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Hult, Håkan
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Allvin, R., Berndtzon, M., Carlzon, L., Edelbring, S., Hult, H., Hultin, M., . . . Tamás, É. (2017). Confident but not theoretically grounded: experienced simulation educators perceptions of their own professional development. Advances in Medical Education and Practice, 8, 99-108
Open this publication in new window or tab >>Confident but not theoretically grounded: experienced simulation educators perceptions of their own professional development
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2017 (English)In: Advances in Medical Education and Practice, ISSN 1179-7258, E-ISSN 1179-7258, Vol. 8, p. 99-108Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Dove Medical Press, 2017
Keywords
continuing professional development; interviews; medical simulation; pedagogical development; simulation educator
National Category
Social Work
Identifiers
urn:nbn:se:liu:diva-145063 (URN)10.2147/AMEP.S123517 (DOI)28176931 (PubMedID)
Available from: 2018-02-08 Created: 2018-02-08 Last updated: 2018-05-04Bibliographically approved
Nyström, S., Dahlberg, J., Edelbring, S., Hult, H. & Abrandt Dahlgren, M. (2017). Continuing professional development: pedagogical practices of interprofessional simulation in health care. Studies in Continuing Education, 39(3), 303-319
Open this publication in new window or tab >>Continuing professional development: pedagogical practices of interprofessional simulation in health care
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2017 (English)In: Studies in Continuing Education, ISSN 0158-037X, E-ISSN 1470-126X, Vol. 39, no 3, p. 303-319Article in journal (Refereed) Published
Abstract [en]

The increasing complexity of health care practice makes continuing professional development (CPD) essential for health care professionals. Simulation-based training is a CPD activity that is often applied to improve interprofessional collaboration and the quality of care. The aim of this study is to explore simulation as a pedagogical practice for the CPD of health care professionals. Specifically, the study focuses on how a professional development activity, the simulation, is enacted to support interprofessional collaboration and learning. A practice theory perspective is used as the theoretical framework. In this, the professional practice is conceptualised as being embodied, relational and situated in sociomaterial arrangements. Ten introduction and reflection sessions following interprofessional full-scale manikin-based simulations with professionals were video-recorded. The recordings were analysed following a stepwise qualitative collaborative approach developed for the purpose. The key findings suggest that the professional competence activity is enacted and interconnected with and governed by historical traditions of institutional teaching practices as well as simulation practices. Despite the intentions of team and interprofessional training, the institutional teaching and simulation practices constrain and hinder the intended outcomes of professional development in interprofessional collaboration.

Place, publisher, year, edition, pages
Routledge, 2017
Keywords
Continuing professional development, healthcare, interprofessional collaboration, simulation, practice theory, qualitative video analysis
National Category
Pedagogy
Identifiers
urn:nbn:se:liu:diva-138028 (URN)10.1080/0158037X.2017.1333981 (DOI)000410888200005 ()
Funder
Swedish Research Council
Note

Funding agencies: Swedish Research Council

Available from: 2017-06-07 Created: 2017-06-07 Last updated: 2018-04-18Bibliographically approved
Nyström, S., Dahlberg, J., Edelbring, S., Hult, H. & Abrandt Dahlgren, M. (2016). Debriefing practices in interprofessional simulation with students: A sociomaterial perspective. BMC Medical Education, 16(148), 1-8
Open this publication in new window or tab >>Debriefing practices in interprofessional simulation with students: A sociomaterial perspective
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2016 (English)In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, no 148, p. 1-8Article in journal (Refereed) Published
Abstract [en]

Background: The debriefing phase is an important feature of simulation activities for learning. This study applies a sociomaterial perspective on debriefing in interprofessional simulation with medical and nursing students. Sociomaterial perspectives are increasingly being used in order to understand professional practice and learning in new ways, conceptualising professional practice as being embodied, relational and situated in sociomaterial relations. The aim of the study is to explore how debriefing is carried out as a practice supporting students’ interprofessional learning.

Methods: Eighteen debriefing sessions following interprofessional full-scale manikin-based simulation with nursing and medical students from two different universities were video-recorded and analysed collaboratively by a team of researchers, applying a structured scheme for constant comparative analysis.

