Frontiers in Medicine is delighted to present the ‘Reviews in’ series of Research Topics. Reviews in is a series being launched across Frontiers in Medicine’s sections which aims to publish high-quality review articles on key topics within the field. The goal of this series is to highlight recent advances within the field, whilst emphasizing important directions and new possibilities for future inquiries. This Research Topic welcomes full-length, mini and systematic review papers on topics within Healthcare Professions Education. New articles will be added to this collection as they are published. Please note that manuscripts consisting solely of bioinformatics or computational analyses of public genomic or transcriptomic databases will not be considered for this collection

Faculty of Medicine, University of Kelaniya

QU Health, Qatar University

Exploring recent advances within healthcare professions and emphasizing new opportunities for inquiry.

. This research topic focuses on professional medical education and clinical reasoning of physicians and nurses, as well as the effectiveness of the BOPPPS teaching strategy compared to traditional lecture-based learning in Chinese medical education. The following are some of the key highlights: <ul> <li>Traditional, constructivist, and blended learning approaches are important for clinicians and healthcare systems to improve the quality of care.</li> <li>The onion model reveals differences in the philosophical and technical layers of clinical reasoning of physicians and nurses.</li> <li>Wrist arthroscopy requires a high level of technical ability and a new progressive wrist training system has been introduced.</li> <li>The BOPPPS method is an effective teaching strategy for Chinese medical students to improve skill scores, knowledge scores, comprehensive ability scores, and teaching satisfaction.</li> </ul>

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Frontiers in Medicine

Healthcare Professions Education

Reviews in Healthcare Professions Education

Rapidly proliferating high-quality evidence supports daily decision-making in clinical practice. Continuing professional medical education links this evidence to practicing clinicians who are strongly motivated to improve the quality of their care by using the latest information. Approaches to professional education vary, and their effects depend on specific scenarios. This narrative review summarizes the main approaches for professional medical education that facilitate the mobilization of evidence for clinicians. It includes traditional learning (passive and active dissemination of educational materials, lectures, and mass media dissemination), constructivist learning (engaging in local consensus processes and education outreach visits, interfacing with local opinion leaders, conducting patient-mediated interventions, employing audit and feedback processes, and utilizing clinical decision-supporting systems), and blended learning approaches (the integration of in-person or online passive learning with active and creative learning by the learners). An optimized selection from these approaches is challenging but critical to clinicians and healthcare systems.

Rapidly proliferating high-quality evidence supports daily decision-making in clinical practice. Continuing professional medical education links this evidence to practicing clinicians who are strongly motivated to improve the quality of their care by using the latest information. Approaches to professional education vary, and their effects depend on specific scenarios. This narrative review summarizes the main approaches for professional medical education that facilitate the mobilization of evidence for clinicians. It includes traditional learning (passive and active dissemination of educational materials, lectures, and mass media dissemination), constructivist learning (engaging in local consensus processes and education outreach visits, interfacing with local opinion leaders, conducting patient-mediated interventions, employing audit and feedback processes, and utilizing clinical decision-supporting systems), and blended learning approaches (the integration of in-person or online passive learning with active and creative learning by the learners). An optimized selection from these approaches is challenging but critical to clinicians and healthcare systems.

Professional medical education approaches: mobilizing evidence for clinicians

Physicians are expected to place the patient’s interests above their own. Such prioritization has worldwide consent. It constitutes the difference between medicine and other professions. The present conceptual opinion paper summarizes the authors’ clinical experience with patient care and student teaching during the last 45 years. The authors comment on their own conception by referring to present debates and prominent statements from the past. Fundamental changes in medicine have taken place over the last five decades. New diseases have emerged while diagnostic and therapeutic options for patients have grown steadily – along with healthcare costs. At the same time, economic and legal constraints for physicians have increased, as has moral pressure. The interaction of physicians with patients has gradually shifted from a personal to a factual relationship. In the factual, more formal relationship, the patient and physician represent equal partners of a legal contract, which jeopardizes the prioritization of the patient’s interests. The formal relationship implies defensiveness. By contrast, in the personal relationship, the physician adopts an existentialist commitment while simultaneously enabling and respecting the patient’s autonomous decision-making. The authors argue for the personal relationship. However, the patient and physician are no friends. Consequently, the physician in effect competes with the patient from a knowledge-based but opposite position. Both need to make efforts to consent and maintain the relationship even when they dissent. This implies that the physician does not simply comply with the patient’s wishes.

