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  • 1. Abdelhai, Rehab
    et al.
    Yassin, Sahar
    Ahmad, Mohamad F.
    Fors, Uno
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för data- och systemvetenskap.
    An e-learning reproductive health module to support improved student learning and interaction: a prospective interventional study at a medical school in Egypt2012Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 12, 11- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The Public Health (PH) course at the medical college of Cairo University is based on traditional lectures. Large enrollment limits students' discussions and interactions with instructors. Aim: Evaluate students' learning outcomes as measured by improved knowledge acquisition and opinions of redesigning the Reproductive Health (RH) section of the PH course into e-learning and assessing e-course utilization. Methods: This prospective interventional study started with development of an e-learning course covering the RH section, with visual and interactive emphasis, to satisfy students' diverse learning styles. Two student groups participated in this study. The first group received traditional lecturing, while the second volunteered to enroll in the e-learning course, taking online course quizzes. Both groups answered knowledge and course evaluation questionnaires and were invited to group discussions. Additionally, the first group answered another questionnaire about reasons for non-participation. Results: Students participating in the e-learning course showed significantly better results, than those receiving traditional tutoring. Students who originally shunned the e-course expressed eagerness to access the course before the end of the academic year. Overall, students using the redesigned e-course reported better learning experiences. Conclusions: An online course with interactivities and interaction, can overcome many educational drawbacks of large enrolment classes, enhance student's learning and complement pit-falls of large enrollment traditional tutoring.

  • 2.
    Andersson, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Verdonk, Petra
    Johansson, Eva E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lagro-Janssen, Toine
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Comparing gender awareness in Dutch and Swedish first-year medical students: results from a questionaire2012Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 12, 3- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To ascertain good and appropriate healthcare for both women and men implementation of gender perspectives in medical education is needed. For a successful implementation, knowledge about students' attitudes and beliefs about men, women, and gender is crucial. The aim of this study was to compare attitudes to gender and gender stereotyping among Dutch and Swedish male and female medical students.

    Methods: In this cross-sectional study, we measured the attitudes and assumptions about gender among 1096 first year medical students (616 Dutch and 480 Swedish) with the validated Nijmegen Gender Awareness in Medicine Scale (N-GAMS). The response rate was 94% in the Netherlands and 93% in Sweden. Univariate analysis of variance (ANOVA) was used to compare the scores between Dutch and Swedish male and female students. Linear regressions were used to analyze the importance of the background variables.

    Results: There were significant differences in attitudes to gender between Dutch and Swedish students. The Swedish students expressed less stereotypical thinking about patients and doctors and the Dutch were more sensitive to gender differences. The students' sex mattered for gender stereotyping, with male students in both countries agreeing more with stereotypical statements. Students' age, father's birth country and mother's education level had some impact on the outcome.

    Conclusions: There are differences between cultures as well as between men and women in gender awareness that need to be considered when implementing gender in medical education. This study suggests that to arouse the students' interest in gender issues and make them aware of the significance of gender in medical work, the examples used in discussions need to be relevant and challenging in the context of the specific country. Due to different levels of knowledge and different attitudes within the student population it is important to create a climate for dialogue where students feel permitted to disclose their ideas and attitudes in order to become aware of what these are as well as their possible consequences on interaction and decision-making in medical work.

  • 3.
    Aronsson, Patrik
    et al.
    Department Pharmacology, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Booth, Shirley
    Department Pedagogical, Curricular and Professional Studies, Faculty of Education, University of Gothenburg, Gothenburg, Sweden; School of Education, University of the Witwatersrand, Johannesburg, South Africa.
    Hägg, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk farmakologi.
    Kjellgren, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten.
    Zetterqvist, Ann
    Department Pedagogical, Curricular and Professional Studies, Faculty of Education, University of Gothenburg, Gothenburg, Sweden.
    Tobin, Gunnar
    Department Pharmacology, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Reis, Margareta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten.
    The understanding of core pharmacological concepts among health care students in their final semester2015Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 15, nr 1, 235Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    The overall aim of the study was to explore health care students´ understanding of core concepts in pharmacology.

    Method

    An interview study was conducted among twelve students in their final semester of the medical program (n = 4), the nursing program (n = 4), and the specialist nursing program in primary health care (n  = 4) from two Swedish universities. The participants were individually presented with two pharmacological clinically relevant written patient cases, which they were to analyze and propose a solution to. Participants were allowed to use the Swedish national drug formulary. Immediately thereafter the students were interviewed about their assessments. The interviews were audio-recorded and transcribed verbatim. A thematic analysis was used to identify units of meaning in each interview. The units were organized into three clusters: pharmacodynamics, pharmacokinetics, and drug interactions. Subsequent procedure consisted of scoring the quality of students´ understanding of core concepts. Non-parametric statistics were employed.

    Results

    The study participants were in general able to define pharmacological concepts, but showed less ability to discuss the meaning of the concepts in depth and to implement these in a clinical context. The participants found it easier to grasp concepts related to pharmacodynamics than pharmacokinetics and drug interactions.

    Conclusion

    These results indicate that education aiming to prepare future health care professionals for understanding of more complex pharmacological reasoning and decision-making needs to be more focused and effective.

  • 4. Botezatu, Mihaela
    et al.
    Hult, Håkan
    Tessma, Mesfin
    Dahlgren, Lars Owe
    Fors, Uno
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för data- och systemvetenskap.
    Virtual Patient Simulation: what do students make of it?: A focus group study2010Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 10, nr 91Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    The learners' perspectives on Virtual Patient Simulation systems (VPS) are quintessential to their successful development and implementation. Focus group interviews were conducted in order to explore the opinions of medical students on the educational use of a VPS, the Web-based Simulation of Patients application (Web-SP).

    Methods

    Two focus group interviews-each with 8 undergraduate students who had used Web-SP cases for learning and/or assessment as part of their Internal Medicine curriculum in 2007-were performed at the Faculty of Medicine of Universidad el Bosque (Bogota), in January 2008. The interviews were conducted in Spanish, transcribed by the main researcher and translated into English. The resulting transcripts were independently coded by two authors, who also performed the content analysis. Each coder analyzed the data separately, arriving to categories and themes, whose final form was reached after a consensus discussion.

    Results

    Eighteen categories were identified and clustered into five main themes: learning, teaching, assessment, authenticity and implementation. In agreement with the literature, clinical reasoning development is envisaged by students to be the main scope of VPS use; transferable skills, retention enhancement and the importance of making mistakes are other categories circumscribed to this theme. VPS should enjoy a broad use across clinical specialties and support learning of topics not seen during clinical rotations; they are thought to have a regulatory effect at individual level, helping the students to plan their learning. The participants believe that assessment with VPS should be relevant for their future clinical practice; it is deemed to be qualitatively different from regular exams and to increase student motivation. The VPS design and content, the localization of the socio-cultural context, the realism of the cases, as well as the presence and quality of feedback are intrinsic features contributing to VPS authenticity.

    Conclusions

    Five main themes were found to be associated with successful VPS use in medical curriculum: Learning, Teaching, Assessment, Authenticity and Implementation. Medical students perceive Virtual Patients as important learning and assessment tools, fostering clinical reasoning, in preparation for the future clinical practice as young doctors. However, a number of issues regarding VPS design, authenticity and implementation need to be fulfilled, in order to reach the potential educational goals of such applications.

  • 5. Brodin, Ulf
    et al.
    Fors, Uno
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för data- och systemvetenskap.
    Bolander Laksov, Klara
    The application of Item Response Theory on a teaching strategy profile questionnaire2010Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 10, nr 14Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    In medical education research, various questionnaires are often used to study possible relationships between strategies and approaches to teaching and learning and the outcome of these. However, judging the applicability of such questionnaires or the interpretation of the results is not trivial.

    Methods

    As a way to develop teacher thinking, teaching strategy profiles were calculated for teachers in a research intensive department at Karolinska Institutet. This study compares the sum score, that was inherent in the questionnaire used, with an Item Response Theory (IRT) approach. Three teaching dimensions were investigated and the intended sum scores were investigated by IRT analysis.

    Results

    Agreements as well as important differences were found. The use of the sum score seemed to agree reasonably with an IRT approach for two of the dimensions, while the third dimension could not be identified neither by a the sum score, nor by an IRT approach, as the items included showed conflicting messages.

    Conclusions

    This study emphasizes the possibilities to gain better insight and more relevant interpretation of a questionnaire by use of IRT. A sum score approach should not be taken for granted. Its use has to be thoroughly evaluated.

  • 6. Charandabi, Sakineh Mohammad-Alizadeh
    et al.
    Vahidi, Rezagoli
    Marions, Lena
    Wahlström, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Effect of a peer-educational intervention on provider knowledge and reported performance in family planning services: a cluster randomized trial2010Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 10Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Peer education is an interactive method of teaching or learning which is widely used for educating school and college students, in a variety of different forms. However, there are few studies on its effectiveness for in-service education. The aim of this study was to evaluate the effect of an educational programme including peer discussions, based on a needs assessment, on the providers' knowledge and reported performance in family planning services. Methods: An educational programme was designed and applied in a random selection of half of in-charges of the 74 family health units (intervention group) in Tabriz at a regular monthly meeting. The other half constituted the control group. The programme included eight pages of written material and a two-hour, face-to-face discussion session with emphasis on the weak areas identified through a needs assessment questionnaire. The educated incharges were requested to carry out a similar kind of programme with all peers at their health facilities within one month. All in-charges received one self-administered questionnaire containing knowledge questions one month after the in-charge education (follow-up I: 61 responses), and another one containing knowledge and self-reported performance questions 26 months later (follow-up II: 61 responses). Also, such tests were done for the peers facilitated by the in-charges one (105 responses) and 27 months (114 responses) after the peer discussions. Multiple linear regression was used for comparing mean total scores, and Chi square for comparing proportions between control and intervention groups, after defining facility as the unit of randomization. Results: The mean total percentage scores of knowledge (percent of maximal possible score) in the intervention group were significantly higher than in the control group, both at follow-up I (63%) and at follow-up II (57%); with a difference of 16 (95% CI: 11, 22) and 5 (95% CI: 0.4, 11) percentage units, respectively. Only two of the nine reported performance items were significantly different among the non in-charges in the intervention group at follow-up II. Conclusions: The educational programme including peer discussions using existing opportunities with no need for additional absence from the workplace might be a useful complement to formal large group education for the providers.

