Why is it so difficult to implement a longitudinal clinical reasoning curriculum? A multicenter interview study on the barriers perceived by European health professions educators
Background Effective clinical reasoning is a core competency of health professionals that is necessary to assure patients' safety. Unfortunately, adoption of longitudinal clinical reasoning curricula is still infrequent. This study explores the barriers that hinder the explicit teaching of clin...
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| Veröffentlicht in: | BMC medical education 2021-11, Vol.21 (1), p.1-575, Article 575 |
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| creator | Sudacka, Małgorzata Adler, Martin Durning, Steven J. Edelbring, Samuel Frankowska, Ada Hartmann, Daniel Hege, Inga Huwendiek, Sören Sobočan, Monika Thiessen, Nils Wagner, Felicitas L. Kononowicz, Andrzej A. |
| description | Background Effective clinical reasoning is a core competency of health professionals that is necessary to assure patients' safety. Unfortunately, adoption of longitudinal clinical reasoning curricula is still infrequent. This study explores the barriers that hinder the explicit teaching of clinical reasoning from a new international perspective. Methods The context of this study was a European project whose aim is to develop a longitudinal clinical reasoning curriculum. We collected data in semi-structured interviews with responders from several European countries who represent various health professions and have different backgrounds, roles and experience. We performed a qualitative content analysis of the gathered data and constructed a coding frame using a combined deductive/inductive approach. The identified themes were validated by parallel coding and in group discussions among project members. Results A total of 29 respondents from five European countries participated in the interviews; the majority of them represent medicine and nursing sciences. We grouped the identified barriers into eight general themes: Time, Culture, Motivation, Clinical Reasoning as a Concept, Teaching, Assessment, Infrastructure and Others. Subthemes included issues with discussing errors and providing feedback, awareness of clinical reasoning teaching methods, and tensions between the groups of professionals involved. Conclusions This study provides an in-depth analysis of the barriers that hinder the teaching of explicit clinical reasoning. The opinions are presented from the perspective of several European higher education institutions. The identified barriers are complex and should be treated holistically due to the many interconnections between the identified barriers. Progress in implementation is hampered by the presence of reciprocal causal chains that aggravate this situation. Further research could investigate the perceptual differences between health professions regarding the barriers to clinical reasoning. The collected insights on the complexity and diversity of these barriers will help when rolling out a long-term agenda for overcoming the factors that inhibit the implementation of clinical reasoning curricula. Keywords: Clinical reasoning, Teaching clinical reasoning, Barriers, Health professions education, Interview study |
| doi_str_mv | 10.1186/s12909-021-02960-w |
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A multicenter interview study on the barriers perceived by European health professions educators</title><source>PMC (PubMed Central)</source><source>DOAJ Directory of Open Access Journals</source><source>SWEPUB Freely available online</source><source>EZB Electronic Journals Library</source><source>SpringerLink Journals - AutoHoldings</source><source>PubMed Central Open Access</source><source>Springer Nature OA Free Journals</source><creator>Sudacka, Małgorzata ; Adler, Martin ; Durning, Steven J. ; Edelbring, Samuel ; Frankowska, Ada ; Hartmann, Daniel ; Hege, Inga ; Huwendiek, Sören ; Sobočan, Monika ; Thiessen, Nils ; Wagner, Felicitas L. ; Kononowicz, Andrzej A.</creator><creatorcontrib>Sudacka, Małgorzata ; Adler, Martin ; Durning, Steven J. ; Edelbring, Samuel ; Frankowska, Ada ; Hartmann, Daniel ; Hege, Inga ; Huwendiek, Sören ; Sobočan, Monika ; Thiessen, Nils ; Wagner, Felicitas L. ; Kononowicz, Andrzej A.