To Örebro University

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.

Background: Peer learning is an emerging educational concept in health education in Sweden and in other countries. Students, as peers, learn from and with each other. Studies show that students develop increased self-confidence, increased independence and confidence in their skill to solve problems and improve the ability for clinical reasoning. The aim of this pilot study was to further develop forms for clinical training which stimulate student active learning and to make the best use of available supervisor resources.

Summary of Work: During 2018, a peer learning activity was tested for medical students during their clinical training at a primary health center. Before the placement, students were informed of the peer learning project. Two students worked together. Before the meeting, the supervisor introduced the students to the tasks to be performed. The students prepared the reception together. At the patient meeting, one student took the active part and the other observed. The students took turns so that they were the active part in every two patient meetings. Feedback with supervisor and between students took place continuously after the visits and at the end of the day. The project was evaluated by a questionnaire to students and supervisors, and a student diary.

Summary of Results: Ten students agreed that they were completely instructed for the task, two agreed partly. Ten supervisors felt they gave instructions completely, five agreed partly and one didn’t answer. On a scale of 1 to 5, students agreed on average 4.3 or more for questions regarding preparation, constructive feedback, facilitated learning and time for reflection and feedback. Supervisors agreed on average 4.1 or more for the same questions with focus on student learning.

Discussion and Conclusions: Although this is a pilot study, the results show that arranging a peer reception, both from student and supervisor perspective, has a positive effect. Diary writing in combination with peer reception contributes to the students gaining a deeper insight into their learning process and skills development. Larger studies are needed to confirm this. Take-home Messages: A peer reception can create a deeper understanding of the learning process and its guidance.

Background: The undergraduate medical education in Sweden is 5½ years long (11 semesters), followed by an 18 months internship before license. The university curriculum used to be 6 theoretical semesters followed by 5 “clinical” semesters. Today it is common with integrated curricula with an early introduction of clinical training.

Method: School of Medicine at Örebro University started in January 2011 and now admits 70 students every semester. The first students graduated in June 2016. The educational approach is problem-based learning and the curriculum is integrated with six themes based on physiological processes. Biomedicine, clinical medicine and professional development are integrated throughout the entire programme.

Results: In total, clinical placement constitutes 74 weeks of which 16 weeks are spread through the first six semesters. The remaining 58 weeks (semester 7-11) are divided into six longer periods related to the themes. The objective of clinical placement during the first 6 semesters is to practice general clinical skills like communication, history-taking and clinical examination, but also to understand the health care system and the tasks of other health care personnel. The clinical placement in semester 6 ends with a seminar for reflection around the professional development and the value of early clinical placement. The students appreciate the early clinical placements. They manage to acquire general professional skills at this early stage and have the possibility to reflect upon their choice of profession. This stimulates theoretical studies and makes them more comfortable when entering the long clinical placements related to the themes. This is beneficial also for the clinical tutors. The first Örebro students that graduated were satisfied with the preparation given “to work as doctors” and gave the University the highest rank in a national survey.

Conclusion: Early clinical training is beneficial for the development of professional skills; it motivates and gives the student an early understanding of their future professional role. A challenge may be to find enough placements and the need for coaching adjusted for different stages of professional development.

Take-home message: Early clinical training is beneficial for the development of professional skills.

This document reports on the work performed in Task 1.1 User requirements analysis and Task 1.2 GiraffPlus Environment Design Principles. Specifically, it describes the results of a deep involvement of users, both primary (elderly living in their apartment), and secondary (health care professional or family members and friends) recruited in our studies. The report details the qualitative and quantitative research carried out in the three countries of Sweden, Spain and Italy, to elicit user requirements and expectations in terms of type of services as well as system design and appearance. Some qualitative cross-cultural analysis has also been performed in order to highlight differences emerged during the studies in the three countries. Result of this effort is list of user requirements and a set of preferences on different mockups of a component of the system that can be both used to influence the future architecture definition and functional specification of the GiraffPlus system. The work described in this deliverable constitutes the starting point of T1.3 Technological Component Assessment and Selection and overall provides useful hints to the whole system development.