Results: The findings show how debriefing is intertwined with, and shaped by social and material relationships. Two patterns of enacting debriefing emerged. Debriefing as algorithm was enacted as a protocol-based, closed inquiry approach. Debriefing as laissez-faire was enacted as a loosely structured collegial conversation with an open inquiry approach.

Conclusion: The findings indicate that neither an imposed structure of the debriefing, nor the lack of structure assured interprofessional collaboration to emerge as a salient topic for reflection, even though that was an explicit learning objective for the simulation. 

Place, publisher, year, edition, pages
BioMed Central, 2016
Keywords
Simulation, Undergraduate health professions education, Multiprofessional, Professionalism, Medical education research methodology
National Category
Pedagogy
Identifiers
urn:nbn:se:liu:diva-128252 (URN)10.1186/s12909-016-0666-5 (DOI)000375990000001 ()27189483 (PubMedID)
Note

Funding agencies: Swedish Research Council

Available from: 2016-05-24 Created: 2016-05-24 Last updated: 2017-11-30
Nyström, S., Dahlberg, J., Hult, H. & Abrandt Dahlgren, M. (2016). Enacting simulation: A sociomaterial perspective on students’ interprofessional collaboration. Journal of Interprofessional Care, 30(4), 441-447
Open this publication in new window or tab >>Enacting simulation: A sociomaterial perspective on students’ interprofessional collaboration
2016 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 30, no 4, p. 441-447Article in journal (Refereed) Published
Abstract [en]

Full-scale simulation exercises are becoming more common as an educational feature of the under- graduate training of health professionals. This study explores how interprofessional collaboration is enacted by the participating students. Practice theory is used as the theoretical framework for a field study of two naturalistic educational settings, when medical and nursing students come together to practice in a simulated emergency situation, where a manikin is replacing the patient. Eighteen sessions of simulations were observed, and data were collected through standardised video recordings that were analysed collaboratively. To ensure transparency and scientific rigour, a stepwise constant comparative analysis was conducted, in which individual observations within and across single video recordings were compared, negotiated and eventually merged. The findings show that the student teams relate to the manikin as a technical, medical, and human body, and that interprofessional knowings and enactments emerge as a fluid movement between bodily positioning in synchrony and bodily positioning out of synchrony in relation to the sociomaterial arrangements. The findings are related to contemporary theorisations of practice comprising an integrated view of body and mind, and it is discussed how the findings can be used in simulation exercises to support participants’ learning in new ways. 

Place, publisher, year, edition, pages
Taylor & Francis, 2016
Keywords
Healthcare; interprofessional collaboration; learning; practice theory; qualitative video analysis; simulation education
National Category
Learning Pedagogy
Identifiers
urn:nbn:se:liu:diva-128254 (URN)10.3109/13561820.2016.1152234 (DOI)000379539100006 ()27197005 (PubMedID)
Note

Funding agencies: Swedish Research Council

Available from: 2016-05-24 Created: 2016-05-24 Last updated: 2017-11-30
Nyström, S., Dahlberg, J., Hult, H. & Abrandt Dahlgren, M. (2016). Observing of interprofessional collaboration in simulation: A socio-material approach. Journal of Interprofessional Care, 30(6), 710-716
Open this publication in new window or tab >>Observing of interprofessional collaboration in simulation: A socio-material approach
2016 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 30, no 6, p. 710-716Article in journal (Refereed) Published
Abstract [en]

Simulation exercises are becoming more common as an educational feature of the undergraduate training of health professionals. Not all students participate in these activities, but are assigned as observers of the actual simulation. This article presents a study that explored how social-material arrangements for observation of interprofessional collaboration in a simulated situation are enacted and how these observations are thematised and made relevant for learning. The empirical data consisted of 18 standardised video recordings of medical and nursing students observing their peer students simulate. Practice theory is used to show how observation is embodied, relational, and situated in social-material relations. The findings show two emerging ways of enacting observation—proximate observation and distant observation. The enactments are characterised by different socio-material arrangements concerning the location where the simulation took place and its material set-up as well as embodied “doings” and “relatings” between the observing students and instructors. The observing students are participating in a passive, normative position as an audience and as judges of what is correct professional behaviour.

