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  • 1.
    Allvin, Renée
    et al.
    Clinical Skills Centre, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro.
    Berndtzon, Magnus
    Metodikum - Skill Centre of Medical Simulation Region County Jönköping, Jönköping.
    Carlzon, Liisa
    Simulation Centre West, Department of Research, Education and Development, Sahlgrenska University Hospital, Gothenburg.
    Edelbring, Samuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm.
    Hult, Håkan
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Hultin, Magnus
    Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Medical Faculty, Umeå University, Umeå.
    Karlgren, Klas
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm; Department of Research, Education and Development and Innovation, Södersjukhuset Hospital, Stockholm.
    Masiello, Italo
    Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset Hospital, Stockholm.
    Södersved Källestedt, Marie-Louise
    Clinical Skills Centre, Centre for Clinical Research, Uppsala University, Västerås.
    Tamás, Éva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Confident but not theoretically grounded: experienced simulation educators perceptions of their own professional development2017In: Advances in Medical Education and Practice, ISSN 1179-7258, E-ISSN 1179-7258, Vol. 8, p. 99-108Article in journal (Refereed)
    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.

  • 2.
    Edelbring, Samuel
    Karolinska Institutet, Stockholm.
    A three-fold framework for relating to innovations and technology in education: learning from, with and about technology2010In: Interprofessional E-Learning and Collaborative Work: practices and technologies / [ed] Adrian Bromage, Lynn Clouder, Jill Thistlethwaite and Frances Gordon, Hershey, PA: IGI Global, 2010, p. 23-33Chapter in book (Refereed)
    Abstract [en]

    In recent years computer technology has developed quickly as have cultural practices in society. However, educational practices with technology have not yet reached the point where educators and learners benefit optimally from innovative technology. In interprofessional education (IPE) there are examples of technology use that forms an integral part of education. To improve IPE there is a need for reflection on how today and tomorrow’s technology can contribute. As technology and its practices melt together this reflection is however, not easily done. A framework intended as a starting point for such reflection is presented in the following chapter which involves learning from, with and about technology. To assess the benefit of technology for learning we need research on technology integration, on outcomes from learning with technology as well as processes of learning in conjunction with technology. This research has to use different perspectives involving various scientific traditions.

  • 3.
    Edelbring, Samuel
    Karolinska Institutet.
    Expectations and experiences of the collaborative aspect of virtual patient work.2013Conference paper (Refereed)
    Abstract [en]

    Background: The small group setting has proved beneficial for learning (Lou et al., 2001). Furthermore, the reasoning process is a goal in itself within an interpersonal view of learning (Crook, 2010). In medical education the use of virtual patients (VPs) has emerged as a method to train clinical reasoning which implies an increased interest for peer collaboration. The VPs are however often used individually in a self-study manner. One study reports 94% individual use (Fall et al., 2005).The aim of this study is to gain knowledge about how students perceive collaboration using VPs and the reasons for individual or collaborative VP work.

    Summary of work: Students worked with four VPs during clinical clerkship in Rheumatology. All students during one semester (n=30) were asked to fill in a questionnaire concerning collaborative VP work. Questionnaire responses were analysed thematically (Braun and Clarke, 2006).

    Summary of results: Twenty-nine students (97%) answered the questionnaire. 62% of the students worked individually with the virtual patients, 24% both individually and collaboratively, and 14% only in the collaborative setting. All of those working in the collaboratively stated learning reasons for doing so. Almost all (94%) of the reasons for working individually were of practical character. Those working in both settings stated both practical and learning reasons for doing so.

    Conclusions: Students clearly see educational benefits of working collaboratively with VPs. However, for practical reasons collaborative case work seems often to give way to the individual self-study approach.

    Take-home messages: Practical opportunities should be arranged for in order to benefit from collaborative learning when using VPs.

  • 4.
    Edelbring, Samuel
    Karolinska Institutet.
    Measuring strategies for learning regulation in medical education: Scale reliability and dimensionality in a Swedish sample.2012In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 12, no 76Article in journal (Refereed)
    Abstract [en]

    Background

    The degree of learners’ self-regulated learning and dependence on external regulation influence learning processes in higher education. These regulation strategies are commonly measured by questionnaires developed in other settings than in which they are being used, thereby requiring renewed validation. The aim of this study was to psychometrically evaluate the learning regulation strategy scales from the Inventory of Learning Styles with Swedish medical students (N = 206).

    Methods

    The regulation scales were evaluated regarding their reliability, scale dimensionality and interrelations. The primary evaluation focused on dimensionality and was performed with Mokken scale analysis. To assist future scale refinement, additional item analysis, such as item-to-scale correlations, was performed.