  • 7. Conte, Helen
    et al.
    Scheja, Max
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för pedagogik och didaktik.
    Hjelmqvist, Hans
    Jirwe, Maria
    Exploring teams of learners becoming WE in the Intensive Care Unit - a focused ethnographic study2015Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 15, 131Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Research about collaboration within teams of learners in intensive care is sparse, as is research on how the learners in a group develop into a team. The aim of this study was to explore the collaboration in teams of learners during a rotation in an interprofessional education unit in intensive care from a sociocultural learning perspective. Methods: Focused Ethnographic methods were used to collect data following eight teams of learners in 2009 and 2010. Each team consisted of one resident, one specialist nurse student and their supervisors (n = 28). The material consisted of 100 hours of observations, interviews, and four hours of sound recordings. A qualitative analysis explored changing patterns of interplay through a constant comparative approach. Results: The learners' collaboration progressed along a pattern of participation common to all eight groups with a chronological starting point and an end point. The progress consisted of three main steps where the learners' groups developed into teams during a week's training. The supervisors' guided the progress by gradually stepping back to provide latitude for critical reflection and action. Conclusion: Our main conclusion in training teams of learners how to collaborate in the intensive care is the crucial understanding of how to guide them to act like a team, feel like a team and having the authority to act as a team.

  • 8.
    Diderichsen, Saima
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Eva E.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Verdonk, Petra
    Lagro-Janssen, Toine
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Few gender differences in specialty preferences and motivational factors: a cross-sectional Swedish study on last-year medical students2013Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 13, 39Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Today, women constitute about half of medical students in several Western societies, yet women physicians are still underrepresented in surgical specialties and clustered in other branches of medicine. Gender segregation in specialty preference has been found already in medical school. It is important to study the career preferences of our future physicians, as they will influence the maintenance of an adequate supply of physicians in all specialties and the future provision of health care. American and British studies dominate the area of gender and medical careers whereas Swedish studies on medical students' reasons for specialty preference are scarce. The aim of this study is to investigate and compare Swedish male and female medical students' specialty preferences and the motives behind them. Methods: Between 2006 and 2009, all last-year medical students at Umea University, Sweden (N = 421), were invited to answer a questionnaire about their future career and family plans. They were asked about their specialty preference and how they rated the impact that the motivational factors had for their choice. The response rate was 89% (N = 372); 58% were women (N = 215) and 42% were men (N = 157). Logistic regression was used to evaluate the independent impact of each motivational factor for specialty preference. Results: On the whole, male and female last-year students opted for similar specialties. Men and women had an almost identical ranking order of the motivational factors. When analyzed separately, male and female students showed both similarities and differences in the motivational factors that were associated with their specialty preference. A majority of the women and a good third of the men intended to work part-time. The motivational factor combining work with family correlated with number of working hours for women, but not for men. Conclusions: The gender similarities in the medical students' specialty preferences are striking and contrast with research from other Western countries where male and female students show more differences in career aspirations. These similarities should be seized by the health care system in order to counteract the horizontal gender segregation in the physician workforce of today.

  • 9.
    Edelbring, Samuel
    Karolinska Institutet.
    Measuring strategies for learning regulation in medical education: Scale reliability and dimensionality in a Swedish sample.2012Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 12, nr 76Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    The degree of learners’ self-regulated learning and dependence on external regulation influence learning processes in higher education. These regulation strategies are commonly measured by questionnaires developed in other settings than in which they are being used, thereby requiring renewed validation. The aim of this study was to psychometrically evaluate the learning regulation strategy scales from the Inventory of Learning Styles with Swedish medical students (N = 206).

    Methods

    The regulation scales were evaluated regarding their reliability, scale dimensionality and interrelations. The primary evaluation focused on dimensionality and was performed with Mokken scale analysis. To assist future scale refinement, additional item analysis, such as item-to-scale correlations, was performed.

    Results

    Scale scores in the Swedish sample displayed good reliability in relation to published results: Cronbach’s alpha: 0.82, 0.72, and 0.65 for self-regulation, external regulation and lack of regulation scales respectively. The dimensionalities in scales were adequate for self-regulation and its subscales, whereas external regulation and lack of regulation displayed less unidimensionality. The established theoretical scales were largely replicated in the exploratory analysis. The item analysis identified two items that contributed little to their respective scales.

    Discussion

    The results indicate that these scales have an adequate capacity for detecting the three theoretically proposed learning regulation strategies in the medical education sample. Further construct validity should be sought by interpreting scale scores in relation to specific learning activities. Using established scales for measuring students’ regulation strategies enables a broad empirical base for increasing knowledge on regulation strategies in relation to different disciplinary settings and contributes to theoretical development

  • 10.
    Edelbring, Samuel
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Karolinska Institutet, Stockholm, Sweden.
    Wahlström, Rolf
    Karolinska Institutet, Stockholm, Sweden.
    Dynamics of study strategies and teacher regulation in virtual patient learning activities: a cross sectional survey2016Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, nr 1, 122- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Students’ self-regulated learning becomes essential with increased use of exploratory web-based activities such as virtual patients (VPs). The purpose was to investigate the interplay between students’ self-regulated learning strategies and perceived benefit in VP learning activities.

    Method

    A cross-sectional study (n = 150) comparing students’ study strategies and perceived benefit of a virtual patient learning activity in a clinical clerkship preparatory course. Teacher regulation varied among three settings and was classified from shared to strong. These settings were compared regarding their respective relations between regulation strategies and perceived benefit of the virtual patient activity.

    Results

    Self-regulation learning strategy was generally associated with perceived benefit of the VP activities (rho 0.27, p < 0.001), but was not true in all settings. The association was higher in the two strongly regulated settings. The external regulation strategy did generally associate weakly with perceived benefit (rho 0.17, p < 0.05) with large variations between settings.

    Conclusions

    The flexible student-autonomous appeal of virtual patients should not lead to the dismissal of guidance and related course activities. External teacher and peer regulation seem to be productive for increasing learners’ perceived benefit. Awareness of the interplay among teacher regulation (external) and various study strategies can increase the value of flexible web-based learning resources to students.

  • 11. Ekblad, Solvig
    et al.
    Mollica, Richard F.
    Fors, Uno
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för data- och systemvetenskap.
    Pantziaras, Ioannis
    Lavelle, James
    Educational potential of a virtual patient system for caring for traumatized patients in primary care2013Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 13, 110- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Virtual Patients (VPs) have been used in undergraduate healthcare education for many years. This project is focused on using VPs for training professionals to care for highly vulnerable patient populations. The aim of the study was to evaluate if Refugee Trauma VPs was perceived as an effective and engaging learning tool by primary care professionals (PCPs) in a Primary Health Care Centre (PHC). Methods: A VP system was designed to create realistic and engaging VP cases for Refugee Trauma for training refugee patient interview, use of established trauma and mental health instruments as well as to give feedback to the learners. The patient interview section was based on video clips with a Bosnian actor with a trauma story and mental health problems. The video clips were recorded in Bosnian language to further increase the realism, but also subtitled in English. The system was evaluated by 11 volunteering primary health clinicians at the Lynn Community Health Centre, Lynn, Massachusetts, USA. The participants were invited to provide insights/feedback about the system's usefulness and educational value. A mixed methodological approach was used, generating both quantitative and qualitative data. Results: Self-reported dimensions of clinical care, pre and post questionnaire questions on the PCPs clinical worldview, motivation to use the VP, and IT Proficiency. Construct items used in these questionnaires had previously demonstrated high face and construct validity. The participants ranked the mental status examination more positively after the simulation exercise compared to before the simulation. Follow up interviews supported the results. Conclusions: Even though virtual clinical encounters are quite a new paradigm in PHC, the participants in the present study considered our VP case to be a relevant and promising educational tool. Next phase of our project will be a RCT study including comparison with specially prepared paper-cases and determinative input on improving clinical diagnosis and treatment of the traumatized refugee patient.

  • 12. Escher, Cecilia
    et al.
    Creutzfeldt, Johan
    Meurling, Lisbet
    Hedman, Leif
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden.
    Kjellin, Ann
    Fellaender-Tsai, Li
    Medical students' situational motivation to participate in simulation based team training is predicted by attitudes to patient safety2017Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 17, 37Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Patient safety education, as well as the safety climate at clinical rotations, has an impact on students' attitudes. We explored medical students' self-reported motivation to participate in simulation-based teamwork training (SBTT), with the hypothesis that high scores in patient safety attitudes would promote motivation to SBTT and that intrinsic motivation would increase after training.

    Methods: In a prospective cohort study we explored Swedish medical students' attitudes to patient safety, their motivation to participate in SBTT and how motivation was affected by the training. The setting was an integrated SBTT course during the surgical semester that focused on non-technical skills and safe treatment of surgical emergencies. Data was collected using the Situational Motivation Scale (SIMS) and the Attitudes to Patient Safety Questionnaire (APSQ).

    Results: We found a positive correlation between students' individual patient safety attitudes and self-reported motivation (identified regulation) to participate in SBTT. We also found that intrinsic motivation increased after training. Female students in our study scored higher than males regarding some of the APSQ sub-scores and the entire group scored higher or on par with comparable international samples.

    Conclusion: In order to enable safe practice and professionalism in healthcare, students' engagement in patient safety education is important. Our finding that students' patient safety attitudes show a positive correlation to motivation and that intrinsic motivation increases after training underpins patient safety climate and integrated teaching of patient safety issues at medical schools in order to help students develop the knowledge, skills and attitudes required for safe practice.

  • 13. Esmaily, Hamideh M.
    et al.
    Savage, Carl
    Vahidi, Rezagoli
    Amini, Abolghasem
    Zarrintan, Mohammad Hossein
    Wahlström, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Identifying outcome-based indicators and developing a curriculum for a continuing medical education programme on rational prescribing using a modified Delphi process.2008Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 8, 33- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND

    Continuing medical education (CME) is compulsory for physicians in Iran. Recent studies in Iran show that modifications of CME elements are necessary to improve the effectiveness of the educational programmes. Other studies point to an inappropriate, even irrational drug prescribing. Based on a needs assessment study regarding CME for general physicians in the East Azerbaijan province in Iran, rational prescribing practice was recognized as a high priority issue. Considering different educational methods, outcome-based education has been proposed as a suitable approach for CME. The purpose of the study was to obtain experts' consensus about appropriate educational outcomes of rational prescribing for general physicians in CME and developing curricular contents for this education.

    METHODS

    The study consisted of two phases: The first phase was conducted using a two-round Delphi consensus process to identify the outcome-based educational indicators regarding rational prescribing for general physicians in primary care (GPs). In the second phase the agreed indicators were submitted to panels of experts for assessment and determination of content for a CME program in the field.

    RESULTS

    Twenty one learning outcomes were identified through a modified Delphi process. The indicators were used by the panels of experts and six educational topics were determined for the CME programme and the curricular content of each was defined. The topics were 1) Principles of prescription writing, 2) Adverse drug reactions, 3) Drug interactions, 4) Injections, 5) Antibiotic therapy, and 6) Anti-inflammatory agents therapy. One of the topics was not directly related to any outcome, raising a question about the need for a discussion on constructive alignment.

