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Article: Medical Students' Learning About Other Professions Using an Interprofessional Virtual Patient While Remotely Connected With a Study Group: Mixed Methods Study.

Tran, Carrie / Toth-Pal, Eva / Ekblad, Solvig / Fors, Uno / Salminen, Helena

JMIR medical education

2023 Volume 9, Page(s) e38599

Abstract: Background: Collaboration with other professions is essential in health care education to prepare students for future clinical teamwork. However, health care education still struggles to incorporate interprofessional education. Distance learning and ... ...

Abstract	Background: Collaboration with other professions is essential in health care education to prepare students for future clinical teamwork. However, health care education still struggles to incorporate interprofessional education. Distance learning and virtual patients (VPs) may be useful additional methods to increase students' possibilities for interprofessional learning. Objective: This study had two aims. The first was to assess if an interprofessional VP case could facilitate medical students' learning about team collaboration in online groups. The second was to assess how students experienced learning with the VP when remotely connected with their group. Methods: A mixed methods design was used. The VP case was a 73-year-old man who needed help from different health professions in his home after a hip fracture. Questionnaires were answered by the students before and directly after each session. Qualitative group interviews were performed with each group of students directly after the VP sessions, and the interviews were analyzed using qualitative content analysis. Results: A total of 49 third-year medical students divided into 15 groups participated in the study. Each group had 2 to 5 students who worked together with the interprofessional VP without a teacher's guidance. In the analysis of the group interviews, a single theme was identified: the interprofessional VP promoted student interaction and gave insight into team collaboration. Two categories were found: (1) the structure of the VP facilitated students' learning and (2) students perceived the collaboration in their remotely connected groups as functioning well and being effective. The results from the questionnaires showed that the students had gained insights into the roles and competencies of other health care professions. Conclusions: This study demonstrates that an interprofessional VP enabled insights into team collaboration and increased understanding of other professions among student groups comprising only medical students. The interprofessional VP seemed to benefit students' learning in an online, remote-learning context. Although our VP was not used as an interprofessional student activity according to the common definition of interprofessional education, the results imply that it still contributed to students' interprofessional learning.
Language	English
Publishing date	2023-01-17
Publishing country	Canada
Document type	Journal Article
ISSN	2369-3762
ISSN	2369-3762
DOI	10.2196/38599
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Virtual patients reflecting the clinical reality of primary care - a useful tool to improve cultural competence.

Rothlind, Erica / Fors, Uno / Salminen, Helena / Wändell, Per / Ekblad, Solvig

BMC medical education

2021 Volume 21, Issue 1, Page(s) 270

Abstract: Background: Virtual patients are educational tools that may be described as case-based interactive computer simulations of clinical scenarios. In terms of learning outcomes, improved clinical reasoning skills and knowledge acquisition have been shown. ... ...

Abstract	Background: Virtual patients are educational tools that may be described as case-based interactive computer simulations of clinical scenarios. In terms of learning outcomes, improved clinical reasoning skills and knowledge acquisition have been shown. For further exploring the role of virtual patients in medical education, a greater focus on context-specific cases, combined with suitable educational activities, has been suggested. A knowledge gap has been identified in cultural competence in primary care. As primary care physicians are often the main medical providers for patients with refugee backgrounds, they would probably benefit from improved training focusing on how to apply cultural competence in everyday work. Using virtual patient cases, as a complement to clinical training, may be one way forward. The aim of this study was therefore to explore a learner perspective on the educational use of a virtual patient system designed to contribute to training in cultural competence in a primary care context. Methods: Three virtual patient cases portraying patients with refugee backgrounds were developed. The cases addressed various issues and symptoms common in primary care consultations, while also incorporating intercultural aspects. The system also provided the informants with individualized feedback. Primary care physicians and medical students were invited to test the cases and participate in an interview about their experience. Data was analyzed using qualitative content analysis. Results: The analysis generated the theme Virtual patients might help improve cultural competence in physicians and medical students by complementing knowledge gained through the informal curriculum. Informants at different educational levels found it suitable as a tool for introducing the topic and for reflecting on one's own consultations. It could also compensate for the predominant informal manner of learning cultural competence, described by the informants. Conclusions: Virtual patients could be useful for gaining cultural competence in a primary care context. Advantages that could benefit learners at both pre- and post-graduate levels are decreased dependence on the informal curriculum and being presented with an illustrative way of how cultural competence may be applied in the consultation.
MeSH term(s)	Clinical Competence ; Cultural Competency ; Curriculum ; Humans ; Primary Health Care ; Students, Medical
Language	English
Publishing date	2021-05-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2044473-4
ISSN	1472-6920 ; 1472-6920
ISSN (online)	1472-6920
ISSN	1472-6920
DOI	10.1186/s12909-021-02701-z
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Article ; Online: Primary care consultations on emotional distress - a part of the acculturation process in patients with refugee backgrounds: a grounded theory approach.

