scholarly journals 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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Małgorzata Sudacka ◽  
Martin Adler ◽  
Steven J. Durning ◽  
Samuel Edelbring ◽  
Ada Frankowska ◽  
...  

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.

Author(s):  
Anja Greinacher ◽  
Anna Cranz ◽  
Julia Jenzer ◽  
Alexander Nikendei ◽  
Renate Kottke ◽  
...  

AbstractPsychosocial emergency care personnel provide voluntary psychological support directly after potentially traumatic events. During emergency responses, they experience challenging situations. However, previous quantitative studies suggest that the psychological burden of psychosocial emergency care personnel does not exceed that of the general population. This study aimed to obtain an in-depth analysis of the volunteers’ psychological reactions and resources regarding emergency responses. 36 psychosocial emergency care volunteers (12 pre-training, 12 post-training, 12 experienced) were invited to participate in semi-structured interviews. The volunteers were selected from previous cross-sectional and longitudinal studies on secondary traumatization in psychosocial emergency care volunteers. A qualitative content analysis of the transcribed interviews was performed following the principles of summary and inductive category development. We identified 845 codes which we summarized in three overarching categories: (I) reactions to emergency responses, (II) psychosocial emergency care work related resources and (III) experiences and changes in life perspective related to working in psychosocial emergency care. The volunteers described both emotional and physical reactions to emergency responses. While they perceived social support as a key coping resource and reported a greater appreciation of their own lives and their families due to their work, many volunteers also felt increased concern that something could happen to them. The volunteers’ reactions and symptoms are reasonable responses to stress and not indicative of serious impairment. Nevertheless, emergency responses are both emotionally and physically challenging. Volunteers should be carefully selected, receive regular supervision and determine the frequency of emergency responses.


Author(s):  
Mehdi Mojadam ◽  
Mohammad Hassan Ehrampoush ◽  
Nematollah Jaafarzadeh Haghighifard ◽  
MortezaAbdullatif Khafaie ◽  
Hossein Fallahzadeh ◽  
...  

Introduction: Dust phenomenon is a major environmental problem in world that threatens the middle-east countries specifically. In order to develop a need-based policy and regulate the supporting health program to reduce dust effects requires a proper understanding of the public beliefs about threats posed by this issue. The purpose of this study was to explain the threat appraisal patients with cardiovascular diseases regarding exposure to dust phenomena. Method: This qualitative content-analysis study was conducted from January to June 2018. The participants included 28 cardiovascular patients who referred to the healthcare centers in Ahvaz City. Semi-structured interviews were conducted with open-ended questions and inspiration from threat appraisal process constructs were used to collect data. All data were gathered, transcribed, and analyzed using MAXQDA-10 software and in-depth analysis. Findings: Perceived threat constructs were used and 4 categories and 9 sub-categories were extracted: perceived likelihood of exposure to dust (perceived likelihood of increased non-respiratory problems, perceived likelihood of increased respiratory problems), belief in seriousness and danger of exposure to dust (understanding the severity of physical complications, understanding the severity of mental and psychological complications, understanding the severity of economic complications), external reward of exposure to dust (improving personal and social relationships, improving financial problems), internal reward of exposure to dust (pleasant feeling). Conclusion: This study provided a clearer and deeper understanding of the threat posed by exposure to dust among cardiovascular patients. Based on the results, the authorities can design more targeted and more effective protective plans to raise awareness among community members, especially cardiovascular patients about the negative effects of exposure to dust and the ways to reduce its exposure.


2019 ◽  
Vol 50 (1) ◽  
pp. 67-80
Author(s):  
Angelo Fynn ◽  
Hugo Denton van der Walt

This article explores the experiences of Master’s programme coordinators in Research Psychology with the purpose of gaining an understanding of the planning and implementation of programmes that are directed at training Research Psychology students. The practical significance of the study was to investigate the course curricula of Research Psychology programmes within the South African context to grasp an understanding of the course structure and the challenges that accompany curriculum development. This article aims to elaborate on underlying tensions and considerations that programme coordinators encounter in structuring and implementing training for Master’s programmes that lead to registration with the Health Professions Council of South Africa. Six of the eight programmes that lead to registration with the Health Professions Council of South Africa were included in this study. Data were collected using semi-structured interviews and analysed using qualitative content analysis. The reflections by the programme coordinators showed a shared pedagogical philosophy of active learning in which students are expected to take ownership of their learning and to participate actively in shaping and constructing the learning process. Reflections on the Research Psychology programmes revealed seven broad content areas concerned with the development of curricula in Research Psychology, namely applied research, ethics, foundational concepts and skills, language and report writing, and project management and micro-skills development within qualitative and quantitative methodological approaches. Programme coordinators also expressed the tensions inherent in attempts to establish neutral ground between the demands of the discipline and the demands of the employers.