    Results

    Scale scores in the Swedish sample displayed good reliability in relation to published results: Cronbach’s alpha: 0.82, 0.72, and 0.65 for self-regulation, external regulation and lack of regulation scales respectively. The dimensionalities in scales were adequate for self-regulation and its subscales, whereas external regulation and lack of regulation displayed less unidimensionality. The established theoretical scales were largely replicated in the exploratory analysis. The item analysis identified two items that contributed little to their respective scales.

    Discussion

    The results indicate that these scales have an adequate capacity for detecting the three theoretically proposed learning regulation strategies in the medical education sample. Further construct validity should be sought by interpreting scale scores in relation to specific learning activities. Using established scales for measuring students’ regulation strategies enables a broad empirical base for increasing knowledge on regulation strategies in relation to different disciplinary settings and contributes to theoretical development

  • 5.
    Edelbring, Samuel
    Karolinska Institutet.
    Research into the use of virtual patients is moving forward by zooming out2013In: Medical Education, ISSN 0308-0110, E-ISSN 1365-2923, Vol. 47, no 6, p. 544-546Article in journal (Other academic)
  • 6.
    Edelbring, Samuel
    Dept of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Technology in education, necessary but not sufficient: understanding learning with virtual patients2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    With the rapid technological development and the broadening access to computers over recent decades, several technological innovations have emerged in medical education, including virtual patients. Students’ use of virtual patients is proposed to fill gaps in clinical exposure, and train clinical reasoning. However, higher education faculties have been slow to adopt new technology as a regular part of curricula. Virtual patients and similar technologies have either been implemented by enthusiastic teachers or by university policy directives. A possible reason for the low uptake of virtual patients in curricula is a lack of a clear understanding of how their use contributes to student learning.

    The four studies described in this thesis address learning with virtual patients from three perspectives: the student perspective on learning with virtual patients; the course integration perspective; and the individual study strategy perspective. A mixed methods approach was used given the overarching interest to seek understanding and clarification of student learning with virtual patients.

    Data were gathered by research interviews with medical students during clerkship, and by questionnaires in clerkship preparatory courses. Interview data was analysed by a phenomenological approach, and scales were formed from questionnaire responses which were analysed cross-sectionally for the four teaching hospitals affiliated with the medical programme at Karolinska Institutet. Use frequency, students’ perceived benefit of virtual patients, their wish for more guidance on using virtual patients and, wish for more assessment and feedback on virtual patient work were targeted in the questionnaires. Furthermore, the students’ preferences of study strategies were analysed in relation to the virtual patient activity using regulation strategy scales from the Inventory of Learning Styles devised by Jan Vermunt.

    The findings suggested that virtual patient learning activities offer possibilities of applying biomedical knowledge to clinical cases in a way that was engaging and supported decisionmaking. Furthermore, the virtual patient learning activities were perceived as having an intermediate function between textbook learning and learning with actual patients. The consequences of integration strategies in the course context were influential for how students perceived the benefit of learning with virtual patients. Intensity of processing of virtual patient cases, and presenting cases for other students were associated with high perceived benefit of virtual patient learning activities. Students’ self-regulation abilities were also associated with perceived benefit of the virtual patient learning activities, although to a lesser extent than the influence of the course context.

    The technology of virtual patients provides possibilities that enhance student learning, and should thus be a necessary part of education. However, this research show that an educational integration strategy is needed that supports students’ active processing of virtual patient cases.

  • 7.
    Edelbring, Samuel
    Karolinska Institutet.
    Validating Knowledge and Fostering Creativity in the University2012In: Thrita, ISSN 2352-0620, Vol. 1, no 2, p. 67-68Article in journal (Refereed)
  • 8.
    Edelbring, Samuel
    et al.
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden.
    Broström, Olle
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sweden.
    Henriksson, Peter
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden.
    Vassiliou, Daphne
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sweden.
    Spaak, Jonas
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden.
    Dahlgren, Lars-Ove
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Fors, Uno
    Department of Computer and Systems Sciences, Faculty of Social Sciences, Stockholm University, Sweden.
    Zary, Nabil
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden.
    Integrating virtual patients into courses: follow-up seminars and perceived benefit2012In: Medical Education, ISSN 0308-0110, E-ISSN 1365-2923, Vol. 46, no 4, p. 417-425Article in journal (Refereed)
    Abstract [en]