Rothlind, Erica / Fors, Uno / Salminen, Helena / Wändell, Per / Ekblad, Solvig

BMC family practice

2021 Volume 22, Issue 1, Page(s) 138

Abstract: Background: Considering the global refugee crisis, there is an increasing demand on primary care physicians to be able to adequately assess and address the health care needs of individual refugees, including both the somatic and psychiatric spectra. ... ...

Abstract	Background: Considering the global refugee crisis, there is an increasing demand on primary care physicians to be able to adequately assess and address the health care needs of individual refugees, including both the somatic and psychiatric spectra. Meanwhile, intercultural consultations are often described as challenging, and studies exploring physician-patient communication focusing on emotional distress are lacking. Therefore, the aim was to explore physician-patient communication, with focus on cultural aspects of emotional distress in intercultural primary care consultations, using a grounded theory approach, considering both the physician's and the patient's perspective. Methods: The study was set in Region Stockholm, Sweden. In total, 23 individual interviews and 3 focus groups were conducted. Resident physicians in family medicine and patients with refugee backgrounds, originating from Somalia, Syria, Afghanistan and Iraq, were included. Data was analysed using a grounded theory approach. Results: Over time, primary care patients with refugee backgrounds seemed to adopt a culturally congruent model of emotional distress. Gradual acceptance of psychiatric diagnoses as explanatory models for distress and suffering was noted, which is in line with current tendencies in Sweden. This acculturation might be influenced by the physician. Three possible approaches used by residents in intercultural consultations were identified: "biomedical", "didactic" and "compensatory". They all indicated that diagnoses are culturally valid models to explain various forms of distress and may thus contribute to shifting patient perceptions of psychiatric diagnoses. Conclusions: Physicians working in Swedish primary care may influence patients' acculturation process by inadvertently shifting their perceptions of psychiatric diagnoses. Residents expressed concerns, rather than confidence, in dealing with these issues. Focusing part of their training on how to address emotional distress in an intercultural context would likely be beneficial for all parties concerned.
MeSH term(s)	Acculturation ; Grounded Theory ; Humans ; Primary Health Care ; Psychological Distress ; Referral and Consultation ; Refugees
Language	English
Publishing date	2021-06-30
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1471-2296
ISSN (online)	1471-2296
DOI	10.1186/s12875-021-01487-9
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Article ; Online: The informal curriculum of family medicine - what does it entail and how is it taught to residents? A systematic review.

Rothlind, Erica / Fors, Uno / Salminen, Helena / Wändell, Per / Ekblad, Solvig

BMC family practice

2020 Volume 21, Issue 1, Page(s) 49

Abstract: Background: The informal curriculum is a seemingly well-explored concept in the realm of medical education. However, it is a concept with multiple definitions and the term "the hidden curriculum" is often used interchangeably. In short, they both refer ... ...