    CONCLUSIONS

    Consensus on learning outcomes was achieved and an educational guideline was designed. Before suggesting widespread use in the country the educational package should be tested in the CME context.

  • 14.
    Fridner, Ann
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen. Karolinska Institutet, Sweden.
    Norell, Alexandra
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Åkesson, Gertrud
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Gustafsson Sendén, Marie
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Løvseth, Lise Tevik
    Schenck-Gustafsson, Karin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen. Karolinska Institutet, Sweden.
    Possible reasons why female physicians publish fewer scientific articles than male physicians: A cross-sectional study2015Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 15, 67Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The proportion of women in medicine is approaching that of men, but female physicians are still in the minority as regards positions of power. Female physicians are struggling to reach the highest positions in academic medicine. One reason for the disparities between the genders in academic medicine is the fact that female physicians, in comparison to their male colleagues, have a lower rate of scientific publishing, which is an important factor affecting promotion in academic medicine. Clinical physicians work in a stressful environment, and the extent to which they can control their work conditions varies. The aim of this paper was to examine potential impeding and supportive work factors affecting the frequency with which clinical physicians publish scientific papers on academic medicine.

    Methods: Cross-sectional multivariate analysis was performed among 198 female and 305 male Swedish MD/PhD graduates. The main outcome variable was the number of published scientific articles.

    Results: Male physicians published significantly more articles than female physicians p <. 001. In respective multivariate models for female and male physicians, age and academic positions were significantly related to a higher number of published articles, as was collaborating with a former PhD advisor for both female physicians (OR = 2.97; 95% CI 1.22–7.20) and male physicians (OR = 2.10; 95% CI 1.08–4.10). Control at work was significantly associated with a higher number of published articles for male physicians only (OR = 1.50; 95% CI 1.08–2.09). Exhaustion had a significant negative impact on number of published articles among female physicians (OR = 0.29; 95% CI 0.12–0.70) whilst the publishing rate among male physicians was not affected by exhaustion.

    Conclusions: Women physicians represent an expanding sector of the physician work force; it is essential that they are represented in future fields of research, and in academic publications. This is necessary from a gender perspective, and to ensure that physicians are among the research staff in biomedical research in the future.

  • 15.
    Hege, Inga
    et al.
    University of Munich, Germany; Geisel School Medical Dartmouth, NH USA.
    Kononowicz, Andrzej A.
    Jagiellonian University, Poland; Karolinska Institute, Sweden.
    Tolks, Daniel
    University of Munich, Germany.
    Edelbring, Samuel
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Karolinska Institute, Sweden.
    Kuehlmeyer, Katja
    University of Munich, Germany.
    A qualitative analysis of virtual patient descriptions in healthcare education based on a systematic literature review2016Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, nr 146Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Virtual Patients (VPs) have been in the focus of research in healthcare education for many years. The aim of our study was to analyze how virtual patients are described in the healthcare education literature, and how the identified concepts relate to each other. Methods: We performed a literature review and extracted 185 descriptions of virtual patients from the articles. In a qualitative content analysis approach we inductively-deductively developed categories and deducted subcategories. We constructed a concept map to illustrate these concepts and their interrelations. Results: We developed the following five main categories: Patient, Teacher, Virtual Patient, Curriculum, and Learner. The concept map includes these categories and highlights aspects such as the under-valued role of patients in shaping their virtual representation and opposing concepts, such as standardization of learner activity versus learner-centeredness. Conclusions: The presented concept map synthesizes VP descriptions and serves as a basis for both, VP use and discussions of research topics related to virtual patients.

  • 16. Jensen, Ulf J.
    et al.
    Jensen, Jens
    Olivecrona, Goran
    Ahlberg, Gunnar
    Lagerquist, Bo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Tornvall, Per
    The role of a simulator-based course in coronary angiography on performance in real life cath lab2014Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 14, 49- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The aim of this study was to explore if a course consisting of lectures combined with simulator training in coronary angiography (CA) could accelerate the early learning curve when performing CA on patients. Knowledge in performing CA is included in the curriculum for the general cardiologist. The method, according to American College of Cardiology and European Society of Cardiology guidelines, for this training is not well defined but simulator training is proposed to be an option. However, the transfer effect from a CA simulator to performance in real world cath lab is not validated. Methods: Fifty-four residents without practical skills in CA completed the course and 12 continued to training in invasive cardiology. These residents were tracked in the Swedish Coronary Angiography and Angioplasty Registry and compared to a control group of 46 novel operators for evaluation of performance metrics. A total of 4472 CAs were analyzed. Results: Course participants demonstrated no consistent acceleration in the early learning curve in real world cath lab. They had longer fluoroscopy time compared to controls (median 360 seconds (IQR 245-557) vs. 289 seconds (IQR 179-468), p < 0.001). Safety measures also indicated more complications appearing at the ward, in particular when using the femoral approach (6.25% vs. 2.53%, p < 0.001). Conclusions: Since the results of this retrospective non-randomized study were negative, the role of a structured course including simulator training for skills acquisition in CA is still uncertain. Randomized transfer studies are warranted to justify further use of simulators for training in CA

  • 17. Kalén, Susanne
    et al.
    Lachmann, Hanna
    Sophiahemmet Högskola.
    Varttinen, Maria
    Möller, Riitta
    Bexelius, Tomas S
    Ponzer, Sari
    Medical students' experiences of their own professional development during three clinical terms: a prospective follow-up study.2017Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 17, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: A modern competency-based medical education is well implemented globally, but less is known about how the included learning activities contribute to medical students' professional development. The aim of this study was to explore Swedish medical students' perceptions of the offered learning activities and their experiences of how these activities were connected to their professional development as defined by the CanMEDS framework.

    METHODS: A prospective mixed method questionnaire study during three terms (internal medicine, scientific project, and surgery) in which data were collected by using contextual activity sampling system, i.e., the students were sent a questionnaire via their mobile phones every third week. All 136 medical students in the 6th of 11 terms in the autumn of 2012 were invited to participate. Seventy-four students (54%) filled in all of the required questionnaires (4 per term) for inclusion, the total number of questionnaires being 1335. The questionnaires focused on the students' experiences of learning activities, especially in relation to the CanMEDS Roles, collaboration with others and emotions (positive, negative, optimal experiences, i.e., "flow") related to the studies. The quantitative data was analysed statistically and, for the open-ended questions, manifest inductive content analysis was used.

    RESULTS: Three of the CanMEDs Roles, Medical Expert, Scholar, and Communicator, were most frequently reported while the four others, e.g., the role Health Advocate, were less common. Collaboration with students from other professions was most usual during the 8th term. Positive emotions and experience of "flow" were most often reported during clinical learning activities while the scientific project term was connected with more negative emotions.

    CONCLUSIONS: Our results showed that it is possible, even during clinical courses, to visualise the different areas of professional competence defined in the curriculum and connect these competences to the actual learning activities. Students halfway through their medical education considered the most important learning activities for their professional development to be connected with the Roles of Medical Expert, Scholar, and Communicator. Given that each of the CanMEDS Roles is at least moderately important during undergraduate medical education, the entire spectrum of the Roles should be emphasised and developed during the clinical years.

  • 18.
    Kononowicz, Andrzej
    et al.
    Karolinska Institutet.
    Zary, Nabil
    Karolinska Institutet.
    Edelbring, Samuel
    Karolinska Institutet.
    Corral, Janet
    University of Colorado.
    Hege, Inga
    University of Munchen.
    Virtual patients - what are we talking about? A framework to classify the meanings of the term in healthcare education2015Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 15, nr 11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    The term "virtual patients" (VPs) has been used for many years in academic publications, but its meaning varies, leading to confusion. Our aim was to investigate and categorize the use of the term "virtual patient" and then classify its use in healthcare education.

    Methods

    A literature review was conducted to determine all articles using the term "virtual patient" in the title or abstract. These articles were categorized into: Education, Clinical Procedures, Clinical Research and E-Health. All educational articles were further classified based on a framework published by Talbot et al. which was further developed using a deductive content analysis approach.

    Results

    536 articles published between 1991 and December 2013 were included in the study. From these, 330 were categorized as educational. Classifying these showed that 37% articles used VPs in the form of Interactive Patient Scenarios. VPs in form of High Fidelity Software Simulations (19%) and Virtual Standardized Patients (16%) were also frequent. Less frequent were other forms, such as VP Games.

    Analyzing the literature across time shows an overall trend towards the use of Interactive Patient Scenarios as the predominant form of VPs in healthcare education.

    Conclusions

    The main form of educational VPs in the literature are Interactive Patient Scenarios despite rapid technical advances that would support more complex applications. The adapted classification provides a valuable model for VP developers and researchers in healthcare education to more clearly communicate the type of VP they are addressing avoiding misunderstandings.

  • 19.
    Kristoffersson, Emelie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Andersson, Jenny
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Bengs, Carita
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Experiences of the gender climate in clinical training: a focus group study among Swedish medical students2016Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, 283Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Research shows that medical education is characterized by unequal conditions for women and men, but there is a lack of qualitative studies investigating the social processes that enable and maintain gender inequalities that include both male and female students. In this focus group study, we therefore explored male aswell as female medical students’ experiences of the gender climate – i.e., how beliefs, values, and norms about gender were communicated – during clinical training and how the students dealt with these experiences.

    Methods: Focus group interviews were conducted with 24 medical students (nine men) at Umeå University, Sweden. The interviews were structured around personal experiences in clinical training where the participants perceived that gender had mattered. Data were analysed using qualitative content analysis.

    Results: The students described gender-stereotyped expectations, discriminatory treatment, compliments, comments, and demeaning jargon. Female students gave more personal and varied examples than the men.The students’ ways of handling their experiences were marked by efforts to fit in, for example, by adapting their appearance and partaking in the prevailing jargon. They felt dependent on supervisors and staff, and due to fear of repercussions they kept silent and avoided unpleasant situations and people rather than challenging humiliating jargon or supervisors who were behaving badly.

    Conclusions: Everyday communication of gender beliefs combined with students’ adaptation to stereotyped expectations and discrimination came across as fundamental features through which unequal conditions for male and female students are reproduced and maintained in the clinic. Because they are in a dependent position, it is often difficult for students to challenge problematic gender attitudes. The main responsibility for improvements, therefore, lies with medical school leadership who need to provide students and supervisors with knowledge about gendered processes, discrimination, and sexism and to organize reflection groups about the gender climate in order to improve students’ opportunities to discuss their experiences, and hopefully find ways to protest and actively demand change.

