Utilization of research methodology in designing and developing an interdisciplinary course in ethics

Within health, it is widely acknowledged that a collaborative, team-oriented approach to care is required to ensure patient safety and quality of service delivery. A pre-qualification interprofessional learning experience should provide an ideal opportunity for students to gain the necessary knowledge, skills and attitudes to enable them to work as part of a patient-centred interprofessional team. In this article we report a multidimensional evaluation of a pre-qualification interprofessional learning (IPL) program. The program brings together senior year students from various health care professions on clinical placement in the same service area of a hospital to take part in shared, structured learning experiences centred on interprofessional teamwork. We used a combination of qualitative and quantitative methods to evaluate the IPL program. Results indicate that students' understanding of the roles of other team members was enhanced, and students and supervisors perceived the program to be of value for student learning. Measured changes in attitude were limited. Unexpected findings emerged in relation to role responsibilities within teams and attitudes towards doctors. We conclude that such programs have the potential to expand students' understanding of the contributions made by other professionals/colleagues to effective patient care, although challenges persist in overcoming pre-existing role stereotypes.     

Interprofessional learning for nursing students in practice periods: problems to overcome and possibilities for uniprofessional campuses

There is an urgent need for educational institutions to prepare students for collaborative practices in health care in the years to come. Facilitation of interprofessional learning (IPL) can be challenging for small campuses with few healthcare and social care education programmes. The aim of this study was to identify hindrances to, and opportunities for accessible interprofessional learning, for nursing students in a uniprofessional learning environment on the Norwegian West coast. Three focus group interviews were conducted with the following groups: nursing teachers, a hospital rehabilitation team and informants from a municipal home rehabilitation team. The data were analysed by hermeneutical phenomenological method. The following four main themes emerged the following: the tradition for interprofessional learning is not yet well established, IPL in the context of existing teams is better than IPL with other students, there is an urgent need to strengthen and adjust professional responsibilities and roles, and there is a need for communication to overcome hindrances to IPL.     

Interprofessional perceptions of health care students

Effective interprofessional working, which is widely considered as essential to high-quality health care, is influenced by the attitudes of health care professionals towards their own and other professional groups. Relatively little is known, however, about interprofessional attitudes, particularly of students in health care professions. This study aimed to increase our understanding of students' attitudes towards their own and other professional groups on entry to a programme of professional education. Hypothesised relationships between stereotypes, professional identity and readiness for professional learning were tested by means of a questionnaire survey of 933 undergraduate health care students drawn from five health care groups (medicine, nursing, dietetics, pharmacy and physiotherapy) within a multi-faculty UK university. Positive statistically significant correlations were found between stereotypes, professional identity and readiness for interprofessional learning. As predicted, students identified strongly with their own professional group at the start of pre-registration education. They were also willing to engage in interprofessional learning. More unexpected was the positive association found between heterostereotype and professional identity scores. There are potential benefits of introducing active interprofessional education activities at an early stage of professional preparation to capitalise on students' positive attitudes towards their own and other professional groups.     

Improving patient safety by using interprofessional simulation training in health professional education

Modern medicine is complex. Reports and surveys demonstrate that patient safety is a major problem. Health educators focus on professional knowledge and less on how to improve patient care and safety. The ability to act as part of a team, fostering communication, co-operation and leadership is seldom found in health education. This paper reports the findings from pilot testing a simulated training program in interprofessional student teams. Four teams each comprising one medical, nursing, and intensive nursing student (n = 12), were exposed to two simulation scenarios twice. Focus groups were used to evaluate the program. The findings suggest that the students were satisfied with the program, but some of the videos and simulation exercises could be more realistic and more in accordance with each other. Generally they wanted more interprofessional team training, and had learned a lot about their own team performance, personal reactions and lack of certain competencies. Involving students in interprofessional team training seem to be more likely to enhance their learning process. The students' struggles with roles, competence and team skills underline the need for more focus on combining professional knowledge learning with team training.     

The impact of an interprofessional standardized patient exercise on attitudes toward working in interprofessional teams

Effective interprofessional education engages participants in authentic tasks, settings and roles. Using these guiding principles, an interprofessional standardized patient exercise (ISPE) was developed and implemented for 101 dental, medical, nurse practitioner, pharmacy and physical therapy students. This study describes the ISPE and evaluates its impact on students' attitudes toward working in interprofessional teams. The attitudes toward health care teams (ATHCT) survey was administered pre- and post-ISPE and to a sample of non-participating students. Faculty and students were surveyed post-ISPE about outcomes and satisfaction. Focus groups were conducted with students from each profession. Students' attitudes toward team-based care improved significantly on the team value and team efficiency subscales of the ATHCT. There were significant differences in attitudes toward team-based care by profession. Faculty and student satisfaction with the ISPE was high. These findings contribute to the growing body of literature on efforts to generate positive attitudes toward interprofessional collaboration early in training, which may influence students' ability to be effective members of healthcare teams.     