Abstract	Background: The informal curriculum is a seemingly well-explored concept in the realm of medical education. However, it is a concept with multiple definitions and the term "the hidden curriculum" is often used interchangeably. In short, they both refer to the implicit learning taking place outside the formal curriculum, encompassing both a trickling down effect of organizational values and attitudes passed on by a mentor or colleague. While the informal curriculum is a recurrent theme in medical education literature; it is seldom discussed in Family Medicine. As the informal curriculum is likely to be highly influential in the forming of future family practitioners, our aim was to explore the area further, with respect to the following: which elements of the informal curriculum are applicable in a Family Medicine context and what educational interventions for Family Medicine residents, visualizing the various educational elements of it, have been performed? Methods: We conducted a systematic review comprising iterative literature searches and a narrative synthesis of the results. Results: Twenty articles, published between 2000 and 2019, were included in the analysis which resulted in three partly interrelated themes comprising the informal curriculum in Family Medicine: gaining cultural competence, achieving medical professionalism and dealing with uncertainty. The themes on cultural competence and uncertainty seemed to be more contextual than professionalism, the latter being discussed in relation to the informal curriculum across other medical disciplines as well. Formalized training for Family Medicine residents in aspects of the informal curriculum appeared to be lacking, and in general, the quality of the few interventional studies found was low. Conclusions: Important aspects of being a family practitioner, such as cultural competence and dealing with uncertainty, are learned through a context-dependent informal curriculum. In order to ensure a more uniform base for all residents and to reduce the impact of the individual supervisor's preferences, complementary formalized training would be beneficial. However, to date there are too few studies published to conclude how to best teach the informal curriculum. Trial registration: The systematic review was registered with Prospero; registration number CRD42018104819.
MeSH term(s)	Curriculum ; Education, Medical/methods ; Family Practice/education ; Humans ; Internship and Residency/methods ; Teaching
Language	English
Publishing date	2020-03-11
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
ISSN	1471-2296
ISSN (online)	1471-2296
DOI	10.1186/s12875-020-01120-1
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: A virtual patient model for students' interprofessional learning in primary healthcare.

Tran, Carrie / Toth-Pal, Eva / Ekblad, Solvig / Fors, Uno / Salminen, Helena

PloS one

2020 Volume 15, Issue 9, Page(s) e0238797

Abstract: Objectives: Interprofessional education is important for increasing the quality of patient care, but organising it in primary healthcare is still challenging. The aim of this study was to develop and assess a virtual patient model for primary healthcare ...

Abstract	Objectives: Interprofessional education is important for increasing the quality of patient care, but organising it in primary healthcare is still challenging. The aim of this study was to develop and assess a virtual patient model for primary healthcare and to investigate students' perceptions of learning with this interprofessional virtual patient model. Methods: The virtual patient case described a patient with several medical conditions who had returned home after surgery. The virtual patient included text files, short videos, and links to illustrate different health professions' roles in home care. Ten interprofessional groups with 39 students assessed the virtual patient from four different study programmes: nursing, physiotherapy, medicine, and occupational therapy. The students answered a questionnaire about how they perceived the usability of the virtual patient and participated in group interviews. Qualitative content analysis was used to analyse the data from the semi-structured group interviews. Results: The analysis of the interviews resulted in four main categories: The virtual patient model facilitated the learning process; It was beneficial to have students from different programmes in the group when working with the virtual patient; Working with the virtual patient helped the students to understand the roles and competencies of their own and other professions and All professions are needed in clinical work in order to help the patient. The students perceived that the mixture of text and multimedia made the virtual patient seem authentic and stimulated their group discussions, which they valued most. The students gave generally high points for usability in the questionnaire, but they also gave input for improvement of the program in their comments. Conclusions: The interprofessional virtual patient model facilitated interactions and discussions between students and may be a useful complement for interprofessional education in clinical contexts and might be a suitable tool in preparing students for future teamwork.
MeSH term(s)	Adult ; Cooperative Behavior ; Female ; Health Occupations/education ; Humans ; Interprofessional Relations ; Learning ; Male ; Primary Health Care ; Students, Health Occupations ; Students, Medical ; Students, Nursing ; Surveys and Questionnaires ; Virtual Reality
Language	English
Publishing date	2020-09-23
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0238797
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Article ; Online: The Effect of Growth Medium Strength on Minimum Inhibitory Concentrations of Tannins and Tannin Extracts against

Štumpf, Sara / Hostnik, Gregor / Primožič, Mateja / Leitgeb, Maja / Salminen, Juha-Pekka / Bren, Urban

Molecules (Basel, Switzerland)

2020 Volume 25, Issue 12

Abstract: In this study the effect of growth medium strength on the minimum inhibitory concentration (MIC) of different tannins and tannin extracts ... ...

