A comparative study of professional and interprofessional values between health professional associations

Abstract

The need for effective interprofessional collaboration to ensure safe patient care is crucial. However, health professions are guided by separate professional codes of conduct. To examine whether professional codes are consistent across professions, this review examines 13 key health professional associations in the United States and compares their values to the guiding principles of interprofessional practice defined by the Interprofessional Professionalism Collaborative (IPC). Findings indicate that all six of the IPC’s principles (altruism/caring, excellence, ethics, respect, communication, and accountability) were shared by the majority of professions, with many emphasizing two additional attributes, integrity and justice, suggesting there is room to expand the IPC’s core principles. Few associations included interprofessional communication and collaboration in their professional codes. There is potential for associations to promote greater interprofessional collaboration by reshaping their professional frameworks. With many shared values across professions, establishing a common framework of interprofessional professionalism is feasible.     

A design thinking approach to evaluating interprofessional education

The complex challenge of evaluating the impact of interprofessional education (IPE) on patient and community health outcomes is well documented. Recently, at the Radcliffe Institute for Advanced Study in the United States, leaders in health professions education met to help generate a direction for future IPE evaluation research. Participants followed the stages of design thinking, a process for human-centred problem solving, to reach consensus on recommendations. The group concluded that future studies should focus on measuring an intermediate step between learning activities and patient outcomes. Specifically, knowing how IPE-prepared students and preceptors influence the organisational culture of a clinical site as well as how the culture of clinical sites influences learners’ attitudes about collaborative practice will demonstrate the value of educational interventions. With a mixed methods approach and an appreciation for context, researchers will be able to identify the factors that foster effective collaborative practice and, by extension, promote patient-centred care.     

Development and validation of a tool to assess self-efficacy for competence in interprofessional collaborative practice

ABSTRACT

Although interprofessional education and collaborative practice have gained increasing attention over the past five decades, development of rigorous tools to assess related competencies is still in infancy. The purpose of this study was to develop an instrument to evaluate health professions students’ self-efficacy in interprofessional collaborative competency and to assess the instrument’s psychometric properties. We developed a new instrument based on the Interprofessional Education Collaborative’s (IPEC) Core Competencies for Interprofessional Collaborative Practice. In a cross-sectional study design, 660 students from 11 health programmes at an urban university in the Midwest USA completed the Interprofessional Education Collaborative Competency Self Efficacy Tool (IPECC-SET). Rasch analysis evaluated the following: (1) functioning of the instrument; (2) fit of items within each subscale to a unidimensional construct; (3) person-response validity; (4) person-separation reliability; and (5) differential item functioning in relation to gender and ethnicity. After removing seven items with suboptimal fit, each subscale demonstrated high internal validity. Two items demonstrated differential item functioning (DIF) for “Gender” and none for “Race/Ethnicity.” Our findings provide early evidence of IPECC-SET as a valid measure of self-efficacy for interprofessional competence for health professions students. Additional research is warranted to establish external validity of the new instrument by conducting studies across institutions.     

Nursing and medical students teaming up: Results of an interprofessional project

Health professions programmes are increasing the number of interprofessional events in their curricula. Many of these programmes are grounded in case study or simulation events in order to prepare students for eventual practice. We designed an interprofessional education collaborative practice (IPECP) that provides direct interprofessional practice experience while students are still in their health profession programmes. In our programme, teams of senior baccalaureate nursing and third-year medical students provided health coaching to patients in need of chronic disease management. The purpose of the project and study was to determine whether repeated exposure to opportunities for interprofessional communication would lead to improvement in the individual and team communication skills. Teams met with their assigned patients monthly to provide coaching and had follow-up conversations with the patients between meetings. Faculty were present at each meeting to review the healthcare and coaching plans, observe the teams’ interactions, and provide a debriefing after each meeting. Results demonstrated that both individual and team communication skills significantly increased over time. The IPECP project was successful in providing a context where students could develop and improve upon key interprofessional communication skills.     