An interprofessional health assessment program in rural amateur sport

Effective interprofessional learning (IPL) in multisectoral collaborations such as those linking health services within communities can provide an authentic experience for students and also appears to be the most effective way to achieve health changes in targeted population groups. The aim of this study was to facilitate the IPL of students at a rural university in a multisectoral health assessment programme and to promote health in players of rural amateur sport. Two rural rugby league teams took part in three pre-season health assessments conducted by general medical practitioners, practice nurses, and nursing, osteopathy, and exercise science students. The Readiness for Interprofessional Learning Scale questionnaire and a series of focus groups were used to evaluate participants’ experiences of the programme. Results indicated that students saw the benefits for patients and 93% valued the opportunity to improve interprofessional communication, problem-solving and team skills. Some students felt they needed to learn more about their own professional role before learning about others, and instances of stereotyping were identified. The programme also enabled early detection of potential health risks and referral for medical care, management of musculoskeletal conditions, and health promotion. These health assessments would be readily transferred to other multisectoral sporting settings.     

Evaluation of a student-led interprofessional innovative health promotion model for an underserved population with diabetes: A pilot project

Interprofessional education seeks to encourage different health professions to interact and learn together during their training process which will eventually lead to collaborative healthcare practices and improved care for patients. This study determined whether student understanding of diabetes management and the role of health professionals in diabetes care improved after the implementation of an interprofessional health promotion program. Sixty-three students from five health professions led six educational sessions concentrating on critical components of diabetes management. The longitudinal program covered topics within the Alphabet Strategy (A-G). Students were surveyed to determine their understanding of diabetes management. Data were gathered at the beginning of the study and its conclusion. Forty-seven students completed the program and the pre- and post-survey. There were significant improvements in students' knowledge of diabetes care, understanding of the roles of healthcare professionals and ability to work with other healthcare professionals. Nineteen patients completed the study. There were no significant differences in patients' diabetes knowledge, understanding of diabetes care and clinical outcomes. This study acknowledged the potential value of an interprofessional team approach to care. This innovative model could be applied to other practice settings and used for the management of other chronic diseases.     

Evaluation of an interprofessional practice placement in a UK in-patient palliative care unit

This paper reports on undergraduate students' evaluation of a new hospice-based interprofessional practice placement (IPP) that took place in the voluntary sector from 2008 to 2009. Ward-based interprofessional training has been successfully demonstrated in a range of clinical environments. However, the multidisciplinary setting within a hospice in-patient unit offered a new opportunity for interprofessional learning. The development and delivery of the IPP initiative is described, whereby multidisciplinary groups of 12 students provided hands-on care for a selected group of patients, under the supervision of trained health care professionals. The placement was positively evaluated and students reported an increased understanding of both their own role and that of other professionals in the team. The evaluation also suggests that additional learning opportunities were provided by the in-patient palliative care unit. The results of this evaluation suggest that the in-patient unit of a hospice caring for patients with life-limiting illness provides a suitable environment to demonstrate and learn about interprofessional practice.     

Interprofessional ambulatory primary care practice-based educational program

Although interprofessional teamwork and collaboration are considered key elements for improving patient outcomes, there are few reports of controlled studies involving interprofessional training of health care learners in the ambulatory primary care setting. We describe an educational program for teams of nurse practitioners, family medicine residents and social work students to work together at clinical sites in the delivery of longitudinal care in primary care ambulatory clinics. Year 1 was a planning year. Program evaluation completed at the end of the second curriculum (Year 3) indicated that the changes the team made at the end of the first curriculum (Year 2) resulted in increased appreciation of the training program, greater perception of value of care delivered by interprofessional teams among team learners as compared to non-team learners, and team learner self assessment of improved team skills including working with other professionals, resolving conflict, and integrating prevention and health promotion into health care. Team learners demonstrated an increased awareness of the limits of their own profession's approach to team care. We conclude that interprofessional ambulatory clinical training in primary care where learners work together providing care to patients can contribute to fostering both positive learner attitudes toward interprofessional work and development of team skills.     

Improving patient safety by using interprofessional simulation training in health professional education

Modern medicine is complex. Reports and surveys demonstrate that patient safety is a major problem. Health educators focus on professional knowledge and less on how to improve patient care and safety. The ability to act as part of a team, fostering communication, co-operation and leadership is seldom found in health education. This paper reports the findings from pilot testing a simulated training program in interprofessional student teams. Four teams each comprising one medical, nursing, and intensive nursing student (n = 12), were exposed to two simulation scenarios twice. Focus groups were used to evaluate the program. The findings suggest that the students were satisfied with the program, but some of the videos and simulation exercises could be more realistic and more in accordance with each other. Generally they wanted more interprofessional team training, and had learned a lot about their own team performance, personal reactions and lack of certain competencies. Involving students in interprofessional team training seem to be more likely to enhance their learning process. The students' struggles with roles, competence and team skills underline the need for more focus on combining professional knowledge learning with team training.     