Learning in clinical education can be understood as a process of becoming a legitimate participant in the relevant context. Interprofessional training wards (IPTWs) are designed to give students from educational programmes in health and social care a realistic experience of collaboration for the purpose of developing teamwork skills. IPTWs have been found to be appreciated by the students and to influence students' understanding of each other's professions. The aim of this study was to describe and analyse the students' learning on an interprofessional training ward in care for older persons through focusing on the students' ways of participating in the communities of practice on the ward. A case study design was chosen. Multiple data sources were used. The findings show that the students engaged as active participants in the care. At the same time there was sometimes a discrepancy between on the one hand expectations and goals, on the other hand actual participation. There were difficulties in making the training relevant for all the student groups involved. The findings indicate that in the planning of interprofessional education the choice of setting and learning situations is crucial with regard to the learning that will occur.

In interprofessional work the striving of the members of each profession to establish their own positive in-group identity can be a source of conflict and have a negative effect on care. To counteract this, interprofessional training wards (IPTWs) have been developed in Sweden. The aim of the present study was to investigate similarities and differences in how student nurses, student occupational therapists and student social workers perceived their own and the other two professions before and after clinical education on an IPTW. Sixteen students were interviewed before and after the training on an IPTW in municipal care for older people in Sweden. A coding scheme developed in an earlier study was used in the analysis of the interviews. The findings indicate that there are changes in the students' stereotyped views, enhancing understanding of each other's professions after three weeks' clinical education on the IPTW. In some areas, however, there are still discrepancies between the description of own profession and the others' understanding of this profession that need to be confronted. In interprofessional training during education in social and health care there needs to be a balance between on the one hand the particular professional identity, on the other the shared identity implied by membership of the health-care team focusing on a common goal.

The overall aim of this thesis was to describe and evaluate interprofessional education on an interprofessional training ward in municipal care for older persons. Interprofessional education has for some years now been proposed as a means to meet the call for effective collaboration, co-ordination and quality in health and social care. On the interprofessional training ward considered in this thesis, stu-dents from nursing, occupational therapy and social work programmes worked together for three weeks to learn with, from and about each other.

In the first study (I) students’ perceptions and attitudes concerning the training on the ward were studied. An attitude questionnaire and a retrospective goal-fulfilment questionnaire were distributed to all students. Non-parametric statistics were used for the quantitative analysis, and qualitative content analysis for the qualitative parts. The results showed that the students had positive attitudes to-wards the training ward and in most respects the learning goals set up for the course were considered to have been met.

In Studies II and III the focus was on students’ knowledge and understanding of their own and the others’ professions. Sixteen students were interviewed before and after. In the analysis of the interviews a phenomenographic approach was used. The findings showed a variation from simplistic conceptions of the profes-sions in terms of tasks to more complex conceptions in terms of the profession’s knowledge, responsibility and values. Differences in the ways professions were described concerning their professional stance towards the patients were espe-cially accentuated. The comparison between before and after indicated that there were changes in the students’ views. In some areas, however, there remained dis-crepancies between students’ understanding of their own profession and the oth-ers’ understanding of this profession. To promote mutual agreement on each other’s role this needs to be given careful consideration.

In the fourth study (IV) the focus was on the students’ participation in the community of practice on the ward, and the findings reveal an ambivalent picture of this participation (and thus of their learning). The students collaborated in the care of the patients. However, they sometimes experienced a gap between expec-tations and reality with regard to both the profession-specific and the interprofes-sional training on the ward: what they had to do was sometimes felt to be be-neath their qualifications and irrelevant to the programme of education they were pursuing. This applied to all three groups, but especially student social workers.

Interprofessional training wards can promote interprofessional learning, but it is crucial that setting should be right: it needs to be realistic for all the students involved, offering relevant profession-specific and interprofessional tasks and situations where the students can develop skills in collaborative, patient-centred care.