Place, publisher, year, edition, pages
Taylor & Francis, 2016
Keywords
Healthcare, interprofessional collaboration, observation, practice theory, qualitative video analysis, simulation education
National Category
Pedagogy
Identifiers
urn:nbn:se:liu:diva-130479 (URN)10.1080/13561820.2016.1203297 (DOI)000387546800004 ()27436691 (PubMedID)
Projects
SIMIPL
Funder
Swedish Research Council
Note

Funding agencies: Swedish Research Council

Available from: 2016-08-09 Created: 2016-08-09 Last updated: 2017-11-28
Sjolin, H., Lindstrom, V., Hult, H., Ringsted, C. & Kurland, L. (2015). What an ambulance nurse needs to know: A content analysis of curricula in the specialist nursing programme in prehospital emergency care. International Emergency Nursing, 23(2), 127-132
Open this publication in new window or tab >>What an ambulance nurse needs to know: A content analysis of curricula in the specialist nursing programme in prehospital emergency care
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2015 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, no 2, p. 127-132Article in journal (Refereed) Published
Abstract [en]

In Sweden, ambulances must be staffed by at least one registered nurse. Twelve universities offer education in ambulance nursing. There is no national curriculum for detailed course content and there is a lack of knowledge about the educational content that deals with the ambulance nurse practical professional work. The aim of this study was to describe the content in course curricula for ambulance nurses. A descriptive qualitative research design with summative content analysis was used. Data were generated from 49 courses in nursing and medical science. The result shows that the course content can be described as medical, nursing and contextual knowledge with a certain imbalance with largest focus on medical knowledge. There is least focus on nursing, the registered nurses main profession. This study clarifies how the content in the education for ambulance nurses in Sweden looks today but there are reasons to discuss the content distribution.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Education; Curriculum; Ambulances; Prehospital emergency nursing; Emergency care; Qualitative content analysis
National Category
Educational Sciences
Identifiers
urn:nbn:se:liu:diva-118872 (URN)10.1016/j.ienj.2014.09.002 (DOI)000354139000017 ()25304861 (PubMedID)
Available from: 2015-06-04 Created: 2015-06-04 Last updated: 2017-12-04
Nyström, S., Abrandt Dahlgren, M. & Håkan, H. (2014). From 'there' to 'here' to 'elsewhere: Enacting debriefing in interprofessional medical education simulation. Paper presented at The 15th Annual Meeting on Simulation in Healthcare, New Orleans, Louisiana, USA, January 10-14, 2015. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 9(6), 422-422, Article ID Board #144.
Open this publication in new window or tab >>From 'there' to 'here' to 'elsewhere: Enacting debriefing in interprofessional medical education simulation
2014 (English)In: Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, ISSN 1559-2332, E-ISSN 1559-713X, Vol. 9, no 6, p. 422-422, article id Board #144Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Hypothesis:

Simulation is gaining international interest as a way to arrange a safe environment for practicing clinical, communicative and interprofessional competence in professional education within health care. However, simulation was originally developed to support and train professionals. The application of medical simulation in interprofessional education for students is still underresearched and undertheorised (1). Recent research and theory argue that professional learning in simulation is embodied, relational, and situated in social-material relations (2,3). Research on how instructional design of simulation as an integrated part of professional curricula support student learning is needed (4), as well as research focusing on what the relevant characteristics of debriefing that lead to effective learning are (1). The aim of this study is to explore the enactment of debriefing as a support for learning in interprofessional medical education simulation.

Methods:

This paper draw on findings from a large research project conducted by research environments at Linköping University (LiU), Karolinska Institute (KI) and University of Gothenburg (GU), Sweden. The data have been collected by standardised video recordings of all phases in the simulation (briefing, simulation and debriefing phases). Totally 30 simulation sessions were video recorded, 10
 sessions by each research team. Out of these recordings, 13 simulation sessions were professional teams and 17 sessions were nursing and medical students simulating as a compulsory part of their education in the last semester before graduation. The student sessions are around 18 hours of recordings and altogether 106 students, 71 females and 35 males, participated in the simulation either as active participants in the simulation or as observers. 66 were nursing students and 40 were medical students. The research project has been ethically approved by Linköping University, Sweden (Dnr 2012/439-31).

