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

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Frontiers in Medicine

Healthcare Professions Education

Reviews in Healthcare Professions Education

Healthcare is a complex and ever-evolving field, encompassing various challenges, advancements, and intricacies that impact patient care, medical education, and clinical practice. Review articles play a crucial role in shedding light on different aspects of healthcare, offering valuable insights into emerging trends, innovative methodologies, and potential areas for improvement. In this editorial, we delve into five review articles that explore diverse facets of healthcare, ranging from evidence translation and patient-physician relationships to clinical reasoning and training methodologies. Through an analysis of these articles, we aim to gain a deeper understanding of the multifaceted nature of healthcare and the implications for medical education and practice.The review articles encompass a wide range of topics, each offering unique perspectives on key aspects of healthcare. One article (<a href="https://doi.org/10.3389/fmed.2023.1071545">Lyu and Li</a>) explores the challenges of translating evidence into practice and the role of clinical practice guidelines in guiding healthcare decisions. It emphasizes the importance of evidence-based practices in improving patient outcomes while highlighting the barriers and limitations in implementing these practices effectively. Another article (<a href="https://doi.org/10.3389/fmed.2023.1098305">Keller et al.</a>) focuses on the evolving patient-physician relationship, particularly in the context of technological advancements. It examines how technology influences communication between patients and healthcare providers, shaping the dynamics of care delivery and patient engagement. The article underscores the need for maintaining personalized, patient-centered care amidst the increasing reliance on digital health tools and telemedicine. Clinical reasoning, a fundamental aspect of healthcare practice, is explored in depth in another article (<a href="https://doi.org/10.3389/fmed.2023.1017783">Vreugdenhil et al.</a>). The review delves into the complexities of clinical reasoning processes among healthcare professionals, highlighting the differences between physicians and nurses in their approaches to problem-solving and decision-making. It emphasizes the importance of understanding these differences to foster effective collaboration and optimize patient care outcomes. Wrist arthroscopy, a specialized surgical technique for diagnosing and treating wrist injuries, is the focus of another review article by <a href="https://doi.org/10.3389/fmed.2022.947459">Shi et al.</a>. The review examines the advantages and challenges associated with wrist arthroscopy and explores evolving methodologies in training programs for surgeons. It highlights the importance of anatomical knowledge, operative skills, and innovative training methods in ensuring optimal surgical outcomes and patient safety. The review article by <a href="https://doi.org/10.3389/fmed.2022.975229">Ma et al.</a> investigates the application of the BOPPPS teaching strategy in medical education in China. It focuses on determining the effectiveness of the BOPPPS strategy in enhancing student engagement and learning outcomes compared to traditional lecture-based methods. This review underscores the potential of innovative teaching approaches in improving medical education delivery and preparing future healthcare professionals for clinical practice.Methodologically, each review article adopts a distinct methodological approach tailored to its research objectives and focus areas. For example, the article by <a href="https://doi.org/10.3389/fmed.2023.1071545">Lyu and Li</a> employs a systematic search methodology, spanning a 10-year period and incorporating gray literature to ensure comprehensive coverage of relevant studies. In contrast, <a href="https://doi.org/10.3389/fmed.2023.1098305">Keller et al.</a> utilize a narrative exploration approach, weaving together patient stories and clinical anecdotes to illustrate the nuances of the patient-physician relationship. <a href="https://doi.org/10.3389/fmed.2023.1017783">Vreugdenhil et al.</a> employ a structured analytical framework, the “onion model,” to dissect clinical reasoning processes into layers, offering a comprehensive understanding of this complex phenomenon. The fourth article synthesizes existing research on wrist arthroscopy training, examining a wide range of methodologies and training programs to identify best practices in surgical education. Lastly, <a href="https://doi.org/10.3389/fmed.2022.975229">Ma et al.</a> utilize a meta-analysis and systematic review approach, adhering to established guidelines such as PRISMA and PICOS to evaluate the effectiveness of the BOPPPS teaching strategy. It conducts a rigorous analysis of available evidence, including the risk of bias assessment and statistical analysis, to draw meaningful conclusions regarding the impact of innovative teaching methods on medical education outcomes.Collectively, these review articles provide valuable insights into the multifaceted nature of healthcare and its implications for medical education and practice. They underscore the importance of evidence-based practices, personalized patient care, interdisciplinary collaboration, and innovative teaching methodologies in addressing the evolving challenges and demands of healthcare. Moving forward, further research is needed to explore the effectiveness of different educational strategies, the impact of technology on patient-provider relationships, and the optimization of clinical reasoning processes across healthcare professions. Additionally, ongoing evaluation and refinement of training methodologies, such as wrist arthroscopy training programs, are essential to ensure the continued advancement of surgical education and patient care.In summary, the review articles offer an exploration of various aspects of healthcare, from evidence translation and patient-physician relationships to clinical reasoning and surgical training. By examining these diverse topics through different methodological lenses, we gain valuable insights into the complexities and challenges of healthcare delivery and medical education. Moving forward, continued research, and innovation are essential to address the evolving needs of patients, healthcare professionals, and healthcare systems worldwide.AS: Supervision, Conceptualization, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. MC: Writing &#x2013; original draft, Writing &#x2013; review &amp; editing.The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.We would like to thanks all the authors for their contributions.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Editorial: 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