</creatorcontrib><description>Background Effective clinical reasoning is a core competency of health professionals that is necessary to assure patients' safety. Unfortunately, adoption of longitudinal clinical reasoning curricula is still infrequent. This study explores the barriers that hinder the explicit teaching of clinical reasoning from a new international perspective. Methods The context of this study was a European project whose aim is to develop a longitudinal clinical reasoning curriculum. We collected data in semi-structured interviews with responders from several European countries who represent various health professions and have different backgrounds, roles and experience. We performed a qualitative content analysis of the gathered data and constructed a coding frame using a combined deductive/inductive approach. The identified themes were validated by parallel coding and in group discussions among project members. Results A total of 29 respondents from five European countries participated in the interviews; the majority of them represent medicine and nursing sciences. We grouped the identified barriers into eight general themes: Time, Culture, Motivation, Clinical Reasoning as a Concept, Teaching, Assessment, Infrastructure and Others. Subthemes included issues with discussing errors and providing feedback, awareness of clinical reasoning teaching methods, and tensions between the groups of professionals involved. Conclusions This study provides an in-depth analysis of the barriers that hinder the teaching of explicit clinical reasoning. The opinions are presented from the perspective of several European higher education institutions. The identified barriers are complex and should be treated holistically due to the many interconnections between the identified barriers. Progress in implementation is hampered by the presence of reciprocal causal chains that aggravate this situation. Further research could investigate the perceptual differences between health professions regarding the barriers to clinical reasoning. The collected insights on the complexity and diversity of these barriers will help when rolling out a long-term agenda for overcoming the factors that inhibit the implementation of clinical reasoning curricula. Keywords: Clinical reasoning, Teaching clinical reasoning, Barriers, Health professions education, Interview study</description><identifier>ISSN: 1472-6920</identifier><identifier>EISSN: 1472-6920</identifier><identifier>DOI: 10.1186/s12909-021-02960-w</identifier><identifier>PMID: 34772405</identifier><language>eng</language><publisher>London: BioMed Central Ltd</publisher><subject>Allied Health Occupations Education ; Barriers ; Beliefs, opinions and attitudes ; Clinical reasoning ; Coding ; Content analysis ; Content Validity ; Core curriculum ; Curricula ; Data collection ; Direct Instruction ; Education ; Educational Development ; Faculty ; Faculty Development ; Health Occupations ; Health professions education ; Higher Education ; Interview study ; Interviews ; Learning Activities ; Medical colleges ; Medical Education ; Medical errors ; Medical teaching personnel ; Native Language ; Occupational Therapy ; Professions ; Reasoning ; Research Design ; Researchers ; Resistance (Psychology) ; Schools ; Semi Structured Interviews ; Study and teaching ; Teachers ; Teaching ; Teaching clinical reasoning ; Teaching Methods ; Validity ; Veterinary medicine</subject><ispartof>BMC medical education, 2021-11, Vol.21 (1), p.1-575, Article 575</ispartof><rights>COPYRIGHT 2021 BioMed Central Ltd.</rights><rights>2021. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c577t-2d3b20b33086bf51be4d88741b75bcfd4b07cbda9dac0e6ef94ae07e60e0656d3</citedby><cites>FETCH-LOGICAL-c577t-2d3b20b33086bf51be4d88741b75bcfd4b07cbda9dac0e6ef94ae07e60e0656d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8588939/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8588939/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,552,727,780,784,864,885,2102,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-95426$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Sudacka, Małgorzata</creatorcontrib><creatorcontrib>Adler, Martin</creatorcontrib><creatorcontrib>Durning, Steven J.</creatorcontrib><creatorcontrib>Edelbring, Samuel</creatorcontrib><creatorcontrib>Frankowska, Ada</creatorcontrib><creatorcontrib>Hartmann, Daniel</creatorcontrib><creatorcontrib>Hege, Inga</creatorcontrib><creatorcontrib>Huwendiek, Sören</creatorcontrib><creatorcontrib>Sobočan, Monika</creatorcontrib><creatorcontrib>Thiessen, Nils</creatorcontrib><creatorcontrib>Wagner, Felicitas L.</creatorcontrib><creatorcontrib>Kononowicz, Andrzej A.