Clinical reasoning: What do nurses, physicians, and students reason about.

Clinical reasoning is a core ability in the health professions, but the term is conceptualised in multiple ways within and across professions. For interprofessional teamwork it is indispensable to recognise the differences in understanding between professions. Therefore, our aim was to investigate how nurses, physicians, and medical and nursing students define clinical reasoning. We conducted 43 semi-structured interviews with an interprofessional group from six countries and qualitatively analysed their definitions of clinical reasoning based on a coding guide. Our results showed similarities across professions, such as the emphasis on clinical skills as part of clinical reasoning. But we also revealed differences, such as a more patient-centered view and a broader understanding of the clinical reasoning concept in nurses and nursing students. The explicit sharing and discussion of differences in the understanding of clinical reasoning across health professions can provide valuable insights into the perspectives of different team members on clinical practice and education. This understanding may lead to improved interprofessional collaboration, and our study's categories and themes can serve as a basis for such discussions.

The use of video in standardized patient training to improve portrayal accuracy: A randomized post-test control group study.

INTRODUCTION: High-stake objective structured clinical examinations (OSCEs) with standardized patients (SPs) should offer the same conditions to all candidates throughout the exam. SP performance should therefore be as close to the original role script as possible during all encounters. In this study, we examined the impact of video in SP training on SPs' role accuracy, investigating how the use of different types of video during SP training improves the accuracy of SP portrayal. METHODS: In a randomized post-test, control group design three groups of 12 SPs each with different types of video training and one control group of 12 SPs without video use in SP training were compared. The three intervention groups used role-modeling video, performance-feedback video, or a combination of both. Each SP from each group had four students encounter. Two blinded faculty members rated the 192 video-recorded encounters, using a case-specific rating instrument to assess SPs' role accuracy. RESULTS: SPs trained by video showed significantly (p < 0.001) better role accuracy than SPs trained without video over the four sequential portrayals. There was no difference between the three types of video training. DISCUSSION: Use of video during SP training enhances the accuracy of SP portrayal compared with no video, regardless of the type of video intervention used.

Validity evidence and reliability of a simulated patient feedback instrument.

BACKGROUND: In the training of healthcare professionals, one of the advantages of communication training with simulated patients (SPs) is the SP's ability to provide direct feedback to students after a simulated clinical encounter. The quality of SP feedback must be monitored, especially because it is well known that feedback can have a profound effect on student performance. Due to the current lack of valid and reliable instruments to assess the quality of SP feedback, our study examined the validity and reliability of one potential instrument, the 'modified Quality of Simulated Patient Feedback Form' (mQSF). METHODS: Content validity of the mQSF was assessed by inviting experts in the area of simulated clinical encounters to rate the importance of the mQSF items. Moreover, generalizability theory was used to examine the reliability of the mQSF. Our data came from videotapes of clinical encounters between six simulated patients and six students and the ensuing feedback from the SPs to the students. Ten faculty members judged the SP feedback according to the items on the mQSF. Three weeks later, this procedure was repeated with the same faculty members and recordings. RESULTS: All but two items of the mQSF received importance ratings of > 2.5 on a four-point rating scale. A generalizability coefficient of 0.77 was established with two judges observing one encounter. CONCLUSIONS: The findings for content validity and reliability with two judges suggest that the mQSF is a valid and reliable instrument to assess the quality of feedback provided by simulated patients.

Effects of communication training on real practice performance: a role-play module versus a standardized patient module.

This study investigated the effectiveness of modules involving standardized patients and role-plays on training communication skills. The first module involved standardized patients and an Objective Structured Clinical Examination (OSCE); the second module consisted of peer role-plays and a written examination. A randomized posttest-only control group design with first-year nursing students was used. The intervention group received one-to-one communication training with direct oral feedback from the standardized patient. The control group had training with peer role-playing and mutual feedback. The posttest involved students' rating their self-efficacy, and real patients and clinical supervisors evaluated their communication skills. No significant differences were found between self-efficacy and patient ratings. However, the clinical supervisors rated the intervention group's communication skills to be significantly (p < 0.0001) superior. Assessments by clinical supervisors indicate that communication training modules including standardized patients and an OSCE are superior to communication training modules with peer role-playing.

[Teaching Interprofessional Patient Pathways in Medical Education in Switzerland - A Collaboration of Multiple Players]. / Lehrveranstaltung zu interprofessionellen Versorgungsketten in der Schweiz.