    CONTEXT The use of virtual patients (VPs) suggests promising effects on student learning. However, currently empirical data on how best to use VPs in practice are scarce. More knowledge is needed regarding aspects of integrating VPs into a course, of which student acceptance is one key issue. Several authors call for looking beyond technology to see VPs in relation to the course context. The follow-up seminar is proposed as an important aspect of integration that warrants investigation. less thanbrgreater than less thanbrgreater thanMETHODS A cross-sectional explanatory study was performed in a clinical clerkship introduction course at four teaching hospitals affiliated to the same medical faculty. The VP-related activities were planned collaboratively by teachers from all four settings. However, each setting employed a different strategy to follow up the activity in the course. Sixteen questionnaire items were grouped into three scales pertaining to: perceived benefit of VPs; wish for more guidance on using VPs, and wish for assessment and feedback on VPs. Scale scores were compared across the four settings, which were ranked according to the level of intensity of students processing of cases during VP follow- up activities. less thanbrgreater than less thanbrgreater thanRESULTS The perceived benefit of VPs and their usage were higher in the two intense-use settings compared with the moderate-and lowintensity settings. The wish for more guidance was high in the low-and one of the highintensity settings. Students in all settings displayed little interest in more assessment and feedback regarding VPs. less thanbrgreater than less thanbrgreater thanCONCLUSIONS High case processing intensity was related to positive perceptions of the benefit of VPs. However, the low interest in more assessment and feedback on the use of VPs indicates the need to clearly communicate the added value of the follow-up seminar. The findings suggest that a more intense follow-up pays off in terms of the benefit perceived by students. This study illustrates the need to consider VPs from the perspective of a holistic

  • 9.
    Edelbring, Samuel
    et al.
    Karolinska Institutet.
    Dahlgren, Lars Owe
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Phenomenology as research approach in medical education. Characteristics and empirical examples2010Conference paper (Refereed)
    Abstract [en]

    Background: In contemporary educational research learning is not necessarily determined by outcomes measured by scales or prefabricated instruments. Student learning is rather looked upon as a process where individuals learn in relation to what is meaningful to him or her (Marton & Booth). This implies that the students’ perception of their learning environment is of importance for the researcher. Phenomenology is a research approach focusing on how individuals experience their environment and thus, suitable for such investigations.

    Summary of work: The empirical phenomenological approach has been investigated regarding its aim and procedures. Elements of this approach will be presented illustrated by a recent study.

    Summary of results: Phenomenology has characteristic core elements that the researcher must acknowledge.

    Conclusions: Husserl’s phenomenological philosophy constitutes an excellent base for a research approach that aims at taking a subjects standpoint as a foundation for the research. A medical education researcher can be overwhelmed by philosophical literature, but contemporary psychologists have worked out empirical methods making the philosophy feasible to carry out in practice.

    Take-home messages: Empirical phenomenology is a research methodology highlighting individuals’ experiences, adapted from Husserl’s philosophical method. There are guidelines that break down the approach into practical procedures that make the approach possible to carry through in a medical education context.

  • 10.
    Edelbring, Samuel
    et al.
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Dastmalchi, Maryam
    Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden.
    Hult, Håkan
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Lundberg, Ingrid E.
    Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden.
    Dahlgren, Lars-Ove
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Experiencing virtual patients in clinical learning: a phenomenological study2011In: Advances in Health Sciences Education, ISSN 1382-4996, E-ISSN 1573-1677, Vol. 16, no 3, p. 331-345Article in journal (Refereed)
    Abstract [en]

    Computerised virtual patients (VPs) are increasingly being used in medical education. With more use of this technology, there is a need to increase the knowledge of students experiences with VPs. The aim of the study was to elicit the nature of virtual patients in a clinical setting, taking the students experience as a point of departure. Thirty-one students used VPs as a mandatory part of an early clinical rotation in rheumatology. Using the qualitative approach of phenomenology, we interviewed these students and then analysed data regarding their experiences of VPs as a learning activity. The result shows that students perceived VP activities in relation to actual patients, the clinical context and other learning activities. The VPs represented typical clinical cases which encouraged clinical reasoning and allowed for decision making. The students experienced the activities as integrating biomedical knowledge and clinical experience, providing structure that prepared for the unstructured clinical environment and patient encounters under unstressful conditions. However, the VPs were experienced as lacking the emotional interactivity and complexity of actual patients. Theoretical frameworks of clinical reasoning and experiential learning are suggested as foundations for further educational integration of VPs in the clinical environment. VP activities during clinical rotations provide experiences of clinical reality and allow students to solve problems actively. These features are dependent on VP technology but are also contingent on the surrounding environment.

  • 11.
    Edelbring, Samuel
    et al.
    Karolinska Institutet.
    Dastmalchi, Maryam
    Karollinska Institutet.
    Lundberg, Ingrid E.
    Karolinska Institutet.
    Hult, Håkan
    Linköping University, Department of Behavioural Sciences and Learning, Education and Adult Learning. Linköping University, Faculty of Educational Sciences.
    Dahlgren, Lars Owe
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Virtual Patients in clinical education from a phenomenological perspective2009Conference paper (Refereed)
    Abstract [en]

    Background: Although Virtual Patients (VPs) are more commonly used today there is no clear-cut picture of the nature of VPs as a learning tool. This means that educators hesitate in further curricular integration of VPs. Students and educators need examples of how this innovation can support student learning in practice.