Abstract	In this study the effect of growth medium strength on the minimum inhibitory concentration (MIC) of different tannins and tannin extracts against
MeSH term(s)	Bacteriological Techniques ; Culture Media/chemistry ; Escherichia coli/drug effects ; Escherichia coli/growth & development ; Gallic Acid/chemistry ; Gallic Acid/pharmacology ; Hydrolyzable Tannins/chemistry ; Hydrolyzable Tannins/pharmacology ; Microbial Sensitivity Tests ; Mimosa/chemistry ; Molecular Structure ; Plant Extracts/chemistry ; Plants/chemistry ; Quercus/chemistry ; Tannins/chemistry ; Tannins/pharmacology
Chemical Substances	Culture Media ; Hydrolyzable Tannins ; Plant Extracts ; Tannins ; vescalagin (36001-47-5) ; Gallic Acid (632XD903SP)
Language	English
Publishing date	2020-06-26
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	1413402-0
ISSN	1420-3049 ; 1431-5165 ; 1420-3049
ISSN (online)	1420-3049
ISSN	1431-5165 ; 1420-3049
DOI	10.3390/molecules25122947
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Article ; Online: 240Pu/239Pu mass ratio in environmental samples in Finland.

Salminen-Paatero, S / Nygren, U / Paatero, J

Journal of environmental radioactivity

2012 Volume 113, Page(s) 163–170

Abstract: The (240)Pu/(239)Pu mass ratio was determined with SF-ICP-MS in lichen, peat, grass, air filter, and hot particle samples obtained in Finland. The main part of the air filters were sampled in northern Finland in 1963, whereas all the other samples were ... ...

Abstract	The (240)Pu/(239)Pu mass ratio was determined with SF-ICP-MS in lichen, peat, grass, air filter, and hot particle samples obtained in Finland. The main part of the air filters were sampled in northern Finland in 1963, whereas all the other samples were collected in southern and central Finland immediately after the Chernobyl accident in 1986. The (240)Pu/(239)Pu mass ratio varied between 0.13 ± 0.01 and 0.53 ± 0.03 in the environmental samples analyzed. The values for the (240)Pu/(239)Pu ratio confirm previous estimations, based on the (238)Pu/(239+240)Pu alpha activity ratio in the same samples, that global fallout from nuclear weapons testing and deposition from the Chernobyl accident have been the main Pu contamination sources in the environment in Finland.
MeSH term(s)	Air Filters ; Environmental Monitoring/methods ; Finland ; Geologic Sediments/analysis ; Lichens/chemistry ; Plutonium/analysis ; Radioactive Fallout ; Soil/analysis
Chemical Substances	Radioactive Fallout ; Soil ; Plutonium (53023GN24M)
Language	English
Publishing date	2012-11
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1483112-0
ISSN	1879-1700 ; 0265-931X
ISSN (online)	1879-1700
ISSN	0265-931X
DOI	10.1016/j.jenvrad.2012.06.005
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Article ; Online: Changes in physical activity levels and relationship to balance performance, gait speed, and self-rated health in older Swedish women: a longitudinal study.

Papp, Marian E / Grahn-Kronhed, Ann Charlotte / Rauch Lundin, Hans / Salminen, Helena

Aging clinical and experimental research

2021 Volume 34, Issue 4, Page(s) 775–783

Abstract: ... 8.5 years after inclusion. The non-parametric Wilcoxon signed-rank test and Mann-Whitney U test were ... and low exercise (LE, n = 51) groups. At baseline the HE group had an OLST of 19 s with eyes open and ... 3 s with eyes closed. In the LE group, these values were 7.3 s and 2 s. At follow-up, differences ...

Abstract	Background and aim: Physical activity levels in older people often decrease and may mean impaired physical functioning leading to an increased fall risk. The aim of this study was to investigate self-reported change in physical activity dose and deterioration in balance performance, gait speed, and self-rated health (SRH) in older women between two time points in a follow-up study. Methods: A cohort of community-living women, aged 69-79 years (n = 351) were evaluated by questionnaire and clinical tests on balance, gait speed, and SRH at baseline. One hundred and eighty-six women were followed-up by these tests 8.5 years after inclusion. The non-parametric Wilcoxon signed-rank test and Mann-Whitney U test were used for the analysis. Results: The greatest changes were seen in one-leg standing time (OLST) with eyes closed (- 60%) and eyes open (- 42%). The population was divided into high exercise (HE, n = 49) and low exercise (LE, n = 51) groups. At baseline the HE group had an OLST of 19 s with eyes open and 3 s with eyes closed. In the LE group, these values were 7.3 s and 2 s. At follow-up, differences between HE and LE concerning tandem walk forwards (steps) (HE = 8.5; LE = 2.5) and backwards (HE = 11; LE = 3.5) emerged. The HE group estimated SRH (VAS-scale) 30 mm higher at baseline and 17 mm higher at follow-up than the LE group. Conclusion: Greater physical activity seems to be an important predictor for maintaining physical function and SRH in older women.
MeSH term(s)	Aged ; Exercise ; Female ; Follow-Up Studies ; Gait ; Humans ; Longitudinal Studies ; Postural Balance ; Sweden ; Walking Speed
Language	English
Publishing date	2021-11-16
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2104785-6
ISSN	1720-8319 ; 1594-0667
ISSN (online)	1720-8319
ISSN	1594-0667
DOI	10.1007/s40520-021-02016-5
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Article ; Online: Circling the undefined-A grounded theory study of intercultural consultations in Swedish primary care.

