Increasing Reasoning Awareness: Video Analysis of Students� Two-Party Virtual Patient Interactions (Preprint)

BACKGROUND Collaborative reasoning occurs in clinical practice but is rarely developed during education. The computerized virtual patient (VP) cases allow for a stepwise exploration of cases and thus stimulate active learning. Peer settings during VP sessions are believed to have benefits in terms of reasoning but have received scant attention in the literature. OBJECTIVE The objective of this study was to thoroughly investigate interactions during medical students’ clinical reasoning in two-party VP settings. METHODS An in-depth exploration of students’ interactions in dyad settings of VP sessions was performed. For this purpose, two prerecorded VP sessions lasting 1 hour each were observed, transcribed in full, and analyzed. The transcriptions were analyzed using thematic analysis, and short clips from the videos were selected for subsequent analysis in relation to clinical reasoning and clinical aspects. RESULTS Four categories of interactions were identified: (1) task-related dialogue, in which students negotiated a shared understanding of the task and strategies for information gathering; (2) case-related insights and perspectives were gained, and the students consolidated and applied preexisting biomedical knowledge into a clinical setting; (3) clinical reasoning interactions were made explicit. In these, hypotheses were followed up and clinical examples were used. The researchers observed interactions not only between students and the VP but also (4) interactions with other resources, such as textbooks. The interactions are discussed in relation to theories of clinical reasoning and peer learning. CONCLUSIONS The dyad VP setting is conducive to activities that promote analytic clinical reasoning. In this setting, components such as peer interaction, access to different resources, and reduced time constraints provided a productive situation in which the students pursued different lines of reasoning.

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The challenges acute care nurse unit managers face and the strategies they use to address them: Perceptions of directors of nursing and nurse unit managers

Journal of Management & Organization ◽

10.1017/s1833367200000572 ◽

2012 ◽

Vol 18 (5) ◽

pp. 625-640 ◽

Cited By ~ 4

Author(s):

Cadeyrn J Gaskin ◽

Cherene M Ockerby ◽

Tammy R Smith ◽

Vibeke Russell ◽

Bev O'Connell

Keyword(s):

Professional Development ◽

Acute Care ◽

Thematic Analysis ◽

Management Education ◽

Team Development ◽

Clinical Aspects ◽

Trial And Error ◽

Care Nurse ◽

Comprehensive Management ◽

Large Organisation

AbstractThe aim of this study was to investigate the challenges that nurse unit managers (NUMs) face while working in acute care settings, the strategies they use to deal with these challenges, and the effectiveness of these strategies from the perspectives of NUMs and their supervisors. NUMs (N = 22) and directors of nursing (N = 3) were interviewed for this study. Thematic analysis revealed 14 challenges relating primarily to NUMs interactions with others, both within and outside of their wards/units. These challenges related to the managerial, but not clinical, aspects of their roles; 16 strategies for managing these challenges were identified, the effectiveness of which seemed dependent on how well they were executed. The strategies are: seeking assistance and support; trial and error; satisficing; taking responsibility for own professional development; scheduling of time; working longer hours; delegation; adaptive staffing and rostering; being a visible presence on the ward; team development; facilitating professional development for staff; being available for staff; negotiation and collaboration; communication; working with the processes of a large organisation; and complying with the demands of others, The findings make a strong case for NUMs to be supported in undertaking comprehensive management education.

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A sexual superpower or a shame? Women’s diverging experiences of squirting/female ejaculation in Sweden

Sexualities ◽

10.1177/13634607211041095 ◽

2021 ◽

pp. 136346072110410

Author(s):

Jessica Påfs

Keyword(s):

Thematic Analysis ◽

Scientific Literature ◽

Women’S Experiences ◽

Sexual Stimulation ◽

Women's Experiences ◽

Female Ejaculation ◽

Scant Attention ◽

The Subject

Squirting, or female ejaculation, is the expulsion of fluid during sexual stimulation. The limited scientific literature has focused primarily on clarifying what this fluid contains, while women’s own voices on the experience have received scant attention. This study explores 28 women’s experiences and applies a thematic analysis. The sensation of squirting is individual and sometimes conflicting. Descriptions range from considering it amazing, a superpower and feminist statement to an unpleasant and/or shameful event. Across the board, there is a wish for nuanced information and for the current taboo and mystification surrounding the subject to be broken.