    Summary of work: We have analysed the use of VPs in a clinical rotation of medical students of rheumatology lasting 2-4 weeks. The phenomenological approach was used in order to maximise the student perspective. Focus lied with the character of VP learning and the immediate framework supporting meaningful learning with VPs at the clinic. We interviewed31 students followed by a phenomenological analysis of the transcriptions. This resulted inincreased knowledge of the value of VPs in this setting.

    Summary of results: VPs as a learning tool play a role of enhancing the value of other learning activities at the clinic. The immediate framework affects the way that students approach VPs. When students work in pairs, reflection and argumentation strengthen the learning experience.

    Conclusions: The study approach provided a way to characterise learning with VPs as enhancing the value of clinical education.

    Take-home messages: Phenomenological research interviews provide a way of discovering the value of innovations in medical education.

  • 12.
    Edelbring, Samuel
    et al.
    Karolinska Institutet.
    Fors, Uno GH
    Karolinska Institutet.
    Saether, Björn
    Statoil ASA.
    SvalSim—field work simulation system for problem-oriented learning in petroleum geology2004In: CAL-laborate International, ISSN 2200-4270, Vol. 12, no 1, p. 9-11Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    The Educational Technology Unit at Karolinska Institutet (KI) in Sweden has developed an on-screen simulation software, SvalSim, that simulates field work for problem-oriented learning in petroleum geology. The system is using numerous authentic geological data, takes the time aspect into account and lets users control almost all events resulting in a very realistic simulation. The educational setting for use of the simulation software is general training in geosciences and field courses in Norway e.g., at Svalbard. This article describes the system and the pedagogical objectives.

  • 13.
    Edelbring, Samuel
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institutet.
    Karlsson, Katarina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Meyer, Frida
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Tamás, Éva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Utvärdering av IPL-simulering på Clinicum: Simuleringsdag ”Akuta situationer” för sistaårsstudenter från sjuksköterske- och läkarprogrammen HT 20162017Report (Other academic)
    Abstract [sv]

    En gemensam simuleringsdag för sjuksköterske- och läkarstudenter har utvärderats och diskuteras här i relation till interprofessionellt lärande och simuleringsbaserat lärande.

    IPL-simuleringen kännetecknas av ett starkt studentengagemang och upplevs som mycket relevant och kliniskt autentisk. Den simuleringsbaserade satsningen är alltså fortsatt aktuell och har utvecklats till en hög nivå med relevans för lärande och klinisk förberedelse. Innehållet rör såväl kliniska som team­relaterade kunskaper och kompetenser. Simulering som undervisningsform uppskattas högt och simulerings­instruktörens bidrag till lärandet lyfts fram. Ambitionsnivån kan ytterligare höjas på några punkter. Kurskamraternas bidrag i lärandet kan ytterligare stärkas, likaså omvårdnads­innehållet i scenarierna.

    IPL-mål adresseras i aktiviteten, i synnerhet ökar teamsamverkan progressivt under dagen. Det inter­professionella lärandet kan stärkas ännu mer  genom att linjera tydligare med övriga IPL-moment samt knyta an till de uttalade IPL-curriculum-målen.

  • 14.
    Edelbring, Samuel
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institutet, Stockholm, Sweden.
    Wahlström, Rolf
    Karolinska Institutet, Stockholm, Sweden.
    Dynamics of study strategies and teacher regulation in virtual patient learning activities: a cross sectional survey2016In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, no 1, p. 122-Article in journal (Refereed)
    Abstract [en]

    Background

    Students’ self-regulated learning becomes essential with increased use of exploratory web-based activities such as virtual patients (VPs). The purpose was to investigate the interplay between students’ self-regulated learning strategies and perceived benefit in VP learning activities.

    Method

    A cross-sectional study (n = 150) comparing students’ study strategies and perceived benefit of a virtual patient learning activity in a clinical clerkship preparatory course. Teacher regulation varied among three settings and was classified from shared to strong. These settings were compared regarding their respective relations between regulation strategies and perceived benefit of the virtual patient activity.

    Results

    Self-regulation learning strategy was generally associated with perceived benefit of the VP activities (rho 0.27, p < 0.001), but was not true in all settings. The association was higher in the two strongly regulated settings. The external regulation strategy did generally associate weakly with perceived benefit (rho 0.17, p < 0.05) with large variations between settings.

    Conclusions

    The flexible student-autonomous appeal of virtual patients should not lead to the dismissal of guidance and related course activities. External teacher and peer regulation seem to be productive for increasing learners’ perceived benefit. Awareness of the interplay among teacher regulation (external) and various study strategies can increase the value of flexible web-based learning resources to students.

