BACKGROUND: Remote patient monitoring implies continuous follow-up of health-related parameters of patients outside healthcare facilities. Patients share health-related data with their healthcare unit and obtain feedback (which may be automatically generated if data are within a predefined range). The goals of remote patient monitoring are improvements for patients and reduced healthcare costs. The aim of this paper is to provide an overview of systematic reviews regarding remote patient monitoring for selected patient groups currently considered for the introduction of remote patient monitoring in Region Västra Götaland, Sweden. The selected sixteen patient groups were: patients with asthma, chronic obstructive pulmonary disease, children and adolescents with complex needs, children and adolescents with cystic fibrosis, children and adolescents with periodic fever, elderly patients with multiple diseases, patients with eye diseases, heart failure, haematological disease, hypertension, inflammatory bowel disease, neurorehabilitation, Parkinson's disease, psoriasis, sleep apnea, and specialist maternity care. Outcomes considered in this overview were patient-relevant clinical benefits as well as risks.

METHODS: A literature search for systematic reviews of clinical trials on remote patient monitoring in the selected patient groups was conducted by two information specialists, followed by assessment of relevance by a team of clinical and methodological experts in Region Västra Götaland, Sweden. The methodological rigour of identified systematic reviews was assessed using QUICKSTAR - a tool for stepwise appraisal of systematic reviews. In a QUICKSTAR assessment, a level of at least five is considered a prerequisite for reliable conclusions regarding the question at issue.

RESULTS: The literature search resulted in 4,049 hits, of which 84 SRs were considered relevant for the question at issue. A QUICKSTAR level of at least five was reached by 13 (15%) of the relevant systematic reviews. Some patient benefit of remote patient monitoring was reported for five patient groups (asthma, chronic obstructive lung disease, heart failure, hypertension, and elderly patients with multiple diseases). For four patient groups (children with complex needs, children with cystic fibrosis, specialist maternity care, and sleep apnea), systematic reviews of adequate quality concluded that scientific evidence on clinical patient benefits of remote monitoring is very limited. For seven patient groups, no systematic reviews of sufficient quality were identified.

CONCLUSION: Clinical benefits and risks of remote patient monitoring as a replacement for, or in addition to, standard of care compared to standard of care (face-to-face visits) are poorly studied for most of the selected patient groups based on systematic reviews of acceptable quality. Patient-relevant clinical benefits are limited or impossible to evaluate for most diagnoses based on currently available scientific information. Possible clinical risks and costs are poorly studied.

Background

New digital learning environments have transformed medical education and training, allowing students and teachers to engage in synchronous, real-time interactions and asynchronous learning activities online. Despite extensive research on the role of digital technologies in education, understanding the interplay between digital technology, work, and learning, especially in complex fields like healthcare, remains a challenge.

Objective

The objective of this study is to examine resident physicians’ perceptions and experiences of using a digital learning environment as part of their specialist medical training. The paper focuses on digital learning through video conferencing (virtual lectures and seminars) and related learning technologies. It aims to understand how resident physicians perceive pedagogical opportunities and challenges in digital learning environments during their medical training and what strategies they use to address these.

Materials and Methods

The methodological approach is qualitative, aiming to capture and understand participants’ experiences and views of digital learning. The empirical data gathered from open-ended responses to four course evaluation surveys and semi-structured interviews with nine physicians from a cohort of participants enrolled in two or more digital courses were analyzed through thematic analysis. The analysis revealed three main themes related to digital transformation of learning: sociotechnical, educational and administrative.

Results

The results suggest that (i) sociotechnical aspects and understanding of the context in which the learning takes place contribute to enhancing digital learning for resident physicians; (ii) insights into participants’ perceptions of digital learning emphasize that interactive communication and group discussions are significant for their learning, and (iii) administrative aspects related to course design, lecture management, and instructional support are more important in digital learning environments compared to traditional teaching and learning.

Conclusion

Findings from this study confirm and extend prior studies on digital learning in healthcare, contributing to a better understanding of how digital learning environments, especially virtual lectures and seminars, can be developed and integrated into residency programs and health professions education to increase their usefulness.

There is an increasing demand in today's society to engage students in learning to learn, enabling them to become lifelong learners and continually develop their skills and competencies throughout their careers. Work-integrated learning (WIL) provides diverse learning environments that help students bridge and integrate experiences from academic and workplace settings, and thus, comprises a crucial component in preparing students for the complexities of modern working life and fostering lifelong learning skills. In the higher education sector, WIL has been developed in several colleges and universities worldwide, and countries like Australia and Canada have designed prominent examples of quality assurance for specific WIL activities. However, there are few national initiatives that combine various stakeholder's perspectives and there is a lack of knowledge about the quality dimension of WIL-based learning in both higher education and working life.

This paper builds on experiences from the strategic and qualitative development of Work-Integrated Learning (WIL) at University West in Sweden. It is part of ongoing research that aims to develop a quality framework to support collaboration and communities of educators in the understanding, design, and application of WIL in both higher education and professional working life. In a previous study, we have identified and provided knowledge underpinning the understanding and application of WIL from a multi-perspective approach involving both educators, researchers, students and strategic partners. Initial findings indicate that fostering collaboration between academia, industry, and society can generate insights, solutions, and mutual development to address societal challenges. Through creating a quality framework for WIL, it becomes evident that through interaction with colleagues and stakeholders the impact of WIL on education and lifelong learning becomes more visible for all stakeholders. In this qualitative study, we take the point of departure specifically from the strategic partner perspective, with the aim to understand WIL in the practice of education according to lifelong learning in a workplace context. We pose the following research question: How can a quality enhancement framework be collaboratively applied in real-world scenarios to enhance WIL quality?