Using reflective practice in interprofessional education and practice: a realist review of its characteristics and effectiveness

ABSTRACT

This article presents the results of a realist review of the use of reflective practice interventions aimed at improving interprofessional education and collaborative practice (IPECP). Reflective practice is recognized as one of the determining factors in health and social service professionals’ skills development and maintenance, as well as in the establishment of good collaboration practices. In this respect, it is a key element of interprofessional education (IPE) and its relevance in this field is being asserted more and more strongly. However, few studies have been conducted to document its effectiveness. The purpose of this article is therefore to advance knowledge in this field. Searches in health and social services electronic databases identified six studies presenting reflective practice interventions in IPECP aimed at enhancing collaboration among students or practicing professionals. Analysis provided preliminary answers as to the effectiveness of reflective practice interventions in IPECP, as well as pertinent information on the best methods for achieving effectiveness. It concludes by proposing recommendations designed to change reflective practice interventions in IPECP and by stressing the importance of further research in order to document more fully the effectiveness of reflective practice in IPECP and to identify the most promising intervention methods in this regard.     

Attitudes of clinician educators towards interprofessional education and collaboration: Insights from two interprofessional scales

The increasing complexity of healthcare needs underlines the growing importance of interprofessional education and collaborative practice (IPECP) in enhancing quality of patient care. In particular, clinician educators play an influential role in advocating IPECP. The primary goal of our exploratory pilot study is to explore 34 clinician educators’ attitudes towards IPECP by using the adapted 14-item Attitudes Toward Health Care Teams Scale (ATHCTS) and 15-item Readiness for Interprofessional Learning Scale (RIPLS). Mean scores of ATHCTS and RIPLS were 3.81 (SD = 0.90) and 4.02 (SD = 0.79), respectively. Using exploratory factor analysis, we identified four factors: team value (ATHCTS), team efficiency (ATHCTS), teamwork and collaboration (RIPLS), and professional socialisation (RIPLS). The “team efficiency” factor on the ATHCTS scored lowest (factor mean = 3.49) compared with other factors (factor means = 3.87–4.08). Correlation analyses revealed that the “team efficiency” factor had small correlations with other factors (r = ?0.05–0.37). Our clinician educators valued IPECP in promoting teamwork and professional socialisation but they perceived IPECP to compromise efficiency. The issue of perceived inefficiency by clinician educators merits attention in order to promote wider implementation of IPECP.     

The United States National Center for Interprofessional Practice and Education: Integrating an informatics approach to interprofessional work

Abstract

The National Center for Interprofessional Practice and Education, a United States public–private partnership, was formed to provide national leadership, scholarship, evidence, and coordination to advance interprofessional education (IPE) and practice. Many external drivers led to the creation of the partnership that culminated in the National Center: patient safety initiatives, the need for care coordination and transitions efforts, quality improvement imperatives, calls for teamwork and workforce optimization, newly defined national core competencies for interprofessional collaborative practice, practice redesign, escalating health care costs, and state and federal policies. The National Center principals who have served in a variety of senior leadership roles—a clinician, educationalist, and informaticist—recognized the opportunity to leverage the potential that informatics could bring not only to the center but also to the field of IPECP. An informatics approach focuses on collaborative processes and works to address information processing, communications, and data collection. To do so, the National Center created multiple platforms: informatics education, a resource exchange, communication strategy, incubator network, national data repository, and learning system.     

Professionalism dilemmas experienced by health professions students: a cross-sectional study

ABSTRACT

Health professions students will invariably confront professionalism dilemmas. These early encounters significantly influence future professional attitudes and behaviours. Heretofore, studies concerning professionalism dilemmas experienced by health professions students across disciplines have been limited. To address this issue, we recruited 56 students with clinical experience from the National Taiwan University College of Medicine in the nursing, dentistry, pharmacy, medical technology, occupational therapy, and physiotherapy programs to participate in this research to compare health professions students’ understandings of professionalism and their experiences of professionalism dilemmas. We used group interviews to uncover students’ experiences of professionalism dilemmas. We identified the six most commonly reported professionalism dilemmas and found that interprofessional dilemmas were the dominant workplace professionalism dilemma for health professions students. We also identified significant disciplinary differences regarding dilemma types and frequencies. We employed the framework of dual identity development to better understand the role of professional and interprofessional identities in interprofessional dilemmas. The professionalism dilemmas that individual students encountered were shaped by disciplinary differences. Our findings suggest that the development of a sense of belonging to both their own profession and a broader interprofessional care team in health professions students can increase the effectiveness of interprofessional healthcare teams.     