  • 15.
    Escher, Cecilia
    et al.
    CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
    Rystedt, Hans
    Department of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden.
    Creutzfeldt, Johan
    CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
    Meurling, Lisbet
    CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
    Nyström, Sofia
    Linköping University, Department of Behavioural Sciences and Learning, Education and Adult Learning. Linköping University, Faculty of Educational Sciences.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Edelbring, Samuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nordahl Amorøe, Torben
    Simulator Centre West, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hult, Håkan
    CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden.
    Felländer-Tsai, Li
    CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Method matters: impact of in-scenario instruction on simulation-based teamwork training2017In: Advances in Simulation, E-ISSN 2059-0628, Vol. 2, no 25Article in journal (Refereed)
    Abstract [en]

    Background

    The rationale for introducing full-scale patient simulators in training to improve patient safety is to recreate clinical situations in a realistic setting. Although high-fidelity simulators mimic a wide range of human features, simulators differ from the body of a sick patient. The gap between the simulator and the human body implies a need for facilitators to provide information to help participants understand scenarios. The authors aimed at describing different methods that facilitators in our dataset used to provide such extra scenario information and how the different methods to convey information affected how scenarios played out.

    Methods

    A descriptive qualitative study was conducted to examine the variation of methods to deliver extra scenario information to participants. A multistage approach was employed. The authors selected film clips from a shared database of 31 scenarios from three participating simulation centers. A multidisciplinary research team performed a collaborative analysis of representative film clips focusing on the interplay between participants, facilitators, and the physical environment. After that, the entire material was revisited to further examine and elaborate the initial findings.

    Results

    The material displayed four distinct methods for facilitators to convey information to participants in simulation-based teamwork training. The choice of method had impact on the participating teams regarding flow of work, pace, and team communication. Facilitators’ close access to the teams’ activities when present in the simulation suite, either embodied or disembodied in the simulation, facilitated the timing for providing information, which was critical for maintaining the flow of activities in the scenario. The mediation of information by a loudspeaker or an earpiece from the adjacent operator room could be disturbing for team communication.

    Conclusions

    In-scenario instruction is an essential component of simulation-based teamwork training that has been largely overlooked in previous research. The ways in which facilitators convey information about the simulated patient have the potential to shape the simulation activities and thereby serve different learning goals. Although immediate timing to maintain an adequate pace is necessary for professionals to engage in training of medical emergencies, novices may gain from a slower tempo to train complex clinical team tasks systematically.

  • 16.
    Friman, Anne
    et al.
    Karolinska Institutet.
    Wiegleb Edström, Desirée
    Karolinska Institutet.
    Edelbring, Samuel
    Karolinska Institutet.
    A mixed methods approach to nursing and medicine students’ attitudes towards collaboration2014Conference paper (Refereed)
    Abstract [en]

    Background: Lack of physician-nurse collaboration in wound management may result in prolonged healing process for the patients (Apelqvist, 2012). In order to facilitate future professional collaboration interprofessional undergraduate learning activities has been proposed (Barr et al., 2005). The aim of this study is to investigate changes and characteristics of nursing and medical students’ attitudes towards each other’s future professions in relation to a joint learning activity.

    Summary of Work: Medical (n=38) and nursing (n=30) students were jointly trained in compression therapy, Doppler assessment and wound case studies. Students were measured by the Jefferson scale on attitudes toward Physician-Nurse Collaboration (Hojat, et al., 1999) and compared to previously gathered baseline scores. Focus group interviews were held to deepen the knowledge about characteristics of attitudes towards both the others’ profession and towards collaboration.

    Summary of Results: Attitudes towards the other profession increased after interprofessional learning activity. This kind of learning activities may increase future professional collaboration and thus improve wound management.

    Discussion and Conclusions: Attitudes towards the other profession increased after interprofessional learning activity. This kind of learning activities may increase future professional collaboration and thus improve wound management.

    Take-home messages: Efforts should be made to find strategies for structures facilitating collaboration in clinical practice. Joint learning activities are appreciated by the students. These may result in better collaboration in students future professionals and may ultimately benefit patient care with better wound healing.

  • 17.
    Friman, Anne
    et al.
    Karolinska Institutet.
    Wiegleb Edström, Desirée
    Karolinska Institutet.
    Edelbring, Samuel
    Karolinska Institutet.
    An effort to winding future nurses and physicians together. Students’ joint learning about wound management.2014Conference paper (Refereed)
    Abstract [en]

    Background Lack of physician-nurse collaboration in wound management may result in prolonged healing process for the patients (Apelqvist, 2012). In order to facilitate future professional collaboration interprofessional undergraduate learning activities has been proposed (Barr et al., 2005).

