The Medical programme has a clear profile with five distinct areas which are problem-based learning, early patient contact, early inclusion in research, regionalized education, and good international opportunities. 

The pedagogical framework problem-based learning has been found to be suitable and relevant for the licensing education that is expected to build the foundations for lifelong learning for the medical professional who needs to solve complicated and complex problems. The learning structures within this pedagogical framework, however, need adaptation to the current generation of students and today’s healthcare. The regionalization of the Medical programme necessitates distance learning, and the future professional role in modern work environment within healthcare presumes high digital literacy. However, in a technology enhanced teaching environment, it is still the teacher’s and student’s ability to form a learning community and interact constructively that is crucial. The teachers’ high competence is fundamental for a high-quality education, therefore education of and support for teachers must be high priority. It is important to provide our teachers with both pedagogical and digital tools, and that teachers also receive regular feedback. 

Good collaboration between Linköping University and the regions in the Southeast healthcare region is essential. There is a call for common processes regarding teacher recruitment and faculty development so that both healthcare and education can be stimulated. 

Läkarprogrammet har en tydlig profil med fem distinkta områden såsom problembaserat lärande, tidig patientkontakt, tidig inkludering i forskning, regionaliserad utbildning och goda internationella möjligheter.

Det pedagogiska ramverket problembaserat lärande har funnits vara lämpligt och relevant för den legitimationsgrundande utbildningen som förväntas bygga grunden till livslångt lärande vilket krävs för läkaryrket som innebär genomförandet av komplicerade och komplexa arbetsuppgifter. Arbetsformerna inom dessa ramar behöver dock anpassning utifrån hur nuvarande generation av studenter lär och hur sjukvården har förändrats under de senaste decennierna. Läkarprogrammets regionalisering fordrar fjärrundervisning, och den framtida yrkesrollen i den moderna arbetsmiljön inom sjukvården förutsätter hög digital literacy. I en digitaliserad undervisningsmiljö är fortfarande lärarens och studentens förmåga att skapa gemenskap och interagera konstruktivt centralt. Lärarnas kompetens är fundamentalt för en högkvalitativ utbildning därför behöver utbildning och stöd till lärare få stort utrymme. Det är viktigt att förse våra lärare med både pedagogiska och digitala verktyg och att lärare får regelbunden återkoppling på sina insatser.

God samverkan mellan Linköpings universitet och regionerna i Sydöstra sjukvårdsregionen är en förutsättning för kvalitetsarbetet. Det finns ett stort behov av gemensamma processer gällande lärarrekrytering och kompetensförsörjning så att både sjukvården och utbildningen främjas.  

AIMS: The HeartMate 3 (HM3) implantable left ventricular assist device connects the left ventricle apex to the aorta via an outflow graft. Extrinsic obstruction of the graft (eOGO) is associated with serious morbidity and mortality and recently led to a Food and Drug Administration Class 1 device recall of HM3. This study aimed to provide a better understanding of the haemodynamic impact of extrinsic stenoses.

METHODS AND RESULTS: Computed tomography (CT) images of two retrospectively identified patients with eOGO (29 and 36% decrease in cross-sectional area, respectively, by radiological evaluation) were acquired with a novel photon-counting CT system. Numerical evaluations of haemodynamics were conducted using a high-fidelity 3D computational fluid dynamics approach on both the patient-specific graft geometries and in two virtually augmented stenotic severities and three device flows. Visual analysis identified increased velocity, pressure, and turbulent flow in the outer anterior curvature of the outflow graft; however, changes in graft pressure gradients were slight (1-9 mmHg) across the range of stenosis severities and flow rates tested.

CONCLUSION: Evidence of eOGO during HM3 support and the recent device recall can provoke clinical apprehension and interventions. The haemodynamic impact of a stenosis detected visually or by quantification of cross-sectional area reduction may be difficult to predict and easily overestimated. This numerical study suggests that, for clinically encountered flow rates and stenosis severities below 61% in cross-sectional area decrease, eOGO may have low haemodynamic impact. This suggests that patients without symptoms or signs consistent with haemodynamically significant obstruction might be managed expectantly.

The Medical Programme at Linköping University, committed to Problem-Based Learning (PBL) and interprofessional education, confronted the necessity for pedagogical revitalization due to an upsurge in student numbers, alterations in national physician licensing criteria, and an organizational framework shift. In response to these challenges, stakeholders conducted a comprehensive systematic self-assessment to navigate a course toward a sustainable and contemporary pedagogical transformation.

The methodology employed in this assessment involved a systematic examination of scientific pedagogical literature, policy documents, educational materials, and schedules. Additionally, valuable insights were gathered through teacher and student surveys. Key findings underscore the importance of a balanced approach that grants students more time for self-study and reflection. Enhancing tools and methodologies for constructive alignment is crucial to achieve equilibrium in both theoretical and practical training settings. Moreover, establishing seamless collaborations between the university and teaching hospitals is deemed essential for faculty development and the long-term competence within both organizations.