  • 20.
    Laksov, Klara Bolander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för pedagogik och didaktik. Karolinska Institutet, Sweden.
    Dornan, Tim
    Teunissen, Pim W.
    Making theory explicit - An analysis of how medical education research(ers) describe how they connect to theory2017Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 17, 18Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: As medical education develops into a varied and well-developed field of research, the issue of quality research anchored in or generating theory has gained increasing importance. Medical education researchers have been criticized of not connecting their work to relevant theory. This paper set out to analyse how researchers can connect to theory in medical education. The goal of this paper is to provide an accessible framework for those entering medical education research, regarding how theory may become an integral part of one's work. Methods: Fifteen purposefully selected researchers in medical education were asked to nominate papers they considered influential in medical education. Through this process 41 papers were identified and included in the study. Results: The papers were analysed with thematic content analysis, which resulted in three approaches to the use of theory: as close-up exploration; as a specific perspective; and as an overview. The approaches are exemplified by quotes from the papers included in our dataset and further illuminated by a metaphoric story. Conclusions: We conclude by pointing at the importance of making explicit how theory is used in medical education as a way to collaboratively take responsibility for the quality of medical education research.

  • 21. Liljedahl, Matilda
    et al.
    Björck, Erik
    Kalén, Susanne
    Ponzer, Sari
    Bolander Laksov, Klara
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för pedagogik och didaktik. Karolinska Institutet, Sweden.
    To belong or not to belong: nursing students' interactions with clinical learning environments - an observational study2016Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, 197Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Belongingness has been argued to be a prerequisite for students' learning in the clinical setting but making students feel like they belong to the workplace is a challenge. From a sociocultural perspective, workplace participatory practices is a framework that views clinical learning environments to be created in interaction between students and the workplace and hence, are dependent on them both. The aim of this study was to explore the interdependence between affordances and engagement in clinical learning environments. The research question was: How are nursing students influenced in their interactions with clinical learning environments? Methods: An observational study with field observations and follow-up interviews was performed. The study setting comprised three academic teaching hospitals. Field observations included shadowing undergraduate nursing students during entire shifts. Fifty-five hours of field observations and ten follow-up interviews with students, supervisors and clinical managers formed the study data. A thematic approach to the analysis was taken and performed iteratively with the data collection. Results: The results revealed that students strived to fill out the role they were offered in an aspirational way but that they became overwhelmed when given the responsibility of care. When students' basic values did not align with those enacted by the workplace, they were not willing to compromise their own values. Workplaces succeeded in inviting students into the community of nurses and the practice of care. Students demonstrated hesitance regarding their desire to belong to the workplace community. Conclusion: The results imply that the challenge for clinical education is not to increase the experience of belongingness but to maintain students' critical and reflective approach to health care practice. Additionally, results suggest students to be included as an important stakeholder in creating clinical learning environments rather than being viewed as consumer of clinical education.

  • 22.
    Lund, Bodil
    et al.
    Karolinska Inst, Dept Dent Med.
    Fors, Uno
    Stockholm Univ, Dept Comp & Syst Sci,.
    Sejersen, Ronny
    Karolinska Institutet, Stockholm.
    Sallnäs Pysander, Eva-Lotta
    KTH, Skolan för datavetenskap och kommunikation (CSC), Människa-datorinteraktion, MDI.
    Rosén, Annika
    Karolinska Institutet, Stockholm.
    Student perception of two different simulation techniques in oral and maxillofacial surgery undergraduate training2011Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 11, nr 1, 82- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Yearly surveys among the undergraduate students in oral and maxillofacial surgery at Karolinska Institutet have conveyed a wish for increased clinical training, and in particular, in surgical removal of mandibular third molars. Due to lack of resources, this kind of clinical supervision has so far not been possible to implement. One possible solution to this problem might be to introduce simulation into the curriculum. The purpose of this study was to investigate undergraduate students' perception of two different simulation methods for practicing clinical reasoning skills and technical skills in oral and maxillofacial surgery. Methods: Forty-seven students participating in the oral and maxillofacial surgery course at Karolinska Institutet during their final year were included. Three different oral surgery patient cases were created in a Virtual Patient (VP) Simulation system (Web-SP) and used for training clinical reasoning. A mandibular third molar surgery simulator with tactile feedback, providing hands on training in the bone removal and tooth sectioning in third molar surgery, was also tested. A seminar was performed using the combination of these two simulators where students' perception of the two different simulation methods was assessed by means of a questionnaire. Results: The response rate was 91.5% (43/47). The students were positive to the VP cases, although they rated their possible improvement of clinical reasoning skills as moderate. The students' perception of improved technical skills after training in the mandibular third molar surgery simulator was rated high. The majority of the students agreed that both simulation techniques should be included in the curriculum and strongly agreed that it was a good idea to use the two simulators in concert. The importance of feedback from the senior experts during simulator training was emphasised. Conclusions: The two tested simulation methods were well accepted and most students agreed that the future curriculum would benefit from permanent inclusion of these exercises, especially when used in combination. The results also stress the importance of teaching technical skills and clinical reasoning in concert.

  • 23. Lund, Bodil
    et al.
    Fors, Uno
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för data- och systemvetenskap.
    Sejersen, Ronny
    Sällnäs, EvaLotta
    Rosén, Annika
    Student perception of two different simulation techniques in oral and maxillofacial surgery undergraduate training2011Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 11, 82- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Yearly surveys among the undergraduate students in oral and maxillofacial surgery at Karolinska Institutet have conveyed a wish for increased clinical training, and in particular, in surgical removal of mandibular third molars. Due to lack of resources, this kind of clinical supervision has so far not been possible to implement. One possible solution to this problem might be to introduce simulation into the curriculum. The purpose of this study was to investigate undergraduate students' perception of two different simulation methods for practicing clinical reasoning skills and technical skills in oral and maxillofacial surgery. Methods: Forty-seven students participating in the oral and maxillofacial surgery course at Karolinska Institutet during their final year were included. Three different oral surgery patient cases were created in a Virtual Patient (VP) Simulation system (Web-SP) and used for training clinical reasoning. A mandibular third molar surgery simulator with tactile feedback, providing hands on training in the bone removal and tooth sectioning in third molar surgery, was also tested. A seminar was performed using the combination of these two simulators where students' perception of the two different simulation methods was assessed by means of a questionnaire. Results: The response rate was 91.5% (43/47). The students were positive to the VP cases, although they rated their possible improvement of clinical reasoning skills as moderate. The students' perception of improved technical skills after training in the mandibular third molar surgery simulator was rated high. The majority of the students agreed that both simulation techniques should be included in the curriculum and strongly agreed that it was a good idea to use the two simulators in concert. The importance of feedback from the senior experts during simulator training was emphasised. Conclusions: The two tested simulation methods were well accepted and most students agreed that the future curriculum would benefit from permanent inclusion of these exercises, especially when used in combination. The results also stress the importance of teaching technical skills and clinical reasoning in concert.

  • 24.
    Manninen, Katri
    et al.
    Department of Learning, Karolinska Institutet, Informatics, Management and Ethics.
    Welin Henriksson, Elisabet
    Department of Neurobiology, Karolinska Institutet; Care Sciences and Society.
    Scheja, Max
    Department of Education, Stockholm University.
    Silén, Charlotte
    Department of Learning, Karolinska Institutet, Informatics, Management and Ethics.
    Patients' approaches to students' learning at a clinical education ward: an ethnographic study2014Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 14, 131Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: It is well known that patients' involvement in health care students' learning is essential and gives students opportunities to experience clinical reasoning and practice clinical skills when interacting with patients. Students encounter patients in different contexts throughout their education. However, looking across the research providing evidence about learning related to patient-student encounters reveals a lack of knowledge about the actual learning process that occurs in encounters between patients and students. The aim of this study was to explore patient-student encounters in relation to students' learning in a patient-centered health-care setting.

    METHODS: An ethnographic approach was used to study the encounters between patients and students. The setting was a clinical education ward for nursing students at a university hospital with eight beds. The study included 10 observations with 11 students and 10 patients. The observer followed one or two students taking care of one patient. During the fieldwork observational and reflective notes were taken. After each observation follow-up interviews were conducted with each patient and student separately. Data were analyzed using an ethnographic approach.

    RESULTS: The most striking results showed that patients took different approaches in the encounters with students. When the students managed to create a good atmosphere and a mutual relationship, the patients were active participants in the students' learning. If the students did not manage to create a good atmosphere, the relationship became one-way and the patients were passive participants, letting the students practice on their bodies but without engaging in a dialogue with the students.

    CONCLUSIONS: Patient-student encounters, at a clinical education ward with a patient-centred pedagogical framework, can develop into either a learning relationship or an attending relationship. A learning relationship is based on a mutual relationship between patients and students resulting in patients actively participating in students' learning and they both experience it as a joint action. An attending relationship is based on a one-way relationship between patients and students resulting in patients passively participating by letting students to practice on their bodies but without engaging in a learning dialogue with the students.

  • 25.
    Meurling, Lisbet
    et al.
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Anaesthesia & Intens Care, SE-14186 Stockholm, Sweden.
    Hedman, Leif
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Orthopaed & Biotechnol, SE-14186 Stockholm, Sweden.
    Lidefelt, Karl-Johan
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Paediat, SE-14186 Stockholm, Sweden.
    Escher, Cecilia
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Anaesthesia & Intens Care, SE-14186 Stockholm, Sweden.
    Fellander-Tsai, Li
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Orthopaed & Biotechnol, SE-14186 Stockholm, Sweden.
    Wallin, Carl-Johan
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Anaesthesia & Intens Care, SE-14186 Stockholm, Sweden.
    Comparison of high- and low equipment fidelity during paediatric simulation team training: a case control study2014Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 14, 221- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: High-fidelity patient simulators in team training are becoming popular, though research showing benefits of the training process compared to low-fidelity models is rare. We explored in situ training for paediatric teams in an emergency department using a low-fidelity model (plastic doll) and a high-fidelity paediatric simulator, keeping other contextual factors constant. The goal was to study differences in trainees' and trainers' performance along with their individual experiences, during in situ training, using either a low-fidelity model or a high-fidelity paediatric simulator.

    Methods: During a two-year period, teams involved in paediatric emergency care were trained in groups of five to nine. Each team performed one video-recorded paediatric emergency scenario. A case control study was undertaken in which 34 teams used either a low-fidelity model (n = 17) or a high-fidelity paediatric simulator (n = 17). The teams' clinical performances during the scenarios were measured as the time elapsed to prescribe as well as deliver oxygen. The trainers were monitored regarding frequency of their interventions. We also registered trainees' and trainers' mental strain and flow experience.

    Results: Of 225 trainees' occasions during 34 sessions, 34 trainer questionnaires, 163 trainee questionnaires, and 28 videos, could be analyzed. Time to deliver oxygen was significantly longer (p = 0.014) when a high-fidelity simulator was used. The trainees' mental strain and flow did not differ between the two types of training. The frequency of trainers interventions was lower (p < 0.001) when trainees used a high-fidelity simulator; trainers' perceived mental strain was lower (< 0.001) and their flow experience higher (p = 0.004) when using high-fidelity simulator.