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Providing Verbal Assistance When Assessing Individuals Living with a Traumatic Brain Injury

Canadian Journal of Occupational Therapy ◽

10.1177/00084174211034263 ◽

2021 ◽

pp. 000841742110342

Author(s):

Mireille Gagnon-Roy ◽

Nathalie Bier ◽

Stéphanie Boulé-Riley ◽

Heidi Keurentjes ◽

Priscilla Lam Wai Shun ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Activities Of Daily Living ◽

Clinical Reasoning ◽

Thematic Analysis ◽

Daily Living ◽

Occupational Therapists ◽

Think Aloud ◽

Accurate Assessment ◽

Level Of Understanding

Background. Occupational therapists play a major role in identifying the assistance needs of individuals living with a traumatic brain injury. However, to obtain an accurate assessment, verbal assistance should be provided only when necessary, according to the person's needs. Purpose. This study aimed to understand (1) how verbal assistance is provided during an evaluation of Instrumental Activities of Daily Living and (2) why it is provided in this manner. Method. Interviews were conducted with three expert occupational therapists using their own videotaped evaluation and a “think-aloud” method to explore their clinical reasoning when providing verbal assistance. Data were analyzed using thematic analysis. Findings. The process of providing verbal assistance was recognized as flexible and nonlinear, and influenced by various factors including the participants’ level of understanding of the client's abilities. Implications. This information will help therapists better understand how and when to provide verbal assistance when assessing their clients.

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Rushing Roulette – how do learners perform routine tasks under time pressure?

10.7287/peerj.preprints.1859v1 ◽

2016 ◽

Author(s):

David Topps ◽

Ana Popovic ◽

Teejay Horne ◽

Jean M Rawling ◽

Maureen Topps

Keyword(s):

Clinical Reasoning ◽

Time Pressure ◽

Predictive Analytics ◽

Virtual Patient ◽

Decision Points ◽

Coaching Methods ◽

Routine Tasks ◽

Learner Activity ◽

Competing Priorities ◽

Situational Judgement

Introduction: Remediating, or preferably, predicting which residents will have difficulty before they need remediating, is a challenging task. Most of us perform better when pumped for an exam. But how do we respond when under routine pressures? Do weaker learners adapt differently, despite coaching? Methods: Using an adaptation of virtual patient software, we explored how learners cope with handling repetitive yet time-sensitive routine tasks. We emulated the performance of routine tasks within a virtual electronic medical record (EMR) environment, tracking individual learner activity and decision pathways, time to act (with and without enforced pressure from programmed time-outs) and their adaptation trajectories over time with coaching. Learners were assessed using Situational Judgement and modified Script Concordance Testing, with reproducible and granular time constraints introduced into the clinical reasoning process. Results: Our case designs introduce a number of competing elements: time pressures, competing priorities and instructions, resource availability and unpredictable outcomes. Learner behaviour is assessed using a variety of metrics including time-stamped decision points, decision pathways and internal counter scores. Clinical reasoning pathways, as compared to a reference peer panel, are in turn compared with and without the time pressures. Conclusions: Predictive analytics have made great promises in diagnosing problems for learners in difficulty but are complex and expensive to deploy widely. Our simpler, rapidly reproducible approach may provide a more practical solution.

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A thematic analysis of library association policies on services to persons with disabilities

Journal of Documentation ◽

10.1108/jd-10-2020-0183 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Heather Hill

Keyword(s):

Thematic Analysis ◽

Information Science ◽

National Level ◽

Shared Understanding ◽

Education Programs ◽

Persons With Disabilities ◽

Content Type ◽

Library Education ◽

Consensus Values ◽

Library Resources

PurposeLibrary association policies and guidelines are important to study because they reflect consensus values of the profession. As such, they can shape the association, itself, and set the tone for the values of its individual members in their professional practice. From the titles alone, these documents proclaim themselves to be guides for the development of individual library policy. Additionally, as library and information science (LIS) graduate education programs are accredited by national associations, LIS schools pay attention to association policies and guidelines to help shape professional and continuing education. In these ways, they have a role in shaping professional ideology around a topic. The paper aims to discuss these issues.Design/methodology/approachThe services to persons with disabilities policies from three national-level LIS organizations were analyzed through a thematic analysis.FindingsThe guidelines speak to a shared understanding of disability and accessibility around the themes of library staff, library policies and library resources and services. While not surprising, additional themes around disability context and legislation show a shared understanding of accessibility that is much broader than what the legislation requires.Originality/valueAn analysis of guidelines on services to persons with disabilities from the American Library Association (ALA), Australian Library and Information Association (ALIA) and Canadian Federation of Library Associations (CFLA) is of interest because of the ways these organizations intersect. The ALA and ALIA have reciprocal agreements so that students in LIS education programs are recognized as equivalents. Second, the ALA accredits library education programs in Canada. Given these intersecting relationships, the guidelines-shared notions of accessibility become of high interest.