Data collection activities include workshops and interviews with participants from target groups at the partner organization. The paper will discuss the application of a WIL quality enhancement framework, with a focus on how it can support designing and applying WIL initiatives effectively in a work-life setting.

A I är här för att stanna. Vi översköljs idag av nyheter om vad AI klarar av att göra, samtidigt har vi svårt att få våra egna datorsystem att kommunicera och faxen blir alltför ofta räddningen när annat havererar. Men vad har AI för potential inom medicinen? Vad händer med tilliten och det mellanmänskliga mötet när vi i allt större utsträckning kommunicerar med AI istället för människor? Är medicinen för komplex för automatisering av AI eller riskerar vi att stå utan arbete framöver? Kan AI vara en framtidsmöjlighet för narrativ medicin?

Background: Recently, all medical universities in Sweden jointly developed a framework for Entrustable Professional Activities (EPAs) for work-based training and assessment. This framework is now being introduced nationally in thenew 6-year undergraduate medical programme that directly lead to a licence to practise. When EPAs are introduced,it is of central importance to gain clinical supervisors’ acceptance to apply the framework in their supervision ofstudents. The aim of this study was therefore to investigate how clinical supervisors, not familiar with EPAs, experienceclinical supervision using the framework for EPAs.

Methods: We used a purposive sampling to recruit clinical supervisors. They were given written information on EPAswith a selection of suitable EPAs and the Swedish observation rating scale for assessment of autonomy, and theywere offered to attend a 30-minute introductory web course. The participants were informed that EPAs were to betested, and the students were asked to participate. After the study period the clinical supervisors participated in semistructured interviews. Inductive qualitative content analysis was used to analyse the transcribed interviews.

Results: Three general themes emerged in the qualitative analysis: Promoting Feedback, Trusting Assessmentsand Engaging Stakeholders. The participants described benefits from using EPAs, but pointed out a need forpreparation and adaptation to facilitate implementation. The structure was perceived to provide structured supportfor feedback, student involvement, entrustment decisions, enabling supervisors to allow the students to do morethings independently, although some expressed caution to rely on others’ assessments. Another concern waswhether assessments of EPAs would be perceived as a form of examination, steeling focus from formative feedback.To understand the concept of EPA, the short web-based course and written information was regarded as sufficient.However, concern was expressed whether EPA could be applied by all clinical supervisors. Involvement and adaptionof the workplace was pointed out as important since more frequent observation and feedback, with documentationrequirements, increase the time required for supervision. 

Conclusions EPAs were accepted as beneficial, promoting structured feedback and assessments of the students’autonomy. Preparation of supervisors and students as well as involvement and adaptation of the workplace waspointed out as important.

Within the healthcare sector in Sweden, efforts are made to strengthen the position of patients and practitioners and the opportunities to co-create planned change. Planned change refers to planned organizational change and change whose initiative is initiated outside the unit where change is planned. The likelihood of successful change becoming sustainable, meeting the needs of those affected, and adapting to the unique context where change is intended to occur increases when patients, practitioners, and other relevant stakeholders see the need and value of planned change and have the opportunity to influence. Despite this, first-line managers and practitioners are often tasked with converting planned changes into a way of working in practice without the feeling that they can influence the implementation and without sufficient prerequisites. Co-creation is one way for patients, practitioners, and managers to influence planned change.

Further, there are existing approaches for how patients, practitioners, and first-line managers can be involved in the development of healthcare, and there are a growing number of studies where change is co-created. Despite this, it is perceived as challenging to influence planned change in healthcare. To develop a model that is used, perceived as valuable, and supports the co-creation of planned change in healthcare, it is important to understand the needs and conditions of the intended users.

The purpose of this study is to investigate different stakeholders' perceptions of a healthcare organization's conditions and needs for making planned change happen through co-creation.

The research approach follows the principles of insider action research, in which the insider action researcher is an active agent who makes development and change happen while co-creating knowledge simultaneously. Action research is a scientific approach and consists of a repeating cyclical process comprising the steps, plan, act, and evaluate. The project has a reference group composed of representatives of the organization and patient representatives. The reference group participates in the project by guiding and influencing the research process to facilitate the implementation of the project and ensure its relevance and value from the different stakeholders’ perspectives, which is an important quality aspect in action research where knowledge is co-created.

This paper presents initial findings from ten semi-structured individual interviews with patient representatives and representatives from the healthcare organisation, all with experience of co-creating planned change in healthcare. The interviews are audio-recorded, transcribed verbatim and analysed using thematic analysis. An inductive approach to thematic analysis is used to stay as close as possible to the respondents' experience and proceed from the data collected without predefined themes.

The study is expected to result in a deeper understanding of the conditions in a healthcare organisation to make planned change happen through co-creation. This understanding can support patients, practitioners, and first-line managers convert planned change into a way of working in healthcare practice through co-creation. The result will also be used to develop a useful, valuable, and supportive model for how planned change can be co-created in healthcare practice.