The self-assessment underscored the critical importance of continuous evaluation in medical educational settings. The approach not only ensures the ongoing relevance of the curricula but also cultivates an environment conducive to student-centred teaching and learning. This, in turn, prepares students for lifelong learning and the diverse challenges in their future medical profession.

Background: The prevalence of aortic valve stenosis (AS) is increasing due to an ageing population. Despite that right ventricular function has prognostic value for postoperative outcome, the right ventricle (RV) is not extensively studied and often not routinely assessed in AS. Our aim was to explore the relation between severe AS and RV function in a surgical aortic valve replacement (SAVR) cohort, comparing two imaging modalities for RV evaluation.Methods: Patients with severe AS, underwent cardiovascular magnetic resonance imaging (CMR) and transthoracic echocardiography (TTE) before SAVR. RV dysfunction was defined as one or more of the following: tricuspid annular plane systolic excursion (TAPSE) < 17 mm, RV free wall strain (RVFWS) > -20% by TTE and RV ejection fraction (RVEF) <50% by CMR.Results: Sixteen (33%) patients were found to have RV dysfunction. Patients with RV dysfunction showed significantly lower indexed aortic valve area, left ventricular (LV) ejection fraction as well as RV and LV stroke volumes compared to patients with maintained RV function. All patients with reduced RVEF also had changes in TAPSE or RVFWS and a larger number of patients had a reduced longitudinal RV function despite a normal RVEF.Conclusion: In a SAVR cohort one-third of the patients had RV dysfunction, defined by RVEF, TAPSE or RVFW strain. Echocardiography detected subtle changes in RV function before RVEF was reduced. It is likely that the more pronounced the AS, the more frequent the occurrence of RV dysfunction.

Purpose Information is scarce on healthcare managers understanding of simulation educators impact on clinical work. Therefore, the aim of this study was to explore healthcare managers perceptions of the significance of clinically active simulation educators for the organisation. Design/methodology/approach Healthcare managers were invited to be interviewed in a semi-structured manner. Inductive thematic analysis was used to identify and analyse patterns of notions describing the managers perceptions of simulation educators impact as co-workers on their healthcare organisations. Findings The identified relevant themes for the healthcare unit were: (1) value for the manager, (2) value for the community and (3) boundaries. Simulation educators were perceived to be valuable gatekeepers of evidence-based knowledge and partners in leadership for educational issues. Their most prominent value for the community was establishing a reflective climate, facilitating open communication and thereby improving the efficacy of teamwork. Local tradition, economy, logistics and staffing of the unit during simulation training were suggested to have possible negative impacts on simulation educators work. Practical implications - The findings might have implications for the implementation and support of simulation training programs. Social implications - Healthcare managers appreciated both the personal value of simulation educators and the effect of their work for their own unit. Local values were prioritised versus global. Simulation training was valued as an educational tool for continual professional development, although during the interviews, the managers did not indicate the importance of employment of pedagogically competent and experienced staff. Originality/value The study provided new insights about how simulation educators as team members affect clinical practice.

Stakeholders in healthcare and education find interprofessional teamwork to be crucial for todays complex healthcare. Consequently, the students need to prepare for future collaboration with other professions. Interprofessional simulation (IPS) is a technique in which several professions can engage together in clinical scenarios. Using a survey we studied the perceived relevance of two IPS settings in which last-year medical and nursing students participated in acute care scenarios. The findings showed that students perceive IPS as being highly relevant and that students from the other profession contributed to their learning. IPS holds promise as a pedagogical tool towards future interprofessional competence. However, pedagogical improvements can be made, and the professional perspectives can be better balanced. Furthermore, in order to equip students with broader interprofessional competence, scenarios should include several professions and a variety of clinical contexts.

Studenter behöver träna på teamarbete och utveckla interprofessionell kompetens för att rustas för framtidens hälso- och sjukvård.

Utbildning för interprofessionell samverkan kan ske genom simulering där läkar- och sjuksköterskestudenter möts och agerar tillsammans i patientscenarier. 

Interprofessionell simulering upplevdes som relevant och engagerande av studenter på två lärosäten. Studenter från den andra professionen bidrog till lärandet. Det finns dock utrymme att ytterligare förbättra det pedagogiska genomförandet, och professionsperspektiven kan balanseras bättre. 