    Objectives The aim of this study is to investigate changes and characteristics of nursing and medical students’ attitudes towards each other’s future professions in relation to a joint learning activity in wound management. Methods Medical (n=40) and nursing (n=50) students were jointly trained in compression therapy, Doppler assessment and wound case studies. Students were measured by the Jefferson scale on attitudes toward Physician-Nurse Collaboration (Hojat, et al., 1999) and compared to previously gathered baseline scores. Focus group interviews were held to deepen the knowledge about characteristics of attitudes towards both the others’ profession and towards collaboration.

    Results Students scored high on the Jefferson scale in conjunction to the IPE activity. However, since also the baseline group scored high, no differences were detected after joint training. Preliminary analysis of qualitative data shows that medical students’ consider the nursing role as practically oriented with focus on the patients’ different needs of care, while nursing students sees the role of physicians as generation bound pointing to elderly physicians’ dominance and younger physicians’ flexibility but also to variations between organizational levels of care. Students experienced a lack of structural support for collaboration in their clinical practice. Interprofessional training was considered as important to gain insight into each other’s complementing knowledge area. Furthermore joint training was considered providing wider perspectives of patient care.

    Implications The joint learning activity provided new insight into the other profession’s competence, and was appreciated by the students. This kind of learning activity may increase future professional collaboration and thus improve wound management. Efforts should be made to find strategies for structures facilitating collaboration in clinical practice.

    Keywords

    nurse-physician student, collaboration, wound management

  • 18.
    Friman, Anne
    et al.
    Karolinska Institutet, Sweden.
    Wiegleb Edström, Desirée
    Karolinska Institutet, Sweden.
    Edelbring, Samuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institutet, Sweden.
    Attitudes and perceptions from nursing and medical students towards the other profession in relation to wound care2017In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 31, no 5, p. 620-627Article in journal (Refereed)
    Abstract [en]

    Lack of nurse‒physician collaboration in wound care may result in prolonged healing times for patients. In order to facilitate future professional collaboration, undergraduate learning activities in interprofessional education (IPE) have been proposed. The aim of this study was to investigate nursing and medical students’ attitudes and perceptions towards each other’s future professions and interprofessional collaboration in wound care. Nursing and medical students took part in an interprofessional learning activity about wound care. Data were collected using the Jefferson Scale of Attitudes towards Physician‒Nurse Collaboration questionnaire to student groups before and after an IPE activity (pooled n = 221). Focus groups were conducted to deepen the knowledge about students’ attitudes and perceptions. The results showed high scores on the attitude scale (mean 53.2, possible maximum = 60) both before and after IPE, indicating positive attitudes towards nurse‒physician collaboration. Nursing students scored higher than medical students both pre-IPE (p < 0.001) and post-IPE (p = 0.006). However, no difference on scale scores could be identified between pre- and post-IPE. The following themes emerged in the analysis of focus group discussions: “Approaching patient care from different perspectives,” “Need for collaboration and clear professional roles in practice,” “Structures hindering future collaboration,” and “IPE as a tool for professional practice and roles.” The shared learning activity provided insights into the other profession’s competence. This kind of learning activity may increase future interprofessional collaboration, and thus, improve wound care.

  • 19.
    Hege, Inga
    et al.
    University of Munich, Germany; Geisel School Medical Dartmouth, NH USA.
    Kononowicz, Andrzej A.
    Jagiellonian University, Poland; Karolinska Institute, Sweden.
    Tolks, Daniel
    University of Munich, Germany.
    Edelbring, Samuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institute, Sweden.
    Kuehlmeyer, Katja
    University of Munich, Germany.
    A qualitative analysis of virtual patient descriptions in healthcare education based on a systematic literature review2016In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, no 146Article, review/survey (Refereed)
    Abstract [en]

    Background: Virtual Patients (VPs) have been in the focus of research in healthcare education for many years. The aim of our study was to analyze how virtual patients are described in the healthcare education literature, and how the identified concepts relate to each other. Methods: We performed a literature review and extracted 185 descriptions of virtual patients from the articles. In a qualitative content analysis approach we inductively-deductively developed categories and deducted subcategories. We constructed a concept map to illustrate these concepts and their interrelations. Results: We developed the following five main categories: Patient, Teacher, Virtual Patient, Curriculum, and Learner. The concept map includes these categories and highlights aspects such as the under-valued role of patients in shaping their virtual representation and opposing concepts, such as standardization of learner activity versus learner-centeredness. Conclusions: The presented concept map synthesizes VP descriptions and serves as a basis for both, VP use and discussions of research topics related to virtual patients.

