reasoning. Learning activities and assessment methods were constructively aligned using a competence-based approach. Progression was described at novice, intermediate and advanced student levels, and at a teaching level.Discussion and Conclusions: Whereas competence-based learning objectives and curricular goals relating to clinical reasoning exist, DID-ACTs collaborative effort presents a novel contribution. It adds to previous work in its explicit focus on clinical reasoning and multiprofessional approach. The presented framework will be used to develop blended learning for students and educators within the consortium and can contri

Clinical reasoning entails the application of knowledge and skills to collect and integrate information, typically with the goal of arriving at a diagnosis and management plan based on the patient's unique circumstances and preferences. Evidence-informed, structured, and explicit teaching and assessment of clinical reasoning in educational programs of medical and other health professions remain unmet needs. We herein summarize recommendations for clinical reasoning learning objectives (LOs), as derived from a consensus approach among European and US researchers and health professions educators. A four-step consensus approach was followed: (1) identification of a convenience sample of the most relevant and applied national LO catalogues for health professions educational programs (N = 9) from European and US countries, (2) extraction of LOs related to clinical reasoning and translation into English, (3) mapping of LOs into predefined categories developed within the Erasmus+ Developing, implementing, and disseminating an adaptive clinical reasoning curriculum for healthcare students and educators (DID-ACT) consortium, and (4) synthesis of analysis findings into recommendations for how LOs related to clinical reasoning could be presented and incorporated in LO catalogues, upon consensus. Three distinct recommendations were formulated: (1) make clinical reasoning explicit, (2) emphasize interprofessional and collaboration aspects of clinical reasoning, and (3) include aspects of teaching and assessment of clinical reasoning. In addition, the consortium understood that implementation of bilingual catalogues with English as a common language might contribute to lower heterogeneity regarding amount, structure, and level of granularity of clinical reasoning LOs across countries. These recommendations will hopefully motivate and guide initiatives towards the implementation of LOs related to clinical reasoning in existing and future LO catalogues., Funding agencies:European Union through the Erasmus+ Knowledge Alliance programme 612454-EPP-1-2019-1-DE-EPPKA2-KAEuropean Commission Joint Research Centre