    Conclusions: Levels of equipment fidelity affect measurable performance variables in simulation-based team training, but trainee s' individual experiences are similar. We also note a reduction in the frequency of trainers' interventions in the scenarios as well as their mental strain, when trainees used a high-fidelity simulator.

  • 26. Muntean, Valentin
    et al.
    Calinici, Tudor
    Tigan, Stefan
    Fors, Uno G. H.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för data- och systemvetenskap.
    Language, culture and international exchange of virtual patients2013Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 13, 21- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Language and cultural differences could be a limiting factor for the international exchange of Virtual Patients (VPs), especially for small countries and languages of limited circulation. Our research evaluated whether it would be feasible to develop a VP based educational program in our Romanian institution, with cases in English and developed in a non-Romanian setting. Method: The participants in the research comprised 4th year Romanian medical students from the Faculty of Medicine in Cluj-Napoca, Romania, with previous training exclusively in Romanian, good English proficiency and no experience with VPs. The students worked on eight VPs in two identical versions, Romanian and English. The first group (2010) of 136 students worked with four VPs developed in Cluj and the second group (2011) of 144 students with four VPs originally developed at an US University. Every student was randomly assigned two different VPs, one in Romanian and another in English. Student activity throughout the case, the diagnosis, therapeutic plan and diagnosis justification were recorded. We also compared student performance on the two VPs versions, Romanian and English and the student performance on the two sets of cases, originally developed in Romania, respectively USA. Results: We found no significant differences between the students' performance on the Romanian vs. English version of VPs. Regarding the students' performance on the two sets of cases, in those originally developed in Romania, respectively in the USA, we found a number of statistically significant differences in the students' activity through the cases. There were no statistically significant differences in the students' ability to reach the correct diagnosis and therapeutic plan. Conclusion: The development of our program with VPs in English would be feasible, cost-effective and in accordance with the globalization of medical education.

  • 27.
    Nesterowicz, Krzysztof
    et al.
    Jagiellonian University.
    Librowski, Tadeusz
    Jagiellonian University.
    Edelbring, Samuel
    Karolinska Institutet.
    Validating e-learning in continuing pharmacy education: user acceptance and knowledge change2014Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 14, nr 33Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Continuing pharmacy education is becoming mandatory in most countries in order to keep the professional license valid. Increasing number of pharmacists are now using e-learning as part of their continuing education. Consequently, the increasing popularity of this method of education calls for standardization and validation practices. The conducted research explored validation aspects of e-learning in terms of knowledge increase and user acceptance.

    Methods

    Two e-courses were conducted as e-based continuing pharmacy education for graduated pharmacists. Knowledge increase and user acceptance were the two outcome measured. The change of knowledge in the first e-course was measured by a pre- and post-test and results analysed by the Wilcoxon signed–rank test. The acceptance of e-learning in the second e-course was investigated by a questionnaire and the results analysed using descriptive statistics.

    Results

    Results showed that knowledge increased significantly (p < 0.001) by 16 pp after participation in the first e-course. Among the participants who responded to the survey in the second course, 92% stated that e-courses were effective and 91% stated that they enjoyed the course.

    Conclusions

    The study shows that e-learning is a viable medium of conducting continuing pharmacy education; e-learning is effective in increasing knowledge and highly accepted by pharmacists from various working environments such as community and hospital pharmacies, faculties of pharmacy or wholesales.

  • 28. Nilsson, Mikael
    et al.
    Bolinder, Gunilla
    Held, Claes
    Karolinska Univ Hosp, Dept Cardiol, Stockholm.
    Johansson, Bo-Lennart
    Fors, Uno
    Östergren, Jan
    Evaluation of a web-based ECG-interpretation programme for undergraduate medical students2008Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 8, 25- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Most clinicians and teachers agree that knowledge about ECG is of importance in the medical curriculum. Students at Karolinska Institute have asked for more training in ECG-interpretation during their undergraduate studies. Clinical tutors, however, have difficulties in meeting these demands due to shortage of time. Thus, alternative ways to learn and practice ECG-interpretation are needed. Education offered via the Internet is readily available, geographically independent and flexible. Furthermore, the quality of education may increase and become more effective through a superior educational approach, improved visualization and interactivity. METHODS: A Web-based comprehensive ECG-interpretation programme has been evaluated. Medical students from the sixth semester were given an optional opportunity to access the programme from the start of their course. Usage logs and an initial evaluation survey were obtained from each student. A diagnostic test was performed in order to assess the effect on skills in ECG interpretation. Students from the corresponding course, at another teaching hospital and without access to the ECG-programme but with conventional teaching of ECG served as a control group. RESULTS: 20 of the 32 students in the intervention group had tested the programme after 2 months. On a five-graded scale (1- bad to 5 - very good) they ranked the utility of a web-based programme for this purpose as 4.1 and the quality of the programme software as 3.9. At the diagnostic test (maximal points 16) by the end of the 5-month course at the 6th semester the mean result for the students in the intervention group was 9.7 compared with 8.1 for the control group (p = 0.03). CONCLUSION: Students ranked the Web-based ECG-interpretation programme as a useful instrument to learn ECG. Furthermore, Internet-delivered education may be more effective than traditional teaching methods due to greater immediacy, improved visualisation and interactivity.

  • 29. Nilsson, Mikael
    et al.
    Östergren, Jan
    Fors, Uno
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för data- och systemvetenskap.
    Rickenlund, Anette
    Jorfeldt, Lennart
    Caidahl, Kenneth
    Bolinder, Gunilla
    Does individual learning styles influence the choice to use a web-based ECG learning programme in a blended learning setting?2012Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 12, 5- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The compressed curriculum in modern knowledge-intensive medicine demands useful tools to achieve approved learning aims in a limited space of time. Web-based learning can be used in different ways to enhance learning. Little is however known regarding its optimal utilisation. Our aim was to investigate if the individual learning styles of medical students influence the choice to use a web-based ECG learning programme in a blended learning setting. Methods: The programme, with three types of modules (learning content, self-assessment questions and interactive ECG interpretation training), was offered on a voluntary basis during a face to face ECG learning course for undergraduate medical students. The Index of Learning Styles (ILS) and a general questionnaire including questions about computer and Internet usage, preferred future speciality and prior experience of E-learning were used to explore different factors related to the choice of using the programme or not. Results: 93 (76%) out of 123 students answered the ILS instrument and 91 the general questionnaire. 55 students (59%) were defined as users of the web-based ECG-interpretation programme. Cronbach's alpha was analysed with coefficients above 0.7 in all of the four dimensions of ILS. There were no significant differences with regard to learning styles, as assessed by ILS, between the user and non-user groups; Active/Reflective; Visual/Verbal; Sensing/Intuitive; and Sequential/Global (p = 0.56-0.96). Neither did gender, prior experience of E-learning or preference for future speciality differ between groups. Conclusion: Among medical students, neither learning styles according to ILS, nor a number of other characteristics seem to influence the choice to use a web-based ECG programme. This finding was consistent also when the usage of the different modules in the programme were considered. Thus, the findings suggest that web-based learning may attract a broad variety of medical students.

  • 30.
    Nordström, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Grysell, Tomas
    Drama as a pedagogical tool for practicing death notification-experiences from Swedish medical students2011Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 11, nr 74, 7- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: One of the toughest tasks in any profession is the deliverance of death notification. Marathon Death is an exercise conducted during the fourth year of medical school in northern Sweden to prepare students for this responsibility. The exercise is designed to enable students to gain insight into the emotional and formal procedure of delivering death notifications. The exercise is inspired by Augusto Boal's work around Forum Theatre and is analyzed using video playback. The aim of the study was to explore reflections, attitudes and ideas toward training in delivering death notifications among medical students who participate in the Marathon Death exercise based on forum play.

    Methods: After participation in the Marathon Death exercise, students completed semi-structured interviews. The transcribed interviews were analyzed using the principles of qualitative content analysis including a deductive content analysis approach with a structured matrix based on Bloom's taxonomy domains.

    Results: The Marathon Death exercise was perceived as emotionally loaded, realistic and valuable for the future professional role as a physician. The deliverance of a death notification to the next of kin that a loved one has died was perceived as difficult. The exercise conjured emotions such as positive expectations and sheer anxiety. Students perceived participation in the exercise as an important learning experience, discovering that they had the capacity to manage such a difficult situation. The feedback from the video playback of the exercise and the feedback from fellow students and teachers enhanced the learning experience.

    Conclusions: The exercise, Marathon Death, based on forum play with video playback is a useful pedagogical tool that enables students to practice delivering death notification. The ability to practice under realistic conditions contributes to reinforce students in preparation for their future professional role.

  • 31. Nordström, Anna
    et al.
    Fjellman-Wiklund, Anncristine
    Grysell, Tomas
    Uppsala universitet, Universitetsförvaltningen.
    Drama as a pedagogical tool for practicing death notification-experiences from Swedish medical students2011Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 11, 74- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: One of the toughest tasks in any profession is the deliverance of death notification. Marathon Death is an exercise conducted during the fourth year of medical school in northern Sweden to prepare students for this responsibility. The exercise is designed to enable students to gain insight into the emotional and formal procedure of delivering death notifications. The exercise is inspired by Augusto Boal's work around Forum Theatre and is analyzed using video playback. The aim of the study was to explore reflections, attitudes and ideas toward training in delivering death notifications among medical students who participate in the Marathon Death exercise based on forum play.

    Methods: After participation in the Marathon Death exercise, students completed semi-structured interviews. The transcribed interviews were analyzed using the principles of qualitative content analysis including a deductive content analysis approach with a structured matrix based on Bloom's taxonomy domains.

    Results: The Marathon Death exercise was perceived as emotionally loaded, realistic and valuable for the future professional role as a physician. The deliverance of a death notification to the next of kin that a loved one has died was perceived as difficult. The exercise conjured emotions such as positive expectations and sheer anxiety. Students perceived participation in the exercise as an important learning experience, discovering that they had the capacity to manage such a difficult situation. The feedback from the video playback of the exercise and the feedback from fellow students and teachers enhanced the learning experience.

    Conclusions: The exercise, Marathon Death, based on forum play with video playback is a useful pedagogical tool that enables students to practice delivering death notification. The ability to practice under realistic conditions contributes to reinforce students in preparation for their future professional role.

  • 32.
    Nyström, Sofia
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Dahlberg, Johanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten.
    Edelbring, Samuel
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Hult, Håkan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Debriefing practices in interprofessional simulation with students: A sociomaterial perspective2016Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, nr 148, 1-8 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The debriefing phase is an important feature of simulation activities for learning. This study applies a sociomaterial perspective on debriefing in interprofessional simulation with medical and nursing students. Sociomaterial perspectives are increasingly being used in order to understand professional practice and learning in new ways, conceptualising professional practice as being embodied, relational and situated in sociomaterial relations. The aim of the study is to explore how debriefing is carried out as a practice supporting students’ interprofessional learning.