  • 20.
    Kononowicz, Andrzej A.
    et al.
    Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Stockholm, Sweden; Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Kraków, Poland.
    Woodham, Luke
    Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Stockholm, Sweden; Institute of Medical and Biomedical Education, St George’s, University of London, London, UK.
    Georg, Carina
    Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Stockholm, Sweden.
    Edelbring, Samuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Stockholm, Sweden.
    Stathakarou, Natalia
    Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Stockholm, Sweden.
    Davies, David
    Warwick Medical School, University of Warwick, Warwick, UK.
    Masiello, Italo
    Department of Clinical Science and Education, Karolinska Institutet, Solna, Stockholm, Sweden.
    Saxena, Nakul
    Health Services and Outcomes Research (HSOR), National Healthcare Group, Singapore, Singapore.
    Tudor Car, Lorainne
    Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
    Car, Josip
    Health Services and Outcomes Research Programme, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK; Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
    Zary, Nabil
    Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Stockholm, Sweden; Mohammed VI University of Health Sciences, Casablanca, Morocco; Medical Education Research and Scholarship Unit, Lee Kong Chian Sch ool of Medicine, Nanyang Technological University, Singapore, Singapore.
    Virtual patient simulations for health professional education2016In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 5, article id CD012194Article in journal (Refereed)
    Abstract [en]

    This is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this review is to evaluate the effectiveness of virtual patient simulation as an educational intervention versus traditional learning, other types of e-Learning interventions and other forms of virtual patient simulation interventions for delivering pre-registration and post-registration healthcare professional education. We will primarily assess the impact of these interventions on learners knowledge, skills and attitudes. Our secondary objective is to assess the cost-effectiveness of these interventions.

  • 21.
    Kononowicz, Andrzej
    et al.
    Karolinska Institutet.
    Zary, Nabil
    Karolinska Institutet.
    Edelbring, Samuel
    Karolinska Institutet.
    Corral, Janet
    University of Colorado.
    Hege, Inga
    University of Munchen.
    Virtual patients - what are we talking about? A framework to classify the meanings of the term in healthcare education2015In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 15, no 11Article in journal (Refereed)
    Abstract [en]

    Background

    The term "virtual patients" (VPs) has been used for many years in academic publications, but its meaning varies, leading to confusion. Our aim was to investigate and categorize the use of the term "virtual patient" and then classify its use in healthcare education.

    Methods

    A literature review was conducted to determine all articles using the term "virtual patient" in the title or abstract. These articles were categorized into: Education, Clinical Procedures, Clinical Research and E-Health. All educational articles were further classified based on a framework published by Talbot et al. which was further developed using a deductive content analysis approach.

    Results

    536 articles published between 1991 and December 2013 were included in the study. From these, 330 were categorized as educational. Classifying these showed that 37% articles used VPs in the form of Interactive Patient Scenarios. VPs in form of High Fidelity Software Simulations (19%) and Virtual Standardized Patients (16%) were also frequent. Less frequent were other forms, such as VP Games.

    Analyzing the literature across time shows an overall trend towards the use of Interactive Patient Scenarios as the predominant form of VPs in healthcare education.

    Conclusions

    The main form of educational VPs in the literature are Interactive Patient Scenarios despite rapid technical advances that would support more complex applications. The adapted classification provides a valuable model for VP developers and researchers in healthcare education to more clearly communicate the type of VP they are addressing avoiding misunderstandings.

  • 22.
    Nesterowicz, Krzysztof
    et al.
    Jagiellonian University.
    Librowski, Tadeusz
    Jagiellonian University.
    Edelbring, Samuel
    Karolinska Institutet.
    Validating e-learning in continuing pharmacy education: user acceptance and knowledge change2014In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 14, no 33Article in journal (Refereed)
    Abstract [en]

    Background

    Continuing pharmacy education is becoming mandatory in most countries in order to keep the professional license valid. Increasing number of pharmacists are now using e-learning as part of their continuing education. Consequently, the increasing popularity of this method of education calls for standardization and validation practices. The conducted research explored validation aspects of e-learning in terms of knowledge increase and user acceptance.

    Methods

    Two e-courses were conducted as e-based continuing pharmacy education for graduated pharmacists. Knowledge increase and user acceptance were the two outcome measured. The change of knowledge in the first e-course was measured by a pre- and post-test and results analysed by the Wilcoxon signed–rank test. The acceptance of e-learning in the second e-course was investigated by a questionnaire and the results analysed using descriptive statistics.

    Results

    Results showed that knowledge increased significantly (p < 0.001) by 16 pp after participation in the first e-course. Among the participants who responded to the survey in the second course, 92% stated that e-courses were effective and 91% stated that they enjoyed the course.

    Conclusions

    The study shows that e-learning is a viable medium of conducting continuing pharmacy education; e-learning is effective in increasing knowledge and highly accepted by pharmacists from various working environments such as community and hospital pharmacies, faculties of pharmacy or wholesales.