Teaching Interprofessional Patient Pathways in Medical Education in Switzerland - A Collaboration of Multiple Players Abstract. The increase of chronic and complex medical disorders challenges actors in the health care system and affects the entire health care system in Switzerland. Through an interprofessional exchange between medical and health care professionals, the individual needs of patients can be better addressed, which has a positive impact on patients' treatments. To prepare students of the Bachelor of Medicine at ETH Zurich for these challenges, the ETH has designed a specific course together with four educational institutions, which is oriented towards the interprofessional, patient-centred supply chain. The aim of this interprofessional module is, that Bachelor of Medicine students, as well as Pharmacy and Nursing students, acquire knowledge about the other areas of responsibility and competences, and at the same time get to know the interfaces of interprofessional cooperations.

[Interprofessional Training for Discharge Planning: Effects of Self-Efficacy in Nursing and Medical Students]. / Interprofessionelle Schulung für die Spital-Austrittsplanung: Effekte der Selbstwirksamkeit bei Pflege- und Medizinstudierenden.

Interprofessional Training for Discharge Planning: Effects of Self-Efficacy in Nursing and Medical Students Abstract. Concordant and methodical briefing about a patient's disposition for discharge from hospital within the interprofessional ward round can facilitate a timely discharge. However, interprofessional ward rounds require not only professional skills but also knowledge of interprofessional cooperation between all the occupational groups involved. The question arose whether students of the various professions could learn the necessary competencies during their studies. To this end, a training course on interprofessional discharge planning was developed for nursing and medical students. The training includes four phases consisting of flipped classroom and interprofessional skills training. After each phase, a questionnaire was distributed to assess the self-efficacy of participating nursing and medical students regarding their interprofessional collaboration skills. The results showed that self-efficacy increased steadily with increasing study duration from phase 1 to 4. The study also shows that despite the differences between nursing and medical school curricula, students' self-efficacy regarding interprofessional collaboration skills increased during the IAVI training, which strongly suggests that they benefited from the training.

Learning in virtual space: an intergenerational pilot project.

Introduction: More and more educational institutions are discovering the advantages of settings for digital teaching and learning and the technology of virtual reality (VR). This also holds true for the BZ Pflege in the field of continuing education with age-heterogeneous groups of participants. The question arises whether baby-boomers and X and Y generation learners accept, understand and perceive the digital form of learning with VR glasses as beneficial for their learning. Project description: A course has been developed with the goal of teaching the anatomy of the heart by immersive visualisation. A questionnaire was used to determine how the use of VR glasses influenced participants` learning, acceptance, understanding and cognitive load. Results: The participants reacted positively to the VR technology. The new learning technology did not lead to cognitive overload. Participants indicated that they were able to link new knowledge with already existing knowledge. They also found the VR glasses easy to use. Conclusion: From the perspective of participants and project management alike, it can be said that age- heterogeneous groups present no obstacle for new innovative teaching methods, such as the use of VR glasses.

Standardized Patients' Perspectives on Workplace Satisfaction and Work-Related Relationships: A Multicenter Study.

INTRODUCTION: The use of standardized patients (SPs) in health care education has grown in the last 50 years. In addition, the requirements for SPs have increased steadily, and thus, the work of SPs has become more difficult and demanding. It has been claimed that SP programs are highly contextualized, having emerged from local, institutional, professional, and national conditions, but their effects on SPs have not been investigated. We have studied the effects of this job development on SPs and their programs. METHODS: The study was conducted using a qualitative research design, with semistructured individual in-depth interviews to understand the reactions, values, and perceptions that underlie and influence SP behavior. To cover SP perspectives from more than 1 SP program, a total of 15 SPs from 8 different nursing schools and medical schools in Switzerland were asked to participate. RESULTS: Standardized patients feel motivated, engaged, and willing to invest effort in their task and do not mind demands increasing as long as the social environment in SP programs is supportive. The role of the SP trainer and the use of feedback are considered very important. CONCLUSIONS: Standardized patient programs require concepts in which the SP perspective has been integrated to better serve SPs' well-being. Standardized patients are valuable partners in the training of health professionals-we need to take care of them.

The Conversion of a Peer Teaching Course in the Puncture of Peripheral Veins for Medical Students into an Interprofessional Course.