Physicians are expected to place the patient&#x2019;s interests above their own. Such prioritization has worldwide consent. It constitutes the difference between medicine and other professions. The present conceptual opinion paper summarizes the authors&#x2019; clinical experience with patient care and student teaching during the last 45&#x2009;years. The authors comment on their own conception by referring to present debates and prominent statements from the past. Fundamental changes in medicine have taken place over the last five decades. New diseases have emerged while diagnostic and therapeutic options for patients have grown steadily &#x2013; along with healthcare costs. At the same time, economic and legal constraints for physicians have increased, as has moral pressure. The interaction of physicians with patients has gradually shifted from a personal to a factual relationship. In the factual, more formal relationship, the patient and physician represent equal partners of a legal contract, which jeopardizes the prioritization of the patient&#x2019;s interests. The formal relationship implies defensiveness. By contrast, in the personal relationship, the physician adopts an existentialist commitment while simultaneously enabling and respecting the patient&#x2019;s autonomous decision-making. The authors argue for the personal relationship. However, the patient and physician are no friends. Consequently, the physician in effect competes with the patient from a knowledge-based but opposite position. Both need to make efforts to consent and maintain the relationship even when they dissent. This implies that the physician does not simply comply with the patient&#x2019;s wishes.

Enemy or friend: the personal and the factual patient-physician relationship

When physicians and nurses are looking at the same patient, they may not see the same picture. If assuming that the clinical reasoning of both professions is alike and ignoring possible differences, aspects essential for care can be overlooked. Understanding the multifaceted concept of clinical reasoning of both professions may provide insight into the nature and purpose of their practices and benefit patient care, education and research. We aimed to identify, compare and contrast the documented features of clinical reasoning of physicians and nurses through the lens of layered analysis and to conduct a simultaneous concept analysis. The protocol of this systematic integrative review was published <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1136/bmjopen-2021-049862" xmlns:xlink="http://www.w3.org/1999/xlink">doi: 10.1136/bmjopen-2021-049862</ext-link>. A comprehensive search was performed in four databases (PubMed, CINAHL, Psychinfo, and Web of Science) from 30th March 2020 to 27th May 2020. A total of 69 Empirical and theoretical journal articles about clinical reasoning of practitioners were included: 27 nursing, 37 medical, and five combining both perspectives. Two reviewers screened the identified papers for eligibility and assessed the quality of the methodologically diverse articles. We used an onion model, based on three layers: Philosophy, Principles, and Techniques to extract and organize the data. Commonalities and differences were identified on professional paradigms, theories, intentions, content, antecedents, attributes, outcomes, and contextual factors. The detected philosophical differences were located on a care-cure and subjective-objective continuum. We observed four principle contrasts: a broad or narrow focus, consideration of the patient as such or of the patient and his relatives, hypotheses to explain or to understand, and argumentation based on causality or association. In the technical layer a difference in the professional concepts of diagnosis and the degree of patient involvement in the reasoning process were perceived. Clinical reasoning can be analysed by breaking it down into layers, and the onion model resulted in detailed features. Subsequently insight was obtained in the differences between nursing and medical reasoning. The origin of these differences is in the philosophical layer (professional paradigms, intentions). This review can be used as a first step toward gaining a better understanding and collaboration in patient care, education and research across the nursing and medical professions.

When physicians and nurses are looking at the same patient, they may not see the same picture. If assuming that the clinical reasoning of both professions is alike and ignoring possible differences, aspects essential for care can be overlooked. Understanding the multifaceted concept of clinical reasoning of both professions may provide insight into the nature and purpose of their practices and benefit patient care, education and research. We aimed to identify, compare and contrast the documented features of clinical reasoning of physicians and nurses through the lens of layered analysis and to conduct a simultaneous concept analysis. The protocol of this systematic integrative review was published <a href="https://doi.org/10.1136/bmjopen-2021-049862" style="color:#63cde5;">doi: 10.1136/bmjopen-2021-049862</a>. A comprehensive search was performed in four databases (PubMed, CINAHL, Psychinfo, and Web of Science) from 30th March 2020 to 27th May 2020. A total of 69 Empirical and theoretical journal articles about clinical reasoning of practitioners were included: 27 nursing, 37 medical, and five combining both perspectives. Two reviewers screened the identified papers for eligibility and assessed the quality of the methodologically diverse articles. We used an onion model, based on three layers: Philosophy, Principles, and Techniques to extract and organize the data. Commonalities and differences were identified on professional paradigms, theories, intentions, content, antecedents, attributes, outcomes, and contextual factors. The detected philosophical differences were located on a care-cure and subjective-objective continuum. We observed four principle contrasts: a broad or narrow focus, consideration of the patient as such or of the patient and his relatives, hypotheses to explain or to understand, and argumentation based on causality or association. In the technical layer a difference in the professional concepts of diagnosis and the degree of patient involvement in the reasoning process were perceived. Clinical reasoning can be analysed by breaking it down into layers, and the onion model resulted in detailed features. Subsequently insight was obtained in the differences between nursing and medical reasoning. The origin of these differences is in the philosophical layer (professional paradigms, intentions). This review can be used as a first step toward gaining a better understanding and collaboration in patient care, education and research across the nursing and medical professions.