    Methods: Eighteen debriefing sessions following interprofessional full-scale manikin-based simulation with nursing and medical students from two different universities were video-recorded and analysed collaboratively by a team of researchers, applying a structured scheme for constant comparative analysis.

    Results: The findings show how debriefing is intertwined with, and shaped by social and material relationships. Two patterns of enacting debriefing emerged. Debriefing as algorithm was enacted as a protocol-based, closed inquiry approach. Debriefing as laissez-faire was enacted as a loosely structured collegial conversation with an open inquiry approach.

    Conclusion: The findings indicate that neither an imposed structure of the debriefing, nor the lack of structure assured interprofessional collaboration to emerge as a salient topic for reflection, even though that was an explicit learning objective for the simulation. 

  • 33. Palmgren, Per J.
    et al.
    Laksov, Klara Bolander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för pedagogik och didaktik.
    Exploring chiropractic students' experiences of the educational environment in healthcare professional training: a qualitative study2015Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 15, 128Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The educational environment has a significant impact on students' behavior, sense of well-being, and academic advancement. While various research methodologies have been used to explore the educational environment, there is a paucity of studies employing qualitative research methods. This study engages in an in-depth exploration of chiropractic students' experiences of the meaning of the educational environment. Methods: A qualitative approach was employed by interviewing 26 students in four focus group interviews at two different points in time. A conventional manifest and latent content analysis was chosen to investigate and interpret the experiences of the educational environment in an undergraduate chiropractic training institution in Sweden. Results: The analysis resulted in five overarching themes: Personal growth; Being part of a community; A place of meaningfulness; Trust in a regulated system; and Scaffolding relationships. Early in the training, the meaning of the educational environment was experienced as part of a vocational community and the scaffolding of intra-institutional relationships. In later stages, the environment was experienced in terms of personal growth - balancing academic pressures and progress within the professional community - thus laying the foundations for autonomy and motivation. During the clinical training, the environment was experienced as where learning happens, thus creating a place of meaningfulness. Throughout the training, the formal and clinical environments were experienced as isolating, with little bridging between the two. A regulated system - conveying an operative organization with clear communication regarding what to expect - was experienced as important for an apt educational environment. Conclusions: We found that experiences of an educational environment are dynamic and change over time. When restructuring or evaluating curriculums, educational managers can consider the emerged themes as constituting facets relating to the educational environment, and thus possible learning conditions. Likewise, researchers can consider these aspects of the educational environment when: interpreting results from quantitative and qualitative inquiries, constructing and refining instruments, or conceptualizing and framing the educational environment phenomenon.

  • 34.
    Rautio, Arja
    et al.
    Department of Pharmacology and Toxicology, University of Oulu.
    Sunnari, Vappu
    Department of Educational Sciences and Teacher Education, University of Oulu.
    Nuutinen, Matti
    Department of Paediatrics, University of Oulu.
    Laitala, Marja
    Department of Paediatrics, University of Oulu.
    Mistreatment of university students most common during medical studies2005Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 5, nr 36Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: This study concerns the occurrence of various forms of mistreatment by staff and fellow students experienced by students in the Faculty of Medicine and the other four faculties of the University of Oulu, Finland.Methods: A questionnaire with 51 questions on various forms of physical and psychological mistreatment was distributed to 665 students (451 females) after lectures or examinations and filled in and returned. The results were analysed by gender and faculty. The differences between the males and females were assessed statistically using a test for the equality of two proportions. An exact two-sided P value was calculated using a mid-P approach to Fisher's exact test (the null hypothesis being that there is no difference between the two proportions).Results: About half of the students answering the questionnaire had experienced some form of mistreatment by staff during their university studies, most commonly humiliation and contempt (40%), negative or disparaging remarks (34%), yelling and shouting (23%), sexual harassment and other forms of gender-based mistreatment (17%) and tasks assigned as punishment (13%). The students in the Faculty of Medicine reported every form of mistreatment more commonly than those in the Faculties of Humanities, Education, Science and Technology. Experiences of mistreatment varied, but clear messages regarding its patterns were to be found in each faculty. Female students reported more instances of mistreatment than males and were more disturbed by them. Professors, lecturers and other staff in particular mistreated female students more than they mistreated males. About half of the respondents reported some form of mistreatment by their fellow students. Conclusion: Students in the Faculty of Medicine reported the greatest amount of mistreatment. If a faculty mistreats its students, its success in the main tasks of universities, research, teaching and learning, will be threatened. The results challenge university teachers, especially in faculties of medicine, to evaluate their ability to create a safe environment conducive to learning.

  • 35.
    Risberg, Gunilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Eva E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Gender awareness among physicians - the effect of speciality and gender: A study of teachers at a Swedish medical school2003Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 3, nr 8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: An important goal for medical education today is professional development including gender equality and awareness of gender issues. Are medical teachers prepared for this task? We investigated gender awareness among physician teachers, expressed as their attitudes towards the role of gender in professional relationships, and how it varied with physician gender and specialty. We discuss how this might be related to the gender climate and sex segregation in different specialties. METHOD: Questionnaires were sent to all 468 specialists in the clinical departments and in family medicine, who were engaged in educating medical students at a Swedish university. They were asked to rate, on visual analogue scales, the importance of physician and patient gender in consultation, of preceptor and student gender in clinical tutoring and of physician gender in other professional encounters. Differences between family physicians, surgical, and non-surgical hospital doctors, and between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. RESULTS: The response rate was 65 %. There were differences between specialty groups in all investigated areas mainly due to disparities among men. The odds for a male family physician to assess gender important were three times higher, and for a male non-surgical doctor two times higher when compared to a male surgical doctor. Female teachers assessed gender important to a higher degree than men. Among women there were no significant differences between specialty groups. CONCLUSIONS: There was an interaction between physician teachers' gender and specialty as to whether they identified gender as important in professional relationships. Male physicians, especially from the surgical group, assessed gender important to a significantly lower degree than female physicians. Physicians' degree of gender awareness may, as one of many factors, affect working climate and the distribution of women and men in different specialties. Therefore, to improve working climate and reduce segregation we suggest efforts to increase gender awareness among physicians, for example educational programs where continuous reflections about gender attitudes are encouraged.

  • 36.
    Risberg, Gunilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Westman, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Attitudes toward and experiences of gender issues among physician teachers: a survey study conducted at a university teaching hospital in Sweden.2008Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 26, nr 8, 10- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Gender issues are important to address during medical education, however research about the implementation of gender in medical curricula reports that there are obstacles. The aim of this study was to explore physician teachers' attitudes to gender issues.

    METHODS: As part of a questionnaire, physician teachers at Umeå University in Sweden were given open-ended questions about explanations for and asked to write examples why they found gender important or not. The 1 469 comments from the 243 respondents (78 women, 165 men) were analyzed by way of content analysis. The proportion of comments made by men and women in each category was compared.

    RESULTS: We found three themes in our analysis: Understandings of gender, problems connected with gender and approaches to gender. Gender was associated with differences between women and men regarding behaviour and disease, as well as with inequality of life conditions. Problems connected with gender included: delicate situations involving investigations of intimate body parts or sexual attraction, different expectations on male and female physicians and students, and difficulty fully understanding the experience of people of the opposite sex. The three approaches to gender that appeared in the comments were: 1) avoidance, implying that the importance of gender in professional relationships was recognized but minimized by comparing gender with aspects, such as personality and neutrality; 2) simplification, implying that gender related problems were easy to address, or already solved; and 3) awareness, implying that the respondent was interested in gender issues or had some insights in research about gender. Only a few individuals described gender as an area of competence and knowledge. There were comments from men and women in all categories, but there were differences in the relative weight for some categories. For example, recognizing gender inequities was more pronounced in the comments from women and avoidance more common in comments from men.

    CONCLUSION: The surveyed physician teachers gave many examples of gender-related problems in medical work and education, but comments describing gender as an area of competence and knowledge were few. Approaches to gender characterized by avoidance and simplification suggest that faculty development programs on gender need to address and reflect on attitudes as well as knowledge.

  • 37.
    Sjöström, Susanne
    et al.
    Karolinska Insitutet.
    Essen, Birgitta
    Uppsala Universitet.
    Gemzell-Danielsson, Kristina
    Karolinska Institutet.
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Medical students are afraid to include abortion in their future practices: in-depth interviews in Maharastra, India2016Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, nr 1, 8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Unsafe abortions are estimated to cause eight per-cent of maternal mortality in India. Lack of providers, especially in rural areas, is one reason unsafe abortions take place despite decades of legal abortion. Education and training in reproductive health services has been shown to influence attitudes and increase chances that medical students will provide abortion care services in their future practice. To further explore previous findings about poor attitudes toward abortion among medical students in Maharastra, India, we conducted in-depth interviews with medical students in their final year of education.

    METHOD:

    We used a qualitative design conducting in-depth interviews with twenty-three medical students in Maharastra applying a topic guide. Data was organized using thematic analysis with an inductive approach.

    RESULTS:

    The participants described a fear to provide abortion in their future practice. They lacked understanding of the law and confused the legal regulation of abortion with the law governing gender biased sex selection, and concluded that abortion is illegal in Maharastra. The interviewed medical students' attitudes were supported by their experiences and perceptions from the clinical setting as well as traditions and norms in society. Medical abortion using mifepristone and misoprostol was believed to be unsafe and prohibited in Maharastra. The students perceived that nurse-midwives were knowledgeable in Sexual and Reproductive Health and many found that they could be trained to perform abortions in the future.

    CONCLUSIONS:

    To increase chances that medical students in Maharastra will perform abortion care services in their future practice, it is important to strengthen their confidence and knowledge through improved medical education including value clarification and clinical training.

  • 38.
    Sjöström, Susanne
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Essén, Birgitta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Gemzell-Danielsson, Kristina
    Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Klingberg-Allvin, Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Medical students are afraid to include abortion in their future practices: in-depth interviews in Maharastra, India2016Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, 8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Unsafe abortions are estimated to cause eight per-cent of maternal mortality in India. Lack of providers, especially in rural areas, is one reason unsafe abortions take place despite decades of legal abortion. Education and training in reproductive health services has been shown to influence attitudes and increase chances that medical students will provide abortion care services in their future practice. To further explore previous findings about poor attitudes toward abortion among medical students in Maharastra, India, we conducted in-depth interviews with medical students in their final year of education.

    METHOD: We used a qualitative design conducting in-depth interviews with twenty-three medical students in Maharastra applying a topic guide. Data was organized using thematic analysis with an inductive approach.