OBJECTIVE: There is a great interest on both a national and international level in promoting cooperation between different occupational groups within the healthcare professions through interprofessional education (IPE) [1], [2], [3]. Within this project, a peer teaching course on the puncture of peripheral veins was therefore converted from a course for medical students into an IPE learning unit. Students from different occupational groups were to learn within the context of this course, according to the definition from the World Health Organisation (WHO), with and from each other [1]. PROJECT DESCRIPTION: This course constituted a small group class in the peer teaching format. The didactic principle was based on the idea that the students were to practice the respective practical skills in pairs and give each other reciprocal feedback. Together with the Department for Health at the Bern University of Applied Sciences (BUAS) and the Bern Center of Higher Education of Nusing (BCHEN), the course, which was conducted by the Institute of Medical Education at the University of Bern (IME), was converted into a voluntary IPE pilot project. Students from all three institutions were represented in terms of participants as well as tutors. RESULTS: The course was evaluated very positively by participants, peer tutors and the participating institutions. By means of an OSCE, it could be proven that the course content had been successfully imparted. On the basis of these results, it was determined that the course should be compulsory in the future for students at all three institutions. DISCUSSION: The evaluation results show the successful conversion of the course into an IPE format within the context of the pilot project. The interactive format of the course created the prerequisite that the students from different professional groups learned with and from each other in actuality, and did not just study the same objectives at the same time as with multiprofessional learning. Cooperation between the three institutions is a cornerstone for the development of a research structure which may examine the effect of IPE in the future.

Interprofessional education in anatomy: Learning together in medical and nursing training.

Teamwork and the interprofessional collaboration of all health professions are a guarantee of patient safety and highly qualified treatment in patient care. In the daily clinical routine, physicians and nurses must work together, but the education of the different health professions occurs separately in various places, mostly without interrelated contact. Such training abets mutual misunderstanding and cements professional protectionism, which is why interprofessional education can play an important role in dismantling such barriers to future cooperation. In this article, a pilot project in interprofessional education involving both medical and nursing students is presented, and the concept and the course of training are described in detail. The report illustrates how nursing topics and anatomy lectures can be combined for interprofessional learning in an early phase of training. Evaluation of the course showed that the students were highly satisfied with the collaborative training and believed interprofessional education (IPE) to be an important experience for their future profession and understanding of other health professionals. The results show that the IPE teaching concept, which combines anatomy and nursing topics, provides an optimal setting for learning together and helps nurses and doctors in training to gain knowledge about other health professionals' roles, thus evolving mutual understanding.

[The costs of new drugs compared to current standard treatment]. / Die Preise neuer Arzneimittel im Vergleich zu ihren therapeutischen Alternativen.

BACKGROUND: Until AMNOG came into effect Germany had free pricing of new drugs. Our exemplary work investigates the costs of new drugs that were licensed in the two years prior to AMNOG, and compares them to the costs of standard treatment that has been used in pivotal trials. Also, the important components of pharmaceutical prices will be illustrated. METHOD: We retrospectively analysed the European Public Assessment Reports of proprietary medicinal products that the European Medicinal Agency initially approved in 2009 and 2010 and that were tested against an active control in at least one pivotal trial. RESULTS: If the standard treatment was a generic, the average pharmacy retail price of new drugs was 7.4 times (median 7.1) higher than that of standard treatment. If the standard treatment was an originator drug the average price was 1.4 times (median 1.2) higher than that of the new drug. There was no clear correlation of an increase in costs for new drugs and their "grade of innovation" as rated according to the criteria of Fricke. Our study shows that prices of new drugs must be linked to the evidence of comparative benefit; since German drug pricing is complex, cost saving effects obtained thereby will depend on a range of other rules and decisions.

New drugs: evidence relating to their therapeutic value after introduction to the market.

BACKGROUND: Drug approval is based on three criteria: quality, efficacy, and safety. We investigated the types of study design and statistical methods employed to demonstrate safety and efficacy of proprietary medicinal products (PMPs) that were approved for use in the European Union through the centralized procedure. METHODS: We retrospectively analyzed the European Public Assessment Reports of PMPs that the European Medicinal Agency approved, either initially or for extended indications, in 2009 and 2010. RESULTS: Data were analyzed for 39 PMPs: 64% of these were new active substances, and 36% were approved for extended indications. 46% of the PMPs had been studied in an active-control trial. In only 28%, superiority of the new PMPs compared to active control had been tested. 46% of the approvals included testing of a patient-relevant primary endpoint. The median size of population used to demonstrate safety was 1700 persons. CONCLUSION: The centralized procedure does not require comparative information from active-control trials. Accordingly, as our descriptive analysis revealed, this information is often not available at the time of market introduction. Pivotal studies only rarely clearly demonstrate an added therapeutic value of a new PMP compared to existing alternatives.