Reasoning like a doctor or like a nurse? A systematic integrative review

The wrist is a complex joint that bridges the hand to the forearm. Patients with wrist disorders increasingly prefer minimally invasive procedures for wrist joint diagnosis and treatment. Wrist arthroscopy offers direct visualization of the structures of the joint anatomy and existing disease processes while causing minimal damage to surrounding soft tissue. However, it requires a high level of technical ability for wrist arthroscopy practitioners. Therefore, an improved focus on wrist arthroscopy training combining new educational media and traditional practice should aid in the development of novel wrist arthroscopy training mode. This article aims to describe the status of wrist training and evaluation systems and introduce a new progressive wrist training system.

The wrist is a complex joint that bridges the hand to the forearm. Patients with wrist disorders increasingly prefer minimally invasive procedures for wrist joint diagnosis and treatment. Wrist arthroscopy offers direct visualization of the structures of the joint anatomy and existing disease processes while causing minimal damage to surrounding soft tissue. However, it requires a high level of technical ability for wrist arthroscopy practitioners. Therefore, an improved focus on wrist arthroscopy training combining new educational media and traditional practice should aid in the development of novel wrist arthroscopy training mode. This article aims to describe the status of wrist training and evaluation systems and introduce a new progressive wrist training system.

The training of wrist arthroscopy

The BOPPPS teaching strategy has been used recently in many medical courses as an improved and more practical pedagogy in China. Nevertheless, the effectiveness of this pedagogy has not been fully assessed in terms of knowledge and skill outcomes in medical education. This meta-analysis aimed to evaluate the effectiveness of the BOPPPS strategy compared with traditional lecture-based learning (LBL) in Chinese medical education. The English electronic databases of Web of Science, PubMed, Embase, and the Cochrane Library and the Chinese electronic databases of CNKI, CQVIP, Wanfang, and CBM were used to search the publications related to the BOPPPS teaching strategy before 6 Jun 2022. Eligibility publications were retrieved and the data were extracted by two researchers independently according to the predefined inclusion and exclusion criteria. Quality analysis was performed using the Cochrane risk-of-bias tool, and the meta-analysis was performed using RevMan 5.3 and StataSE. We retrieved 367 records and 41 studies with a total of 5,042 medical students in the meta-analysis, which included 34 randomized controlled trials (RCTs) and 7 Cohort studies. In the cumulative meta-analysis, BOPPPS strategy significantly increased skill scores (SS) (SMD: 1.15, 95% CI: 1.00–1.30, P < 0.00001), knowledge examination scores (KES) (SMD: 1.56, 95% CI: 1.24–1.89, P < 0.00001), comprehensive ability scores (CAS) (SMD: 1.22, 95%CI: 0.85–1.59; P < 0.00001), and teaching satisfaction (TS) (OR: 3.64; 95%CI: 2.97–4.46; P < 0.0001) compared to the LBL model among those medical students. Statistically similar results were obtained in the sensitivity analysis. These results showed that the BOPPPS method is an effective teaching strategy for Chinese medical students to improve SS, knowledge scores, CAS, and TS when compared with LBL in medical education. Because of the limited quantity and quality of the included studies, further rigorous studies are needed to conclude with more confidence.

The BOPPPS teaching strategy has been used recently in many medical courses as an improved and more practical pedagogy in China. Nevertheless, the effectiveness of this pedagogy has not been fully assessed in terms of knowledge and skill outcomes in medical education. This meta-analysis aimed to evaluate the effectiveness of the BOPPPS strategy compared with traditional lecture-based learning (LBL) in Chinese medical education. The English electronic databases of Web of Science, PubMed, Embase, and the Cochrane Library and the Chinese electronic databases of CNKI, CQVIP, Wanfang, and CBM were used to search the publications related to the BOPPPS teaching strategy before 6 Jun 2022. Eligibility publications were retrieved and the data were extracted by two researchers independently according to the predefined inclusion and exclusion criteria. Quality analysis was performed using the Cochrane risk-of-bias tool, and the meta-analysis was performed using RevMan 5.3 and StataSE. We retrieved 367 records and 41 studies with a total of 5,042 medical students in the meta-analysis, which included 34 randomized controlled trials (RCTs) and 7 Cohort studies. In the cumulative meta-analysis, BOPPPS strategy significantly increased skill scores (SS) (SMD: 1.15, 95% CI: 1.00–1.30, P &lt; 0.00001), knowledge examination scores (KES) (SMD: 1.56, 95% CI: 1.24–1.89, P &lt; 0.00001), comprehensive ability scores (CAS) (SMD: 1.22, 95%CI: 0.85–1.59; P &lt; 0.00001), and teaching satisfaction (TS) (OR: 3.64; 95%CI: 2.97–4.46; P &lt; 0.0001) compared to the LBL model among those medical students. Statistically similar results were obtained in the sensitivity analysis. These results showed that the BOPPPS method is an effective teaching strategy for Chinese medical students to improve SS, knowledge scores, CAS, and TS when compared with LBL in medical education. Because of the limited quantity and quality of the included studies, further rigorous studies are needed to conclude with more confidence.

Effectiveness of bridge-in, objective, pre-assessment, participatory learning, post-assessment, and summary teaching strategy in Chinese medical education: A systematic review and meta-analysis