Getting on the same page: an interprofessional common reading program as foundation for patient-centered care

A primary goal of interprofessional education is to produce clinicians who practice collaboratively to provide patient-centered care. This exploratory study evaluated whether students’ attitudes about a literary account of an illness experience endured after a year of professional and clinical education and if students applied lessons learned from a common reading to the delivery of patient centered care. Six focus groups were completed with health professions students and five main themes emerged from the focus group data. Themes include: Seeing family members as stakeholders; Establishing common ground with peers and the larger reason for graduate school; Applying lessons to clinical practice that see the patient as a person; Experiencing an emotional connection with a story and its characters; and Taking alternative perspectives/stepping into the shoes of the patient. Study results are discussed in relation to the interprofessional education literature, with implications for educators and interprofessional curricula also presented. We conclude that a common reading program may provide an effective means for developing health professions students’ knowledge and attitudes in the tenets of patient-centered collaborative care. It has the potential to build community through shared intellectual experience, facilitating meaningful reflection and perspective-taking in interprofessional learners.     

An interprofessional socialization framework for developing an interprofessional identity among health professions students

Abstract

Although health professional educational programs have been successful in equipping graduates with skills, knowledge and professionalism, the emphasis on specialization and profession-specific education has enhanced the development of a uniprofessional identity, which has been found to be a major barrier to interprofessional collaborative person-centred practice (IPCPCP). Changes within healthcare professional education programs are necessary to enable a shift in direction toward interprofessional socialization (IPS) to promote IPCPCP. Currently, there is a paucity of conceptual frameworks to guide IPS. In this article, we present a framework designed to help illuminate an IPS process, which may inform efforts by educators and curriculum developers to facilitate the development of health professions students’ dual identity, that is, an interprofessional identity in addition to their existing professional identity, as a first step toward IPCPCP. This framework integrates concepts derived from social identity theory and intergroup contact theory into a dual identity model of IPS.     

Competent in any context: An integrated model of interprofessional education

ABSTRACT

While most graduate health professions programs in the United States have accepted the Interprofessional Education Collaborative’s core competencies for collaborative practice, there is no consistent way to integrate the competencies into courses of study already crowded with uniprofessional competencies. A potential negative effect of treating interprofessional education as an add-on is that learners will not engage deeply with the competencies required to work effectively in health care teams. To design an integrated model, one institution adopted a theory from the management literature that frames professional competence as a way of being, not simply a body of knowledge to master. Viewing competence as a way of being ensures that learners can act collaboratively in any context. The model, called IMPACT Practice, provides multiple settings where learners can practice the competencies and make connections to their uniprofessional studies. By embedding the interprofessional competencies into all programs of study, learners come to see collaboration as a core element of what it means to be an effective health professional.     

Examining student perceptions of an inter-institutional interprofessional stroke simulation activity

Integration of interprofessional educational (IPE) activities into health professions’ curricula aims to promote collaborative practice with a goal of improving patient care. An interprofessional stroke simulation involving standardised patients was organised for IPE student learners from a number of different health professions programmes based across several different institutions. In this article, we describe the development of an inter-institutional IPE activity and examine the outcomes of this activity on student interprofessional growth. Using a pre-post-study design, all participants were invited to anonymously respond to the 16-question IPEC Competency Self-Assessment tool to examine self-assessed interprofessional interactions and values as a result of the simulation. The questionnaire was available to the students using an online platform, and paired t-tests were used to analyse the responses. Quantitative data revealed significant positive changes in both the values and interaction domains of the assessment from pre- to post-simulation experience (p < 0.0001 and p = 0.0003, respectively). Student reflections identified new realisations around the concepts of leadership and team member roles in the context of patient care. Results of this endeavour support the effectiveness of this activity for developing interprofessional competencies among students, suggest that the self-assessment tool may be used as a means to detect these changes, and lend support to our methods for establishing inter-institutional IPE partnerships.     

Validation of the interprofessional collaborative competency attainment survey (ICCAS)

Abstract

The purpose of this study was to obtain evidence regarding the validity and reliability of an instrument to measure the self-reported competencies of interprofessional care in interprofessional education programs. Five hundred and eighty-four students and clinicians in Canada and New Zealand who were registered in 15 interprofessional education undergraduate, postgraduate, and continuing professional development programs completed the Interprofessional Collaborative Competency Attainment Survey (ICCAS) using a retrospective pre-test/post-test design. Factor analyses showed the presence of two factors in the pre-program items and one factor in the post-program items. Tests conducted provided evidence in support of the validity and reliability of the ICCAS as a self-assessment instrument for interprofessional collaborative practice. Internal consistency was high for items loading on factor 1 (α?=?0.96) and factor 2 (α?=?0.94) in the pre-program assessment and for the items in the post-program assessment (α?=?0.98). The transition from a two factor solution to a single factor structure suggests interventions influence learners’ understanding of interprofessional care by promoting the recognition of the high degree of interrelation among interprofessional care competencies. Scores on the ICCAS are reliable and predict meaningful outcomes with regard to attitudes toward interprofessional competency attainment.     