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Learning clinical reasoning: how virtual patient case format and prior knowledge interact

BMC Medical Education ◽

10.1186/s12909-020-1987-y ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Jan Kiesewetter ◽

Michael Sailer ◽

Valentina M. Jung ◽

Regina Schönberger ◽

Elisabeth Bauer ◽

...

Keyword(s):

Prior Knowledge ◽

Clinical Reasoning ◽

Virtual Patient ◽

Patient Case

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Qualitative development and content validation of the “SPART” model; a focused ethnography study of observable diagnostic and therapeutic activities in the emergency medical services care process

BMC Emergency Medicine ◽

10.1186/s12873-021-00526-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Bert Dercksen ◽

Michel M. R. F. Struys ◽

Fokie Cnossen ◽

Wolter Paans

Keyword(s):

Emergency Medical Services ◽

Clinical Reasoning ◽

Thematic Analysis ◽

Real Life ◽

Care Process ◽

Medical Services ◽

Focused Ethnography ◽

Reasoning Task ◽

Emergency Medical ◽

Video Observations

Abstract Background Clinical reasoning is a crucial task within the Emergency Medical Services (EMS) care process. Both contextual and cognitive factors make the task susceptible to errors. Understanding the EMS care process’ structure could help identify and address issues that interfere with clinical reasoning. The EMS care process is complex and only basically described. In this research, we aimed to define the different phases of the process and develop an overarching model that can help detect and correct potential error sources, improve clinical reasoning and optimize patient care. Methods We conducted a focused ethnography study utilizing non-participant video observations of real-life EMS deployments combined with thematic analysis of peer interviews. After an initial qualitative analysis of 7 video observations, we formulated a tentative conceptual model of the EMS care process. To test and refine this model, we carried out a qualitative, thematic analysis of 28 video-recorded cases. We validated the resulting model by evaluating its recognizability with a peer content analysis utilizing semi-structured interviews. Results Based on real-life observations, we were able to define and validate a model covering the distinct phases of an EMS deployment. We have introduced the acronym “SPART” to describe ten different phases: Start, Situation, Prologue, Presentation, Anamnesis, Assessment, Reasoning, Resolution, Treatment, and Transfer. Conclusions The “SPART” model describes the EMS care process and helps to understand it. We expect it to facilitate identifying and addressing factors that influence both the care process and the clinical reasoning task embedded in this process.

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Debriefing of virtual patient encounters: Systematic collection of nursing students clinical reasoning activities

10.7287/peerj.preprints.1172v1 ◽

2015 ◽

Author(s):

Carina Georg ◽

Elisabet Welin Henriksson ◽

Maria Jirwe ◽

Johanna Ulfvarson ◽

Nabil Zary

Keyword(s):

Nursing Education ◽

Nursing Students ◽

Clinical Reasoning ◽

Clinical Judgment ◽

Virtual Patient ◽

Learning Activity ◽

Virtual Patients ◽

Feed Forward ◽

Undergraduate Nursing ◽

Starting Point

Background. Studies have shown that nursing students have challenges in translating and applying their theoretical knowledge in a clinical context. Virtual patients (VPs) have been proposed as an adequate learning and assessment activity to improve clinical reasoning. Although feedback and debriefing are essential aspects to foster learning in medical simulation, few studies have explored systematic and theory anchored ways of supporting feed forward and debriefing based on student activity collected in a systematic manner. Objective. The aim of this study was to develop a systematic approach for collecting the nursing students’ clinical reasoning artifacts as they encounter virtual patients. Method. The Outcome-Present-State-Test (OPT) model for clinical reasoning was used as the starting point since it is an internationally common model used by faculty to plan for and design learning activities in nursing education (Pesut & Herman, 1999). Two virtual patients were developed using the virtual patient nursing design model vpNDM (Georg &Zary, 2014). Nighty-five participants from undergraduate nursing education encountered the VPs and the intervention was composed of the exploration of methods for tracking and collecting the participants’ clinical reasoning artifacts. Results. An instrument to collect the students’ clinical reasoning was developed. Artifacts are collected during the whole virtual patient encounter. The aspects collected are related to clinical judgment, nursing action, outcome and present states, cue logic and the client in context. The empirical demonstrated that the instrument was able to collect and expose quantitative and qualitative aspects of the students’ clinical reasoning. Conclusions. A method to systematically collect aspects of clinical reasoning during a virtual patient driven learning activity would allow purposeful feed forward and provide the necessary information for constructive debriefing sessions.

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