Results:

A framework for the analysis of the video recordings was developed on the basis of socio-material theory, with a particular focus on interprofessional collaboration. Sayings, doings and relatings in the debriefing with regard to specific activities or events during the sequence of the scenario were noted through ethnographic field notes and selected segments were transcribed (5). A purposeful constant comparative qualitative analysis (6) was made in three steps comparing sequences of the scenario 1) within a single video recording 2) between different video recordings of the same scenario 3) between video recordings of different scenarios. The findings suggest that interprofessional learning in medical education simulation can become jeopardised in the debriefing. Three interrelated aspects of lacking support for learning were identified, a) debriefing as algorithm or as laisséz-faire, b) neglect of team performance as a topic for reflection, and c) time constraints.

Conclusion:

The results raise questions whether debriefing in medical simulation as modelled on training of qualified health professionals provides a useful framework applied in undergraduate education with students learning to become health professionals. The experiences of the simulation ‘there’ are intended to become re-contextualised in the debriefing ‘here’. Our findings indicate that the socio-material arrangements of the debriefing instead risk taking the students ‘elsewhere’.  Structure or lack of structure of the debriefing seem both to jeopardise the support of interprofessional learning or even overlook interprofessional collaboration as a topic for reflection. The time constraints of the complex logistics of arranging interprofessional simulation-based education as a regular curricular activity for large classes can potentially turn debriefing into a superficial exercise with little or no connection to the intended learning outcomes.

REFERENCES

1) Issenberg B. Ringsted C. Østergaard D. Dieckmann P. Setting a Research Agenda for Simulation-Based Healthcare Education. A Synthesis of the Outcome From an Utstein Style Meeting. Sim Healthcare 2011; 6:155–167.

2) Nyström S. Dahlberg J. Hult H. Crossing locations of enacting and observing simulations: Ways of constructing interprofessional learning. Paper to be presented at the Second International ProPEL conference 'Professional Matters: Materialities and Virtualities of Professional Learning', University of Stirling, UK; 2014, 25-27 June.

3) Schatzki T. The site of the social: A philosophical account of the constitution of social life and change. University Park: Pennsylvania State University Press; 2002.

4) Motola I, Sullivan J, Issenberg S, Devine L, Chung H. Simulation in healthcare education: A best evidence practical guide. AMEE Guide No. 82. Medical Teacher [serial online]. October 1, 2013;35(10):e1511-e1530.

5) Heath C. Hindmarsh J. Luff P. Video in qualitative research: analysing social interaction in everyday life. Los Angeles: SAGE; 2010.

6) Boeije H. A Purposeful Approach to the Constant Comparative Method in the Analysis of Qualitative Interviews. Quality & Quantity 2002; 36:391–409.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2014
National Category
Clinical Medicine Educational Sciences
Identifiers
urn:nbn:se:liu:diva-113843 (URN)10.1097/01.SIH.0000459313.37986.46 (DOI)
Conference
The 15th Annual Meeting on Simulation in Healthcare, New Orleans, Louisiana, USA, January 10-14, 2015
Projects
Interprofessionellt lärande i simuleringsbaserad utbildning för hälso- och sjukvårdens professioner.
Funder
Swedish Research Council, C0545001
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2017-12-05Bibliographically approved
Thörne, K., Hult, H., Andersson Gäre, B. & Abrandt Dahlgren, M. (2014). The Dynamics of Physicians’ Learning and Support of Others’ Learning. Professions & Professionalism, 4(1)
Open this publication in new window or tab >>The Dynamics of Physicians’ Learning and Support of Others’ Learning
2014 (English)In: Professions & Professionalism, ISSN 1893-1049, E-ISSN 1893-1049, Vol. 4, no 1Article in journal (Refereed) Published
Abstract [en]

Learning has been defined as a condition for improving the quality of healthcare practice. The focus of this paper is on physicians’ learning and their support of others’ learning in the context of Swedish healthcare. Data were generated through individual and focus group interviews and analyzed from a socio-material practice theory perspective. During their workday, physicians dynamically alternated between their own learning and their support of others’ learning in individual patient processes. Learning and learning support were interconnected with the versatile mobility of physicians across different contexts and their participation in multiple communities of collaboration and through tensions between responsibilities in healthcare. The findings illustrate how learning enactments are framed by the existing “practice architectures.” We argue that productive reflection on dimensions of learning enactments in practice can enhance physicians’ professional learning and improve professional practice.