Interprofessional professionalism: Linking professionalism and interprofessional care

The provision of high-quality education and training that is responsive, relevant, accessible and evidence based is critical if the vision for quality mental health services presented in recent policy initiatives in Ireland is to be fulfilled. This paper reports the findings related to pedagogical approaches and quality assurance mechanisms utilized within mental health education. The study involved canvassing all Higher Education Institutions in Ireland. A total of 227 courses in 31 educational institutes were identified and 149 questionnaires were returned from 129 Course Coordinators. Various quality processes were identified in existing programs; however, formal feedback from service providers, service users and carers was seldom reported. Ongoing evaluation and quality assurance strategies are a key element of governance and there is a need to develop strategies that explore the impact of education programs on mental health education and health outcomes. Recommendations are made in terms of future interprofessional mental health education and practice.     

Professionalism as ideology: a socio-historical analysis of the discourse of professionalism in nursing

Professionalism as ideology: a socio-historical analysis of the discourse of professionalism in nursing
For most of this century, extensive and heated discourse has surrounded defining, conceptualizing, and implementing nursing professionalism. These discussions, for the most part, have approached professionalism as a set of universal, unchanging, objectively-measured criteria. This study explores professionalism as an ideology; an image drat a social group gives of itself to itself, as a community with a history and identity. Analyses of eight decades of the American Journal of Nursing identify ways that the language of professionalism gives meaning to changing and competing social structures through rationalization and legitimation. The study further identifies how change has often been illusionary, illuminating how the language of professionalism has served to legitimate, and conceal reality. Identifying and understanding how political, social, and economic domination and asymmetry are rationalized and legitimated through language and ideology will allow nursing to demystify constraints and coercion in the delivery of health care.
School of Nursing Graduate Faculty, Kent State University, Kent OH 44242, USA     

Best practice interprofessional stroke care collaboration and simulation: The student perspective

Interprofessional practice (IPP) is the accepted standard of care for clients following a stroke. A brief, embedded and evidence-based IPP team simulation was designed to address stroke care knowledge and IPP competencies for students within limited curriculum space. Each team was required to construct a collaborative care plan for their patient during the simulation and submit the care plan for evaluation of best practice stroke care knowledge and implementation with evidence of interprofessional collaboration (IPC). A total of 302 students (274 on-site, 28 by distance technology) representing four professions comprised of 55 teams took part in this experience. Post-simulation, voluntary and anonymous programme evaluations were completed using the standardised interprofessional collaborative competency assessment scale (ICCAS) and open-ended free-text responses to five questions. There was a significant improvement for all pre–post ratings on the ICCAS regardless of profession or previous interprofessional experience. Additionally, the open-ended responses indicated perceived changes to role clarification, communication, and teamwork. The combined interpretation of the programme evaluation results supports interprofessional team simulation as an effective and efficient learning experience for students regardless of previous interprofessional experience, and demonstrated positive changes in stroke best-practice knowledge and IPC competencies.     

Preparation for becoming members of health care teams: findings from a 5-year evaluation of a student interprofessional training ward

Setting.?An orthopaedic interprofessional training ward manned by students at a University Hospital.Objective.?To assess to what extent students from different undergraduate programmes evaluated the effects of a 2-week rotation at the ward on their professional roles and the value of teamwork within health care.Method.?A questionnaire was filled in by 841 students by the end of a 2-week rotation at the ward over 5 years. Questions concerned students’ estimate of how the rotation had strengthened their insight into their own future professional role, into other students’ professional roles and into the value of teamwork within health care. Differences between the different student categories and possible associations between the different estimates were statistically analysed.Results.?Students from all programmes reported that the rotation at the student ward had dramatically strengthened their insight about their own future professional role as well as the roles of the other professions and the value of teamwork within health care.Conclusion.?Health care is a complicated system based on cooperation and professionalism. We suggest that interprofessional training of students from all professions within health care should be a part of their education as a worthwhile preparation for their future professional work and to ensure high-quality health care.