  • 23.
    Nyström, Sofia
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education and Adult Learning. Linköping University, Faculty of Educational Sciences.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Edelbring, Samuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Hult, Håkan
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Continuing professional development: pedagogical practices of interprofessional simulation in health care2017In: Studies in Continuing Education, ISSN 0158-037X, E-ISSN 1470-126X, Vol. 39, no 3, p. 303-319Article in journal (Refereed)
    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.

    The full text will be freely available from 2018-12-06 14:53
  • 24.
    Nyström, Sofia
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education and Adult Learning. Linköping University, Faculty of Educational Sciences.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Edelbring, Samuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Hult, Håkan
    Linköping University, Department of Behavioural Sciences and Learning, Education and Adult Learning. Linköping University, Faculty of Educational Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Debriefing practices in interprofessional simulation with students: A sociomaterial perspective2016In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, no 148, p. 1-8Article in journal (Refereed)
    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. 

  • 25.
    Wahlgren, Carl-Fredrik
    et al.
    Karolinska Institutet.
    Edelbring, Samuel
    Karolinska Institutet.
    Fors, Uno GH
    Karolinska Institutet.
    Hindbeck, Hans
    Karolinska Institutet.
    Ståhle, Mona
    Karolinska Institutet.
    Evaluation of an interactive case simulation system in dermatology and venereology for medical students2006In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 6, no 40Article in journal (Refereed)
    Abstract [en]

    Background

    Most of the many computer resources used in clinical teaching of dermatology and venereology for medical undergraduates are information-oriented and focus mostly on finding a "correct" multiple-choice alternative or free-text answer. We wanted to create an interactive computer program, which facilitates not only factual recall but also clinical reasoning.

    Methods

    Through continuous interaction with students, a new computerised interactive case simulation system, NUDOV, was developed. It is based on authentic cases and contains images of real patients, actors and healthcare providers. The student selects a patient and proposes questions for medical history, examines the skin, and suggests investigations, diagnosis, differential diagnoses and further management. Feedback is given by comparing the user's own suggestions with those of a specialist. In addition, a log file of the student's actions is recorded. The program includes a large number of images, video clips and Internet links. It was evaluated with a student questionnaire and by randomising medical students to conventional teaching (n = 85) or conventional teaching plus NUDOV (n = 31) and comparing the results of the two groups in a final written examination.

    Results

    The questionnaire showed that 90% of the NUDOV students stated that the program facilitated their learning to a large/very large extent, and 71% reported that extensive working with authentic computerised cases made it easier to understand and learn about diseases and their management. The layout, user-friendliness and feedback concept were judged as good/very good by 87%, 97%, and 100%, respectively. Log files revealed that the students, in general, worked with each case for 60–90 min. However, the intervention group did not score significantly better than the control group in the written examination.

    Conclusion

    We created a computerised case simulation program allowing students to manage patients in a non-linear format supporting the clinical reasoning process. The student gets feedback through comparison with a specialist, eliminating the need for external scoring or correction. The model also permits discussion of case processing, since all transactions are stored in a log file. The program was highly appreciated by the students, but did not significantly improve their performance in the written final examination.

  • 26.
    Wijk, Linda
    et al.
    Karolinska Institutet.
    Edelbring, Samuel
    Karolinska Institutet.
    Svensson, Anna-Karin
    Karolinska Institutet.
    Karlgren, Klas
    Karolinska Institutet.
    Kristiansson, Marianne
    Karolinska Institutet.
    Fors, Uno GH
    Karolinska Institutet.
    A pilot for a computer-based simulation system for risk estimation and treatment of mentally disordered offenders.2009In: Informatics for Health and Social Care, ISSN 1753-8157, E-ISSN 1753-8165, Vol. 34, no 2, p. 106-115Article in journal (Refereed)
    Abstract [en]

    Risk/need analysis and treatment of mentally disordered offenders (MDOs) take place in constrained clinical settings, but violence has to be considered in a context where both social and cultural factors are of significance. One way to improve treatment and risk/need analysis of MDOs could be to develop simulation systems where users interact with video-based scenarios. The objective of this study was to develop and pilot test a simulation system to be used as a tool to study MDOs and possibly also to play a part in their rehabilitation. Collaboration between simulation and forensic psychiatry experts and a professional film team was set up. A simulation system called 'Reactions on Display' (RoD) was developed and a pilot study with eight patients and 13 staff members was carried out. Results from the study showed that RoD's interface and design were well received by patients and staff. Participants indicated that they found the video sequences realistic and the system enjoyable to use. The pilot study of RoD was positive, but further research should study possible clinical outcomes of the system. However, we believe that RoD could provide an advance in treatment and risk/need analysis of MDOs.

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