Rothlind, Erica / Fors, Uno / Salminen, Helena / Wändell, Per / Ekblad, Solvig

PloS one

2018 Volume 13, Issue 8, Page(s) e0203383

Abstract: Well-functioning physician-patient communication is central to primary care consultations. An increasing demand on primary care in many countries to manage a culturally diverse population has highlighted the need for improved communication skills in ... ...

Abstract	Well-functioning physician-patient communication is central to primary care consultations. An increasing demand on primary care in many countries to manage a culturally diverse population has highlighted the need for improved communication skills in intercultural consultations. In previous studies, intercultural consultations in primary care have often been described as complex for various reasons, but studies exploring physician-patient interactions contributing to the understanding of why they are complex are lacking. Therefore, the aim of this study was to explore intercultural physician-patient communication in primary care consultations, generating a conceptual model of the interpersonal interactions as described by both the patients and the physicians. Using grounded theory methodology, 15 residents in family medicine and 30 foreign-born patients, the latter with Arabic and Somali as native languages, were interviewed. The analysis generated a conceptual model named circling the undefined, where a silent agreement on issues fundamental to the core of the consultation was inadequately presumed and the communicative behaviors used did not contribute to clarity. This could be a possible contributory cause of the perceived complexity of intercultural consultations. Identifying what takes place on an interpersonal level in intercultural consultations might be a first step towards building a common ground for increased mutual understanding, thereby bringing us one step closer to sharing, rather than circling the undefined.
MeSH term(s)	Adult ; Communication ; Culture ; Female ; Grounded Theory ; Humans ; Male ; Models, Theoretical ; Physician-Patient Relations ; Primary Health Care ; Referral and Consultation ; Sweden
Language	English
Publishing date	2018-08-30
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0203383
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Article: ²⁴⁰Pu/²³⁹Pu mass ratio in environmental samples in Finland

Salminen-Paatero, S / Nygren, U / Paatero, J

Journal of environmental radioactivity. 2012 Nov., v. 113

2012

Abstract: The ²⁴⁰Pu/²³⁹Pu mass ratio was determined with SF-ICP-MS in lichen, peat, grass, air filter, and hot particle samples obtained in Finland. The main part of the air filters were sampled in northern Finland in 1963, whereas all the other samples were ... ...

Abstract	The ²⁴⁰Pu/²³⁹Pu mass ratio was determined with SF-ICP-MS in lichen, peat, grass, air filter, and hot particle samples obtained in Finland. The main part of the air filters were sampled in northern Finland in 1963, whereas all the other samples were collected in southern and central Finland immediately after the Chernobyl accident in 1986. The ²⁴⁰Pu/²³⁹Pu mass ratio varied between 0.13 ± 0.01 and 0.53 ± 0.03 in the environmental samples analyzed. The values for the ²⁴⁰Pu/²³⁹Pu ratio confirm previous estimations, based on the ²³⁸Pu/²³⁹⁺²⁴⁰Pu alpha activity ratio in the same samples, that global fallout from nuclear weapons testing and deposition from the Chernobyl accident have been the main Pu contamination sources in the environment in Finland.
Keywords	accidents ; air ; air filters ; grasses ; lichens ; peat ; radioactivity ; Finland ; Ukraine
Language	English
Dates of publication	2012-11
Size	p. 163-170.
Publishing place	Elsevier Ltd
Document type	Article
Note	NAL-AP-2-clean
ZDB-ID	1483112-0
ISSN	1879-1700 ; 0265-931X
ISSN (online)	1879-1700
ISSN	0265-931X
DOI	10.1016/j.jenvrad.2012.06.005
Database	NAL-Catalogue (AGRICOLA)

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