    RESULTS: The participants described a fear to provide abortion in their future practice. They lacked understanding of the law and confused the legal regulation of abortion with the law governing gender biased sex selection, and concluded that abortion is illegal in Maharastra. The interviewed medical students' attitudes were supported by their experiences and perceptions from the clinical setting as well as traditions and norms in society. Medical abortion using mifepristone and misoprostol was believed to be unsafe and prohibited in Maharastra. The students perceived that nurse-midwives were knowledgeable in Sexual and Reproductive Health and many found that they could be trained to perform abortions in the future.

    CONCLUSIONS: To increase chances that medical students in Maharastra will perform abortion care services in their future practice, it is important to strengthen their confidence and knowledge through improved medical education including value clarification and clinical training.

  • 39.
    Skyvell Nilsson, Maria
    et al.
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care.
    Pennbrant, Sandra
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care.
    Pilhammar, Ewa
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care.
    Wenestam, Claes-Goran
    Högskolan Kristianstad, Sektionen för Lärarutbildning.
    Pedagogical strategies used in clinical medical education: an observational study2010Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 10, 9- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Clinical teaching is a complex learning situation influenced by the learning content, the setting and the participants' actions and interactions. Few empirical studies have been conducted in order to explore how clinical supervision is carried out in authentic situations. In this study we explore how clinical teaching is carried out in a clinical environment with medical students. METHODS: Following an ethnographic approach looking for meaning patterns, similarities and differences in how clinical teachers manage clinical teaching; non-participant observations and informal interviews were conducted during a four month period 2004-2005. The setting was at a teaching hospital in Sweden. The participants were clinical teachers and their 4th year medical students taking a course in surgery. The observations were guided by the aim of the study. Observational notes and notes from informal interviews were transcribed after each observation and all data material was analysed qualitatively. RESULTS: Seven pedagogical strategies were found to be applied, namely: 1) Questions and answers, 2) Lecturing, 3) Piloting, 4) Prompting, 5) Supplementing, 6) Demonstrating, and 7) Intervening. CONCLUSIONS: This study contributes to previous research in describing a repertoire of pedagogical strategies used in clinical education. The findings showed that three superordinate qualitatively different ways of teaching could be identified that fit Ramsden's model. Each of these pedagogical strategies encompass different focus in teaching; either a focus on the teacher's knowledge and behaviour or the student's behaviour and understanding. We suggest that an increased awareness of the strategies in use will increase clinical teachers' teaching skills and the consequences they will have on the students' ability to learn. The pedagogical strategies need to be considered and scrutinized in further research in order to verify their impact on students' learning.

  • 40.
    Skyvell Nilsson, Maria
    et al.
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för vårdvetenskap på grundnivå.
    Pennbrant, Sandra
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för vårdvetenskap på avancerad nivå.
    Pilhammar, Ewa
    University of Gothenburg.
    Wenestam, Claes-Göran
    Kristianstad University College, School of Teacher Education.
    Pedagogical Strategies Used in Clinical Medical Education: An Observational Study2010Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 10, nr 9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:  Clinical teaching is a complex learning situation influenced by the learning content, the setting and the participants' actions and interactions. Few empirical studies have been conducted in order to explore how clinical supervision is carried out in authentic situations. In this study we explore how clinical teaching is carried out in a clinical environment with medical students.

    Methods:  Following an ethnographic approach looking for meaning patterns, similarities and differences in how clinical teachers manage clinical teaching; non-participant observations and informal interviews were conducted during a four month period 2004-2005. The setting was at a teaching hospital in Sweden. The participants were clinical teachers and their 4th year medical students taking a course in surgery. The observations were guided by the aim of the study. Observational notes and notes from informal interviews were transcribed after each observation and all data material was analysed qualitatively.

    Results:  Seven pedagogical strategies were found to be applied, namely: 1) Questions and answers, 2) Lecturing, 3) Piloting, 4) Prompting, 5) Supplementing, 6) Demonstrating, and 7) Intervening.

    Conclusions:  This study contributes to previous research in describing a repertoire of pedagogical strategies used in clinical education. The findings showed that three superordinate qualitatively different ways of teaching could be identified that fit Ramsden's model. Each of these pedagogical strategies encompass different focus in teaching; either a focus on the teacher's knowledge and behaviour or the student's behaviour and understanding. We suggest that an increased awareness of the strategies in use will increase clinical teachers' teaching skills and the consequences they will have on the students' ability to learn. The pedagogical strategies need to be considered and scrutinized in further research in order to verify their impact on students' learning.

  • 41.
    Thor, Johan
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Karolinska institutet.
    Olsson, Daniel
    Karolinska institutet.
    Nordenström, Jörgen
    Karolinska institutet.
    The design, fate and impact of a hospital-wide training program in evidence-based medicine for physicians: An observational study2016Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, 86Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Many doctors fail to practice Evidence-Based Medicine (EBM) effectively, in part due to insufficient training. We report on the design, fate and impact of a short learner-centered EBM train-the-trainer program aimed at all 2400 doctors at the Karolinska University Hospital in Sweden on the heels of a tumultuous merger, focusing particularly on whether it affected the doctors' knowledge, attitudes and skills regarding EBM. 

    Methods: We used a validated EBM instrument in a before-and-after design to assess the impact of the training. Changes in responses were analyzed at the individual level using the Wilcoxon matched pairs test. We also reviewed documentation from the program - including the modular EBM training schedule and the template for participants' Critically Appraised Topic reports - to describe the training's content, design, conduct, and fate. 

    Results: The training, designed to be delivered in modules of 45 min totaling 1.5 days, failed to reach most doctors at the hospital, due to cost cutting pressures and competing demands. Among study participants (n = 174), many reported suboptimal EBM knowledge and skills before the training. Respondents' strategies for solving clinical problems changed after the training: the proportion of respondents reporting to use (or intend to use) secondary sources "Often/very often" changed from 5 % before the training to 76 % after the training; in parallel, reliance on textbooks and on colleagues fell (48 to 23 % and 79 to 65 %, respectively). Participants' confidence in assessing scientific articles increased and their attitudes toward EBM became more positive. The proportion of correct answers in the EBM knowledge test increased from 52 to 71 %. All these changes were statistically significant at p < 0.05. 

    Conclusions: Many study participants, despite working at a university hospital, lacked basic EBM knowledge and skills and used the scientific literature suboptimally. The kind of short learner-centered EBM training evaluated here brought significant improvements among the minority of hospital doctors who were able to participate and, if applied widely, could contribute to better, safer and more cost-effective care.

  • 42.
    Wahlgren, Carl-Fredrik
    et al.
    Karolinska Institutet.
    Edelbring, Samuel
    Karolinska Institutet.
    Fors, Uno GH
    Karolinska Institutet.
    Hindbeck, Hans
    Karolinska Institutet.
    Ståhle, Mona
    Karolinska Institutet.
    Evaluation of an interactive case simulation system in dermatology and venereology for medical students2006Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 6, nr 40Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Most of the many computer resources used in clinical teaching of dermatology and venereology for medical undergraduates are information-oriented and focus mostly on finding a "correct" multiple-choice alternative or free-text answer. We wanted to create an interactive computer program, which facilitates not only factual recall but also clinical reasoning.

    Methods

    Through continuous interaction with students, a new computerised interactive case simulation system, NUDOV, was developed. It is based on authentic cases and contains images of real patients, actors and healthcare providers. The student selects a patient and proposes questions for medical history, examines the skin, and suggests investigations, diagnosis, differential diagnoses and further management. Feedback is given by comparing the user's own suggestions with those of a specialist. In addition, a log file of the student's actions is recorded. The program includes a large number of images, video clips and Internet links. It was evaluated with a student questionnaire and by randomising medical students to conventional teaching (n = 85) or conventional teaching plus NUDOV (n = 31) and comparing the results of the two groups in a final written examination.

    Results

    The questionnaire showed that 90% of the NUDOV students stated that the program facilitated their learning to a large/very large extent, and 71% reported that extensive working with authentic computerised cases made it easier to understand and learn about diseases and their management. The layout, user-friendliness and feedback concept were judged as good/very good by 87%, 97%, and 100%, respectively. Log files revealed that the students, in general, worked with each case for 60–90 min. However, the intervention group did not score significantly better than the control group in the written examination.

    Conclusion

    We created a computerised case simulation program allowing students to manage patients in a non-linear format supporting the clinical reasoning process. The student gets feedback through comparison with a specialist, eliminating the need for external scoring or correction. The model also permits discussion of case processing, since all transactions are stored in a log file. The program was highly appreciated by the students, but did not significantly improve their performance in the written final examination.

  • 43.
    Westin, Lars
    et al.
    Univ Skovde, Sch Hlth & Educ, Skovde, Sweden.
    Sundler, Annelie J.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Univ Skovde, Sch Hlth & Educ, Skovde, Sweden.
    Berglund, Mia
    Univ Skovde, Sch Hlth & Educ, Skovde, Sweden.
    Students' experiences of learning in relation to didactic strategies during the first year of a nursing programme: a qualitative study2015Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 15, 49Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In university undergraduate nursing programmes, didactic strategies that enable students to learn nursing skills, solve problems and develop reflective and critical thinking and practice are needed. The aim of this study was to explore how different didactic strategies support nursing students' experiences of learning during the first year of a reconstructed nursing curriculum. Methods: This study employed a qualitative approach. The data were gathered through written narratives that were analysed using qualitative content analysis. Results: Nursing students' experiences of learning through different didactic strategies, were evident in the text. These perspectives were organised into the following themes: To focus on the patient perspective and paying more attention to others, Learning from discussions and reflections on one's own learning, Training for the professional role and becoming more courage, and Gaining insights into nursing and increasing one's self-awareness. The education increased the students' self-awareness, which helped them to pay greater attention to patients and their relative. During the learning process, the students became more courageous, reflected and discovered their shortcomings. Conclusion: Stated didactic strategies supported a broad base of knowledge on nursing and the professional role of nurses. Educators are challenged to strengthen meaningful learning in nursing and to facilitate the progression of nursing programmes.

  • 44.
    Westin, Lars
    et al.
    Högskolan i Skövde, Institutionen för hälsa och lärande. Högskolan i Skövde, Forskningsspecialiseringen Hälsa och Lärande.
    Sundler, Annelie Johansson
    Högskolan i Skövde, Institutionen för hälsa och lärande. Högskolan i Skövde, Forskningsspecialiseringen Hälsa och Lärande. School of Health, Care and Social Welfare, Mälardalens University, Västerås, Sweden.
    Berglund, Mia
    Högskolan i Skövde, Institutionen för hälsa och lärande. Högskolan i Skövde, Forskningsspecialiseringen Hälsa och Lärande.
    Students' experiences of learning in relation to didactic strategies during the first year of a nursing programme: a qualitative study2015Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 15, 49Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    In university undergraduate nursing programmes, didactic strategies that enable students to learn nursing skills, solve problems and develop reflective and critical thinking and practice are needed. The aim of this study was to explore how different didactic strategies support nursing students’ experiences of learning during the first year of a reconstructed nursing curriculum.