</creatorcontrib><title>Why is it so difficult to implement a longitudinal clinical reasoning curriculum? A multicenter interview study on the barriers perceived by European health professions educators</title><title>BMC medical education</title><description>Background Effective clinical reasoning is a core competency of health professionals that is necessary to assure patients' safety. Unfortunately, adoption of longitudinal clinical reasoning curricula is still infrequent. This study explores the barriers that hinder the explicit teaching of clinical reasoning from a new international perspective. Methods The context of this study was a European project whose aim is to develop a longitudinal clinical reasoning curriculum. We collected data in semi-structured interviews with responders from several European countries who represent various health professions and have different backgrounds, roles and experience. We performed a qualitative content analysis of the gathered data and constructed a coding frame using a combined deductive/inductive approach. The identified themes were validated by parallel coding and in group discussions among project members. Results A total of 29 respondents from five European countries participated in the interviews; the majority of them represent medicine and nursing sciences. We grouped the identified barriers into eight general themes: Time, Culture, Motivation, Clinical Reasoning as a Concept, Teaching, Assessment, Infrastructure and Others. Subthemes included issues with discussing errors and providing feedback, awareness of clinical reasoning teaching methods, and tensions between the groups of professionals involved. Conclusions This study provides an in-depth analysis of the barriers that hinder the teaching of explicit clinical reasoning. The opinions are presented from the perspective of several European higher education institutions. The identified barriers are complex and should be treated holistically due to the many interconnections between the identified barriers. Progress in implementation is hampered by the presence of reciprocal causal chains that aggravate this situation. Further research could investigate the perceptual differences between health professions regarding the barriers to clinical reasoning. The collected insights on the complexity and diversity of these barriers will help when rolling out a long-term agenda for overcoming the factors that inhibit the implementation of clinical reasoning curricula. 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A multicenter interview study on the barriers perceived by European health professions educators</title><author>Sudacka, Małgorzata ; Adler, Martin ; Durning, Steven J. ; Edelbring, Samuel ; Frankowska, Ada ; Hartmann, Daniel ; Hege, Inga ; Huwendiek, Sören ; Sobočan, Monika ; Thiessen, Nils ; Wagner, Felicitas L. ; Kononowicz, Andrzej A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c577t-2d3b20b33086bf51be4d88741b75bcfd4b07cbda9dac0e6ef94ae07e60e0656d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Allied Health Occupations Education</topic><topic>Barriers</topic><topic>Beliefs, opinions and attitudes</topic><topic>Clinical reasoning</topic><topic>Coding</topic><topic>Content analysis</topic><topic>Content Validity</topic><topic>Core curriculum</topic><topic>Curricula</topic><topic>Data collection</topic><topic>Direct Instruction</topic><topic>Education</topic><topic>Educational Development</topic><topic>Faculty</topic><topic>Faculty Development</topic><topic>Health Occupations</topic><topic>Health professions education</topic><topic>Higher Education</topic><topic>Interview study</topic><topic>Interviews</topic><topic>Learning Activities</topic><topic>Medical colleges</topic><topic>Medical Education</topic><topic>Medical errors</topic><topic>Medical teaching personnel</topic><topic>Native Language</topic><topic>Occupational Therapy</topic><topic>Professions</topic><topic>Reasoning</topic><topic>Research Design</topic><topic>Researchers</topic><topic>Resistance (Psychology)</topic><topic>Schools</topic><topic>Semi Structured Interviews</topic><topic>Study and teaching</topic><topic>Teachers</topic><topic>Teaching</topic><topic>Teaching clinical reasoning</topic><topic>Teaching Methods</topic><topic>Validity</topic><topic>Veterinary medicine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sudacka, Małgorzata</creatorcontrib><creatorcontrib>Adler, Martin</creatorcontrib><creatorcontrib>Durning, Steven J.</creatorcontrib><creatorcontrib>Edelbring, Samuel</creatorcontrib><creatorcontrib>Frankowska, Ada</creatorcontrib><creatorcontrib>Hartmann, Daniel</creatorcontrib><creatorcontrib>Hege, Inga</creatorcontrib><creatorcontrib>Huwendiek, Sören</creatorcontrib><creatorcontrib>Sobočan, Monika</creatorcontrib><creatorcontrib>Thiessen, Nils</creatorcontrib><creatorcontrib>Wagner, Felicitas L.</creatorcontrib><creatorcontrib>Kononowicz, Andrzej A.