Place, publisher, year, edition, pages
Högskolan Oslo och Akershus, 2014
Keywords
professional practice; physicians; learning; workplace learning; practice theory; interprofessional learning
National Category
Medical and Health Sciences Social Sciences
Identifiers
urn:nbn:se:liu:diva-105998 (URN)10.7577/pp.605 (DOI)
Available from: 2014-04-16 Created: 2014-04-16 Last updated: 2018-04-20Bibliographically approved
Stenfors-Hayes, T., Hult, H. & Abrandt Dahlgren, M. (2013). A phenomenographic approach to research in medical education. Medical Education, 47(3), 261-270
Open this publication in new window or tab >>A phenomenographic approach to research in medical education
2013 (English)In: Medical Education, ISSN 0308-0110, E-ISSN 1365-2923, Vol. 47, no 3, p. 261-270Article in journal (Refereed) Published
Abstract [en]

Context  Phenomenography is a qualitative approach to research which has revolutionised the way that researchers and teachers think about the processes and outcomes of learning in higher education. Phenomenography has also been used successfully in medical and health care research for the last 20 years. Phenomenography provides a lens through which to view certain types of research question. It also provides direction for how to empirically carry out the research.

Methods  This paper introduces phenomenography as a viable qualitative approach for use in medical education research.

Results  A phenomenographic study maps the qualitatively different ways in which people experience a phenomenon. This type of study can have an important impact on, for example, patient communication, clinical practice and health care education.

Conclusion  We suggest that a phenomenographic approach can be used to explore many medical education research issues, and can facilitate more solid links between research and educational development and change.

Place, publisher, year, edition, pages
Blackwell Publishing, 2013
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-90062 (URN)10.1111/medu.12101 (DOI)000314915100008 ()
Available from: 2013-03-21 Created: 2013-03-19 Last updated: 2017-12-06
Lindh Falk, A., Hult, H., Hammar, M., Hopwood, N. & Abrandt Dahlgren, M. (2013). One site fits all? A student ward as a learning practice for interprofessional development. Journal of Interprofessional Care, 27(6), 476-481
Open this publication in new window or tab >>One site fits all? A student ward as a learning practice for interprofessional development
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2013 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 27, no 6, p. 476-481Article in journal (Refereed) Published
Abstract [en]

Interprofessional training wards (IPTWs), aiming to enhance interprofessional collaboration, have been implemented in medical education and evaluated over the last decade. The Faculty of Health Sciences, Linkoping University has, in collaboration with the local health provider, arranged such training wards since 1996, involving students from the medical, nursing, physiotherapy, and occupational therapy programs. Working together across professional boundaries is seen as a necessity in the future to achieve sustainable and safe healthcare. Therefore, educators need to arrange learning contexts which enhance students interprofessional learning. This article shows aspects of how the arrangement of an IPTW can influence the students collaboration and learning. Data from open-ended questions from a questionnaire survey, during autumn term 2010 and spring term 2011 at an IPTW, was analyzed qualitatively using a theoretical framework of practice theory. The theoretical lens gave a picture of how architectures of the IPTW create a clash between the "expected" professional responsibilities and the "unexpected" responsibilities of caring work. Also revealed was how the proximity between students opens up contexts for negotiations and boundary work. The value of using a theoretical framework of professional learning in practice within the frames of healthcare education is discussed.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keywords
Collaboration, interprofessional education, interprofessional training ward, practice theory, professional boundaries, qualitative method
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-102721 (URN)10.3109/13561820.2013.807224 (DOI)000327284700006 ()
Available from: 2013-12-19 Created: 2013-12-19 Last updated: 2017-12-06
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