2020 ◽  
Vol 25 (2) ◽  
pp. 319-333
Author(s):  
Edina Ajanovic ◽  
Beykan Çizel

Considering the significant influence of online hotel reviews on both tourism demand and supply side, these may be considered as a successful persuasive tool. Accordingly, it is necessary to investigate the broader context in which reviews are generated and what are the components that contribute to their effectiveness. The main goal of this study was to analyze the communication occurring on hotel review platforms from a social psychological perspective through understanding structure, characteristics, and functions of attitudes expressed in guests' reviews. In addition, it aims to identify how persuasive cues in review responses should be defined. Following this aim, the authors applied multiple case study design and collected data in several stages through document analysis, participant observation, netnography, and interviews with different stakeholders involved in online review management process. Results of the qualitative content analysis showed that, in order to use the full persuasive potential of review platforms, it is necessary for hotel management to define its presence and visibility on these platforms, to conduct in-depth analysis of structure, characteristics, and functions of attitudes expressed in reviews, and to establish a systematic approach towards use of central and peripheral cues in review responses to induce desired cognitive processing of these messages.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mahboobeh Asadi ◽  
Mahnaz Noroozi ◽  
Mousa Alavi

Abstract Background Numerous changes occur in different aspects of women’s lives in the postpartum period. Women’s adjusting with problems and taking advantage of this opportunity can develop their personality. In this regard, accurate knowledge of their experiences and feelings is necessary to help them to benefit from this period. Therefore, the present study aimed to explore the experiences related to postpartum changes in women. Methods In the present qualitative study, 23 participants, including women of childbearing age who gave birth and healthcare providers (midwives and obstetricians) in Isfahan, Iran were selected using purposive sampling with a maximum variation strategy. Data were collected through in-depth semi structured interviews, field notes, and daily notes, and simultaneously analyzed using the conventional qualitative content analysis. Results The data analysis results led to the extraction of three main categories including “feeling of decreased female attractiveness” (with two sub-categories of “ feeling of decreased beauty” and “feeling of decreased sexual function”), “feeling of insolvency and helplessness” (with two sub-categories of “physical burnout”, and “mental preoccupations”) and “beginning a new period in life” (with three sub-categories of “changing the meaning of life”, “feeling of maturity” and “deepening the communication”). Conclusions Findings of this study can provide a good context for designing interventions to improve the women’s quality of life by explaining and highlighting their experiences in the postpartum period. In this regard, providing sufficient empathy, social and psychological support from family members (especially husband), performing appropriate educational interventions and also regular assessment of women’s psychological state by healthcare providers in postpartum period can reduce their concerns and help to improve their health.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Åse Lundin ◽  
Anna Bergenheim

Abstract Background Suicide is a serious public health issue and one of the most common causes of death globally. Suicide has long-lasting impact on personal, relational, community and societal levels. Research has shown that patients often seek help in the primary healthcare system preceding a suicide. Studies exploring the experiences of encountering patients at risk for suicide have been performed among various categories of healthcare personnel, such as nurses and psychiatry residents as well as emergency room staff. There is a lack of research regarding primary healthcare rehabilitation staff, despite the fact that physiotherapists are the third largest health profession in the Western hemisphere and often work with patients experiencing mental health symptoms. The aim of this study was to explore the experiences of encountering patients at risk for suicide among physiotherapists working in a primary healthcare rehabilitation setting. Methods Semi-structured interviews were conducted with 13 physiotherapists working in primary healthcare rehabilitation clinics in the Gothenburg area, Sweden. The interviews were recorded on audio and transcribed into written text. A qualitative content analysis was performed on the material collected. Results The analysis of the material revealed an overarching theme, Through barriers and taboos – the physiotherapist finds a way, with five main categories: possibilities for identification, obstacles in meeting suicide, workplace environment matters, where does the patient belong? and education and experience are keys. Conclusions The present study indicates that physiotherapists in the primary healthcare system encounter patients experiencing suicidality, and they expressed a strong desire to care for both the physical and mental wellbeing of the patients. Despite reporting many barriers, the physiotherapists often found a way to form a meaningful therapeutic alliance with the patient and to ask about possible suicidality in their clinical practice. The result suggests that physiotherapists could play a larger role in working with patients experiencing suicidality in a primary healthcare setting and that they could be viewed as possible gatekeepers in identification as well as referral of these patients into other parts of the healthcare system.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M.-C. Audétat ◽  
S. Cairo Notari ◽  
J. Sader ◽  
C. Ritz ◽  
T. Fassier ◽  
...  