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection【Remote access available】</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Education Database (Alumni Edition)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>Social Science Premium Collection (Proquest) (PQ_SDU_P3)</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Education Collection (Proquest) (PQ_SDU_P3)</collection><collection>Coronavirus Research Database</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Education Database (ProQuest)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest Healthcare Administration Database</collection><collection>PML(ProQuest Medical Library)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Education</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SWEPUB Örebro universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Örebro universitet</collection><collection>SwePub Articles full text</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>BMC medical education</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sudacka, Małgorzata</au><au>Adler, Martin</au><au>Durning, Steven J.</au><au>Edelbring, Samuel</au><au>Frankowska, Ada</au><au>Hartmann, Daniel</au><au>Hege, Inga</au><au>Huwendiek, Sören</au><au>Sobočan, Monika</au><au>Thiessen, Nils</au><au>Wagner, Felicitas L.</au><au>Kononowicz, Andrzej A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Why is it so difficult to implement a longitudinal clinical reasoning curriculum? A multicenter interview study on the barriers perceived by European health professions educators</atitle><jtitle>BMC medical education</jtitle><date>2021-11-12</date><risdate>2021</risdate><volume>21</volume><issue>1</issue><spage>1</spage><epage>575</epage><pages>1-575</pages><artnum>575</artnum><issn>1472-6920</issn><eissn>1472-6920</eissn><abstract>Background Effective clinical reasoning is a core competency of health professionals that is necessary to assure patients' safety. Unfortunately, adoption of longitudinal clinical reasoning curricula is still infrequent. This study explores the barriers that hinder the explicit teaching of clinical reasoning from a new international perspective. Methods The context of this study was a European project whose aim is to develop a longitudinal clinical reasoning curriculum. We collected data in semi-structured interviews with responders from several European countries who represent various health professions and have different backgrounds, roles and experience. We performed a qualitative content analysis of the gathered data and constructed a coding frame using a combined deductive/inductive approach. The identified themes were validated by parallel coding and in group discussions among project members. Results A total of 29 respondents from five European countries participated in the interviews; the majority of them represent medicine and nursing sciences. We grouped the identified barriers into eight general themes: Time, Culture, Motivation, Clinical Reasoning as a Concept, Teaching, Assessment, Infrastructure and Others. Subthemes included issues with discussing errors and providing feedback, awareness of clinical reasoning teaching methods, and tensions between the groups of professionals involved. Conclusions This study provides an in-depth analysis of the barriers that hinder the teaching of explicit clinical reasoning. The opinions are presented from the perspective of several European higher education institutions. The identified barriers are complex and should be treated holistically due to the many interconnections between the identified barriers. Progress in implementation is hampered by the presence of reciprocal causal chains that aggravate this situation. Further research could investigate the perceptual differences between health professions regarding the barriers to clinical reasoning. The collected insights on the complexity and diversity of these barriers will help when rolling out a long-term agenda for overcoming the factors that inhibit the implementation of clinical reasoning curricula. Keywords: Clinical reasoning, Teaching clinical reasoning, Barriers, Health professions education, Interview study</abstract><cop>London</cop><pub>BioMed Central Ltd</pub><pmid>34772405</pmid><doi>10.1186/s12909-021-02960-w</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Allied Health Occupations Education Barriers Beliefs, opinions and attitudes Clinical reasoning Coding Content analysis Content Validity Core curriculum Curricula Data collection Direct Instruction Education Educational Development Faculty Faculty Development Health Occupations Health professions education Higher Education Interview study Interviews Learning Activities Medical colleges Medical Education Medical errors Medical teaching personnel Native Language Occupational Therapy Professions Reasoning Research Design Researchers Resistance (Psychology) Schools Semi Structured Interviews Study and teaching Teachers Teaching Teaching clinical reasoning Teaching Methods Validity Veterinary medicine |
| title | Why is it so difficult to implement a longitudinal clinical reasoning curriculum? A multicenter interview study on the barriers perceived by European health professions educators |
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