    Methods

    This study employed a qualitative approach. The data were gathered through written narratives that were analysed using qualitative content analysis.

    Results

    Nursing students’ experiences of learning through different didactic strategies, were evident in the text. These perspectives were organised into the following themes: To focus on the patient perspective and paying more attention to others, Learning from discussions and reflections on one’s own learning, Training for the professional role and becoming more courage, and Gaining insights into nursing and increasing one’s self-awareness. The education increased the students’ self-awareness, which helped them to pay greater attention to patients and their relative. During the learning process, the students became more courageous, reflected and discovered their shortcomings.

    Conclusion

    Stated didactic strategies supported a broad base of knowledge on nursing and the professional role of nurses. Educators are challenged to strengthen meaningful learning in nursing and to facilitate the progression of nursing programmes.

  • 45. Westin, Lars
    et al.
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Berglund, Mia
    Students' experiences of learning in relation to didactic strategies during the first year of a nursing programme: a qualitative study.2015Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 15Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In university undergraduate nursing programmes, didactic strategies that enable students to learn nursing skills, solve problems and develop reflective and critical thinking and practice are needed. The aim of this study was to explore how different didactic strategies support nursing students' experiences of learning during the first year of a reconstructed nursing curriculum.

    METHODS: This study employed a qualitative approach. The data were gathered through written narratives that were analysed using qualitative content analysis.

    RESULTS: Nursing students' experiences of learning through different didactic strategies, were evident in the text. These perspectives were organised into the following themes: To focus on the patient perspective and paying more attention to others, Learning from discussions and reflections on one's own learning, Training for the professional role and becoming more courage, and Gaining insights into nursing and increasing one's self-awareness. The education increased the students' self-awareness, which helped them to pay greater attention to patients and their relative. During the learning process, the students became more courageous, reflected and discovered their shortcomings.

    CONCLUSION: Stated didactic strategies supported a broad base of knowledge on nursing and the professional role of nurses. Educators are challenged to strengthen meaningful learning in nursing and to facilitate the progression of nursing programmes.

  • 46.
    Wijma, Barbro
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Zbikowski, Anke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Ryhov County Hospital, Sweden.
    Brüggemann, Jelmer
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Silence, shame and abuse in health care: theoretical development on basis of an intervention project among staff2016Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, nr 75Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    As health care exists to alleviate patients suffering it is unacceptable that it inflicts unnecessary suffering on patients. We therefore have developed and evaluated a drama pedagogical model for staff interventions using Forum Play, focusing on staffs experiences of failed encounters where they have perceived that the patient felt abused. In the current paper we present how our preliminary theoretical framework of intervening against abuse in health care developed and was revised during this intervention. During and after the intervention, five important lessons were learned and incorporated in our present theoretical framework. First, a Forum Play intervention may break the silence culture that surrounds abuse in health care. Second, organizing staff training in groups was essential and transformed abuse from being an individual problem inflicting shame into a collective responsibility. Third, initial theoretical concepts "moral resources" and "the vicious violence triangle" proved valuable and became useful pedagogical tools during the intervention. Four, the intervention can be understood as having strengthened staffs moral resources. Five, regret appeared to be an underexplored resource in medical training and clinical work. The occurrence of abuse in health care is a complex phenomenon and the research area is in need of theoretical understanding. We hope this paper can inspire others to further develop theories and interventions in order to counteract abuse in health care.

  • 47.
    Wilhelmsson, Margareta
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Ponzer, Sari
    Karolinska Institute, Stockholm.
    Dahlgren, Lars-Ove
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för studier av vuxenutbildning, folkbildning och högre utbildning (VUFo). Linköpings universitet, Utbildningsvetenskap.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Folkhälsovetenskapligt centrum.
    Faresjö, Tomas
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Are female students in general and nursing students more ready for teamwork and interprofessional collaboration in healthcare?2011Ingår i: BMC Medical Education, ISSN 1472-6920, Vol. 11, nr 15Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Interprofessional Education (IPE) is now spreading worldwide and many universities are now including IPE in their curricula. The aim of this study was to investigate whether or not such student characteristics as gender, previous working experience in healthcare, educational progress and features of the learning environment, such as educational programmes and curriculum design, have an impact on their open-mindedness about co-operation with other professions. Methods: Medical and nursing students at two Swedish universities were invited to fill in the Readiness for Interprofessional Learning Scale (RIPLS). Totally, 955 students were invited and 70.2% (n = 670) participated in the study. A factor analysis of the RIPLS revealed four item groupings (factors) for our empirical data, but only one had sufficient internal consistency. This factor was labelled "Team Player". Results: Regardless of the educational programme, female students were more positive to teamwork than male students. Nursing students in general displayed more positive beliefs about teamwork and collaboration than medical students. Exposure to different interprofessional curricula and previous exposure to interprofessional education were only to a minor extent associated with a positive attitude towards teamwork. Educational progress did not seem to influence these beliefs. Conclusions: The establishment of interprofessional teamwork is a major challenge for modern healthcare. This study indicates some directions for more successful interprofessional education. Efforts should be directed at informing particularly male medical students about the need for teamwork in modern healthcare systems. The results also imply that study of other factors, such as the students personality, is needed for fully understanding readiness for teamwork and interprofessional collaboration in healthcare. We also believe that the RIPL Scale still can be further adjusted.

  • 48.
    Wu, Xi Vivien
    et al.
    Högskolan i Jönköping, Hälsohögskolan. National University of Singapore.
    Enskär, Karin
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD.
    Pua, Lay Hoon
    Tan Tock Seng Hospital, Singapore.
    Heng, Doreen Gek Noi
    National University Hospital, Singapore.
    Wang, Wenru
    National University of Singapore.
    Development and psychometric testing of Holistic Clinical Assessment Tool (HCAT) for undergraduate nursing students2016Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, 1-9 s., 248Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:A major focus in nursing education is on the judgement of clinical performance, and it is a complexprocess due to the diverse nature of nursing practice. A holistic approach in assessment of competency is advocated.Difficulties in the development of valid and reliable assessment measures in nursing competency have resulted in thedevelopment of assessment instruments with an increase in face and content validity, but few studies have testedthese instruments psychometrically. It is essential to develop a holistic assessment tool to meet the needs of the clinicaleducation. The study aims to develop a Holistic Clinical Assessment Tool (HCAT) and test its psychometric properties.

    Methods:The HCAT was developed based on the systematic literature review and the findings of qualitative studies.An expert panel was invited to evaluate the content validity of the tool. A total of 130 final-year nursing undergraduatestudents were recruited to evaluate the psychometric properties (i.e. factor structure, internal consistency and test-retestreliability) of the tool.

    Results:The HCAT has good content validity with content validity index of .979. The exploratory factor analysis revealsa four-factor structure of the tool. The internal consistency and test-retest reliability of the HCAT are satisfactory withCronbach alpha ranging from .789 to .965 and Intraclass Correlation Coefficient ranging from .881 to .979 for the foursubscales and total scale.

    Conclusions:HCAT has the potential to be used as a valid measure to evaluate clinical competence in nursingstudents, and provide specific and ongoing feedback to enhance the holistic clinical learning experience. In addition,HCAT functions as a tool for self-reflection, peer-assessment and guides preceptors in clinical teaching and assessment.

  • 49.
    Zetterqvist, Ann
    et al.
    University of Gothenburg, Sweden.
    Aronsson, Patrik
    University of Gothenburg, Sweden.
    Hägg, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk farmakologi.
    Kjellgren, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Reis, Margareta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten.
    Tobin, Gunnar
    University of Gothenburg, Sweden.
    Booth, Shirley
    University of Gothenburg, Sweden; University of Witwatersrand, South Africa.
    On the pedagogy of pharmacological communication: a study of final semester health science students2015Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 15Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is a need to improve design in educational programmes for the health sciences in general and in pharmacology specifically. The objective of this study was to investigate and problematize pharmacological communication in educational programmes for the health sciences. Methods: An interview study was carried out where final semester students from programmes for the medical, nursing and specialist nursing in primary health care professions were asked to discuss the pharmacological aspects of two written case descriptions of the kind they would meet in their everyday work. The study focused on the communication they envisaged taking place on the concerns the patients were voicing, in terms of two features: how communication would take place and what would be the content of the communication. A phenomenographic research approach was used. Results: The results are presented as outcome spaces, sets of categories that describe the variation of ways in which the students voiced their understanding of communication in the two case descriptions and showed the qualitatively distinct ways in which the features of communication were experienced. Conclusions: The results offer a base of understanding the students perspectives on communication that they will take with them into their professional lives. We indicate that there is room for strengthening communication skills in the field of pharmacology, integrating them into programmes of education, by more widely implementing a problem-based, a case-oriented or role-playing pedagogy where final year students work across specialisations and there is a deliberate effort to evoke and assess advanced conceptions and skills.

  • 50.
    Öhman, Eva
    et al.
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Alinaghizadeh, Hassan
    Karolinska Institute, Sweden.
    Kaila, Paivi
    Karolinska Institute, Sweden.
    Hult, Håkan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Nilsson, Gunnar H.
    Karolinska Institute, Sweden.
    Salminen, Helena
    Karolinska Institute, Sweden.
    Adaptation and validation of the instrument Clinical Learning Environment and Supervision for medical students in primary health care2016Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, 308Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Clinical learning takes place in complex socio-cultural environments that are workplaces for the staff and learning places for the students. In the clinical context, the students learn by active participation and in interaction with the rest of the community at the workplace. Clinical learning occurs outside the university, therefore is it important for both the university and the student that the student is given opportunities to evaluate the clinical placements with an instrument that allows evaluation from many perspectives. The instrument Clinical Learning Environment and Supervision (CLES) was originally developed for evaluation of nursing students clinical learning environment. The aim of this study was to adapt and validate the CLES instrument to measure medical students perceptions of their learning environment in primary health care. Methods: In the adaptation process the face validity was tested by an expert panel of primary care physicians, who were also active clinical supervisors. The adapted CLES instrument with 25 items and six background questions was sent electronically to 1,256 medical students from one university. Answers from 394 students were eligible for inclusion. Exploratory factor analysis based on principal component methods followed by oblique rotation was used to confirm the adequate number of factors in the data. Construct validity was assessed by factor analysis. Confirmatory factor analysis was used to confirm the dimensions of CLES instrument. Results: The construct validity showed a clearly indicated four-factor model. The cumulative variance explanation was 0.65, and the overall Cronbachs alpha was 0.95. All items loaded similarly with the dimensions in the non-adapted CLES except for one item that loaded to another dimension. The CLES instrument in its adapted form had high construct validity and high reliability and internal consistency. Conclusion: CLES, in its adapted form, appears to be a valid instrument to evaluate medical students perceptions of their clinical learning environment in primary health care.

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