Echocardiographic assessment of the left ventricular diastolic function (LVDF), an integrated part of evaluation of left ventricular function is still a delicate task and is performed with substantial inter-rater variability. Therefore, we aimed to create and evaluate a guidelines-based automated decision support. An algorithm was created for a hierarchical analysis of LVDF based on variables as recommended by the latest guidelines. Age-adjusted normal ranges were pooled from previously published studies into an integrated reference table. For proof-of-concept, 20 echocardiographic examinations were analyzed offline by four experienced physicians with more than 10 years of echocardiographic experience. The first assessments were to be performed as they would be in the clinical practice. Six months later, the assessments were repeated based on the 2017 ASE/EACVI guidelines. The overall inter-rater agreement for the first clinical assessments was moderate, while the guidelines-based assessments had only fair inter-rater agreement. Both kinds of manual assessment had poor agreement with the standardized automated assessment algorithm of LVDF. In conclusion, the presented automated decision support for evaluation of diastolic LV function by Doppler echocardiography is mainly based on current guidelines involving multiple parameters in combination. Incorporating age dependency aspects in our program (available for use at https://liu.se/en/research/left-ventricular-diastolic-function-decision-support) enhances the accuracy of the evaluation and reduces variability in evaluation of LVDF. The large inter-rater variation in classification in this study also underscores the usefulness of tools to support a standardized evaluation.

Från och med 2009 erbjuds praktiska färdighetsövningar på Clinicum där läkarstudenter under handledning går genom teoretisk bakgrund och övar genomförande av praktiska färdigheter kopplade till mål inom cirkulation, respiration och ortopedi på anatomiska modeller. En observationsstudie genomfördes med fokus på studentcentrerat lärande, meningsfullhet och relevans, samt lärande i samarbete med andra. Det konstaterades att lärmomentet genomförs i enlighet med grundläggande principer för PBL, är stark kopplat till den kliniska praktiken, samt att det bjuder in till att lära i samarbete med andra.

Förbättringsmöjligheter identifierades i tillgänglighet av referensmaterial om teoretisk bakgrund före utbildningsmomentet för att underlätta undervisningens anpassning till studenternas aktuella kunskaper. Att dessutom göra det möjligt att skicka frågor till lärarna som förberedelse skulle bidra till ökad individualisering och effektivisering av utbildningsmomenten.

Background: Medical simulation enables the design of learning activities for competency areas (eg, communication and leadership) identified as crucial for future health care professionals. Simulation educators and medical teachers follow different career paths, and their education backgrounds and teaching contexts may be very different in a simulation setting. Although they have a key role in facilitating learning, information on the continuing professional development (pedagogical development) of simulation educators is not available in the literature.

Objectives: To explore changes in experienced simulation educators’ perceptions of their own teaching skills, practices, and understanding of teaching over time.

Methods: A qualitative exploratory study. Fourteen experienced simulation educators participated in individual open-ended interviews focusing on their development as simulation educators. Data were analyzed using an inductive thematic analysis.

Results: Marked educator development was discerned over time, expressed mainly in an altered way of thinking and acting. Five themes were identified: shifting focus, from following to utilizing a structure, setting goals, application of technology, and alignment with profession. Being confident in the role as an instructor seemed to constitute a foundation for the instructor’s pedagogical development.

Conclusion: Experienced simulation educators’ pedagogical development was based on self-confidence in the educator role, and not on a deeper theoretical understanding of teaching and learning. This is the first clue to gain increased understanding regarding educational level and possible education needs among simulation educators, and it might generate several lines of research for further studies.

The advantages of providing standardized education avoiding exposure of real patients to interventions by novices are appealing both from patient safety and teaching aspects, thus medical simulation has become an integrated part of the healthcare curriculum.

We explored the impact of gender and an acting vs. an observing role in simulation on students’ perceptions of learning outcomes, and of simulation as a learning activity.

A prospective survey for graduating medical students participating in a full day simulated team training session was conducted over three terms. The questionnaire addressed issues related to the session, teamwork and simulation training in general. Participation was voluntary and the study was approved by the regional ethics committee.

The overall response rate was 90.8 %. Authenticity and relevance were considered to be high, though male students scored significantly higher both for authenticity and for relevance.  Communication and teamwork were considered to be different, depending on gender and assigned role. Female students and students in an acting role were more ready to discuss knowledge gaps, experienced “good” communication significantly more often, and defined their work as teamwork more frequently.  The scenarios were found to be more stimulating and motivating by female students and acting individuals. Self-confidence and self-awareness were declared to be more enhanced for male students and for those who were acting during the simulation sessions. Observers and female students scored significantly lower as regards satisfaction with both the extent of the reflection and the individual feedback.

The perceptions of authenticity and relevance of simulation sessions and students’ readiness to discuss knowledge gaps differed between genders. Furthermore, perceived changes in self-confidence and self-awareness seemed to be different. The observing role implies a different kind of learning process, which is not necessarily inferior to learning by acting.