Maria Ekelin

Monitoring progression of clinical reasoning skills during health sciences education using the case method – a qualitative observational study

BackgroundOutcome- or competency-based education is well established in medical and health sciences education. Curricula are based on courses where students develop their competences and assessment is also usually course-based. Clinical reasoning is an important competence, and the aim of this study was to monitor and describe students’ progression in professional clinical reasoning skills during health sciences education using observations of group discussions following the case method.MethodsIn this qualitative study students from three different health education programmes were observed while discussing clinical cases in a modified Harvard case method session. A rubric with four dimensions – problem-solving process, disciplinary knowledge, character of discussion and communication – was used as an observational tool to identify clinical reasoning. A deductive content analysis was performed.ResultsThe results revealed the students’ transition over time from reasoning based strictly on theoretical knowledge to reasoning ability characterized by clinical considerations and experiences. Students who were approaching the end of their education immediately identified the most important problem and then focused on this in their discussion. Practice knowledge increased over time, which was seen as progression in the use of professional language, concepts, terms and the use of prior clinical experience. The character of the discussion evolved from theoretical considerations early in the education to clinical reasoning in later years. Communication within the groups was supportive and conducted with a professional tone.ConclusionsOur observations revealed progression in several aspects of students’ clinical reasoning skills on a group level in their discussions of clinical cases. We suggest that the case method can be a useful tool in assessing quality in health sciences education.

“I Didn’t Know What to Ask About”: First-Time Mothers’ Conceptions of Prenatal Preparation for the Early Parenthood Period

The aim of this phenomenographic study was to describe first-time mothers’ conceptions of prenatal preparation for the early parenthood period in relation to their experiences of early parenthood. Eighteen first-time mothers were interviewed approximately 1 month after giving birth. The categories identified in the analysis were: accessing appropriate sources of support, gaining knowledge to form realistic expectations, and mobilizing and strengthening personal resources. First-time mothers want health professionals to actively address postnatal issues as they have difficulties in knowing prenatally what knowledge will prepare them for early parenthood. Both professional and peer support during pregnancy were conceived as important for gaining knowledge. Professionals can support by guidance to reliable sources of information and encouraging personal reflections and partner communication.

Not now but later – a qualitative study of non-exercising pregnant women’s views and experiences of exercise

BackgroundEvidence has shown that there are several physical and mental advantages of exercise during pregnancy. Despite this, the recommendations for exercise during pregnancy are poorly fulfilled. The aim of this study was to illuminate non-exercising pregnant women’s views and experiences concerning exercise before and during pregnancy.MethodThe study had a qualitative design with an inductive approach and was analysed by content analysis. A total of 16 individual and face-to-face interviews were conducted with healthy pregnant women, mainly in the third trimester and living in Sweden. The participating women had not been exercising 3 months before pregnancy or during pregnancy.ResultsThe main category “Insurmountable now, but possible in the future” was based on the four categories: “Lost and lack of routines”, “Feelings of inadequacy”, “Having a different focus” and “Need for support”. The women experienced that their lack of routines was a major barrier that prevented them from exercising. Other factors that contributed were, for example, pregnancy-related problems, long working days and prioritizing family life. The women described it as difficult to combine exercise with their focus on the pregnancy and they missed continuous support from the antenatal care provider. The women expressed a need for suggestions concerning exercise during pregnancy and follow-up on previous counselling, especially when pregnancy-related issues arose. Information about easily accessible alternatives or simple home exercises was requested. They felt immobile and were not satisfied with their inactivity and tried to partly compensate with everyday activities. The women identified the postpartum period as an important possibility for becoming more active, for their own sake, but also because they wanted to become role models for their children.ConclusionContinuous support during pregnancy is needed concerning exercise. Pregnancy is mostly a barrier that prevents exercise for this group of women but, at the same time, may be a motivator and a possibility for better health. As the result showed that these women were highly motivated to a life-style change post-pregnancy, it may be crucial to support previously non-exercising women postpartum.

Expectant parents’ attitudes to termination of pregnancy in general and in cases of fetal abnormality

The aim of this article was to explore whether expectant parents’ attitudes to termination or continuation of pregnancy, both in general and in case of fetal abnormality, are affected by previous experiences of miscarriage and whether attitudes change after ultrasound screening with normal findings. It was also of interest to investigate differences in attitudes in relation to age, parity and gender. A prospective one-year cohort study was carried out. Questionnaires were administered before and after the ultrasound examination. Analyses included 1258 women and 925 men. A comparison between the results pre- and post-ultrasound showed that after the ultrasound examination, there were significant changes towards a more positive attitude to give birth to a baby with an abnormality. Men were significantly more willing to terminate for a fetal abnormality and significantly less hesitant towards abortion in general than women. Women aged 35 years or older were significantly less willing to give birth to a baby with an abnormality and significantly more positive to termination for fetal abnormality than younger women. Parents showed understanding attitudes towards other parents’ decisions no matter what these were. We conclude that parents need individualized information and support in connection with prenatal diagnosis, due to parental hesitancy. Midwives play an important role in this.

To know or not to know – parents’ attitudes to and preferences for prenatal diagnosis

Abstract Objective To highlight expectant parents’ attitudes concerning prenatal diagnosis, what the parents wish to know and what they chose not to know about their unborn baby, also in what form and to what extent they wish for prenatal diagnosis. Background: Parents have to make decisions concerning prenatal diagnosis. Screening programmes change rapidly and there is a need for parental influence on this development. Methods: An interview study with 10 women in late pregnancy and six partners. Results: The main categories ‘A time for preparation’ and ‘A lot but not everything’ included the parents’ positive attitudes towards prenatal diagnosis, especially if it could be carried out in early pregnancy and was of help for the baby, but also their negative attitudes toward information about possible future diseases that could not be prevented and towards invasive diagnosis. The parents had confidence in the caregivers’ offers of screening programmes, but described their own attitudes as changing from before pregnancy, when newly pregnant and after their ultrasound examination. The parents described themselves as partly lacking knowledge about what the existing options for prenatal diagnosis involved. Conclusions: There is a great need for competent caregivers to inform the parents-to-be about the different methods for fetal diagnosis available to them and also what information the different methods can give. Partners need to be involved in the decision-making process.