Abstract Background Primary care physicians are at the very heart of managing patients suffering from multimorbidity. However, several studies have highlighted that some physicians feel ill-equipped to manage these kinds of complex clinical situations. Few studies are available on the clinical reasoning processes at play during the long-term management and follow-up of patients suffering from multimorbidity. This study aims to contribute to a better understanding on how the clinical reasoning of primary care physicians is affected during follow-up consultations with these patients. Methods A qualitative research project based on semi-structured interviews with primary care physicians in an ambulatory setting will be carried out, using the video stimulated recall interview method. Participants will be filmed in their work environment during a standard consultation with a patient suffering from multimorbidity using a “button camera” (small camera) which will be pinned to their white coat. The recording will be used in a following semi-structured interview with physicians and the research team to instigate a stimulated recall. Stimulated recall is a research method that allows the investigation of cognitive processes by inviting participants to recall their concurrent thinking during an event when prompted by a video sequence recall. During this interview, participants will be prompted by different video sequence and asked to discuss them; the aim will be to encourage them to make their clinical reasoning processes explicit. Fifteen to twenty interviews are planned to reach data saturation. The interviews will be transcribed verbatim and data will be analysed according to a standard content analysis, using deductive and inductive approaches. Conclusion Study results will contribute to the scientific community’s overall understanding of clinical reasoning. This will subsequently allow future generation of primary care physicians to have access to more adequate trainings to manage patients suffering from multimorbidity in their practice. As a result, this will improve the quality of the patient’s care and treatments.


Author(s):  
Katharina Diehl ◽  
Tatiana Görig ◽  
Charlotte Jansen ◽  
Maike Carola Hruby ◽  
Annette B. Pfahlberg ◽  
...  

Pharmacists and pharmaceutical technicians play an important role in counselling customers regarding sunscreen use and sun protection measures. A potentially helpful tool that can be used during counselling is the ultraviolet index (UVI), which informs individuals when and what sun protection measures are needed at a specific place and time. Our aim in this qualitative study was to explore awareness, knowledge, and use of the UVI during counselling in pharmacies. We used semi-structured interviews with pharmacists and pharmaceutical technicians (n = 20) to answer our research questions. Interviews were audiotaped, transcribed verbatim, and analyzed using qualitative content analysis. During the interviews pharmacists and pharmaceutical technicians revealed a lot of uncertainty and lack of knowledge regarding the UVI. Eight professionals were able to give a correct definition of UVI. Amongst others, the UVI was confused with sun protection factor. Overall, the UVI was hardly used during the counselling of customers. The UVI was developed to provide guidance when which type of sun protection is required to avoid detrimental effects of ultraviolet radiation. For effective implementation, both the general population and health professionals (e.g., pharmacists) have to increase their knowledge about the UVI. This would strengthen its use during professional counselling in pharmacies and may help to reduce the incidence of skin cancer over the long term.


2021 ◽  
pp. 030802262098847
Author(s):  
Tawanda Machingura ◽  
Chris Lloyd ◽  
Karen Murphy ◽  
Sarah Goulder ◽  
David Shum ◽  
...  

Introduction Current non-pharmacological treatment options for people with schizophrenia are limited. There is, however, emerging evidence that sensory modulation can be beneficial for this population. This study aimed to gain insight into sensory modulation from the user’s and the treating staff’s perspectives. Method A qualitative content analysis design was used. Transcripts from occupational therapists ( n=11) and patients with schizophrenia ( n=13) derived from in-depth semi-structured interviews were analysed for themes using content analysis. Results Five themes emerged from this study: Service user education on the sensory approach is the key; A variety of tools should be tried; Sensory modulation provides a valued treatment option; There are challenges of managing perceived risk at an organisational level; and There is a shortage of accessible and effective training. Conclusion People with schizophrenia and treating staff had congruent perceptions regarding the use of sensory modulation as a treatment option. The findings suggest that sensory modulation can be a valued addition to treatment options for people with schizophrenia. We suggest further research on sensory modulation intervention effectiveness using quantitative methods so these results can be further explored.


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