Interprofessional perceptions of health care students

Effective interprofessional working, which is widely considered as essential to high-quality health care, is influenced by the attitudes of health care professionals towards their own and other professional groups. Relatively little is known, however, about interprofessional attitudes, particularly of students in health care professions. This study aimed to increase our understanding of students' attitudes towards their own and other professional groups on entry to a programme of professional education. Hypothesised relationships between stereotypes, professional identity and readiness for professional learning were tested by means of a questionnaire survey of 933 undergraduate health care students drawn from five health care groups (medicine, nursing, dietetics, pharmacy and physiotherapy) within a multi-faculty UK university. Positive statistically significant correlations were found between stereotypes, professional identity and readiness for interprofessional learning. As predicted, students identified strongly with their own professional group at the start of pre-registration education. They were also willing to engage in interprofessional learning. More unexpected was the positive association found between heterostereotype and professional identity scores. There are potential benefits of introducing active interprofessional education activities at an early stage of professional preparation to capitalise on students′ positive attitudes towards their own and other professional groups.     

Reflections and unprompted observations by healthcare students of an interprofessional shadowing visit

This paper reports work from a Centre for Interprofessional Practice in a higher education institution in the UK that offers four levels of interprofessional learning (IPL) to all healthcare students. The second level (IPL2) integrates professional practice into the learning process, requiring students to shadow a qualified healthcare professional (from a different profession) for half a day. Students complete a reflective statement upon their learning experience on their return. A study was undertaken to analyse students' reflective statements in depth to see their observations and reflections on the shadowing visit. Using frame analysis, 160 reflective statements were analyzed, identifying common words and phrases used by students, which were then grouped together under six themes. Three of these related directly to the assignment: communication styles and techniques; communication between healthcare professionals and comparison of students' own and other healthcare professionals' roles. Three themes emerged from student's own interpretation of observations and reflections made during the shadowing of a different professional: attitudes toward other professions; power structures between professionals and patients and between professionals and impact of communication on patient care. Interprofessional shadowing gives students an opportunity to observe communication between healthcare professionals and patients and to reflect on broader issues surrounding collaborative working.     

Extending conceptual understanding: How interprofessional education influences affective domain development

Interprofessional learning (IPL) can influence affective domain development of students through teaching activities that facilitate learning with, from, and about other professions. Current quantitative evidence offers limited explanation of how this learning is achieved within IPL programmes. This article tests a conceptual framework drawn from theories on IPL and affective domain development (attitudes, values, and behaviours) to explain what works for whom, when, and in what circumstances. The objectives of the study were twofold: to evaluate the impact of the IPL programme on the student’s attitudes and values, and to identify behaviour changes in clinical practice towards interprofessional working. Using an action research approach, based in practice, an IPL programme was delivered over 6 weeks. Students from five professions, nursing, radiography, physiotherapy, social work, and podiatry (n = 63), participated over the two action research cycles and in semi-structured focus groups (n = 37). The recorded personal experiences of the IPL activities on the students were examined in relation to the type of activity; impact on the affective domain of learning (attitude, value, or behaviour) and self-reported outcome on application to their practice. Modification in affective domain development was measured to identification or internalisation stage for 30 of the students. Self-reported outcomes on application to practice included direct impact on patient care, personal resilience building, improved communication, and ability to challenge practice. This article presents a conceptual framework not evident in current research, in regard to what IPL works for whom, in what circumstances, and when. IPL activities that address a personal reward or incentive and are delivered over four weeks, imitating ‘circles of care,’ that explore self-assessment, team building, and reflection can lead to sustained change in values, attitudes, and behaviours.     

Students' perceptions of the interprofessional team in practice through the application of servant leadership principles

This study examined students' perceptions of interprofessional practice within a framework of servant leadership principles, applied in the care of rural older adults utilizing a service learning model. Mobile wellness services were provided through the Idaho State University Senior Health Mobile project in a collaborative team approach in the community-based setting. Students from varied health professional programs were placed in teams for the provision of wellness care, with communication among team members facilitated by a health professions faculty member serving as field coordinator. The Interdisciplinary Education Perception Scale (IEPS) was used to measure students' perceptions of interprofessional practice using a pretest post-test research design. Multivariate analysis was performed revealing a significant pretest to post-test effect on students' perceptions as measured by factors inherent in the IEPS and deemed essential to effective interprofessional practice. Univariate analysis revealed a significant change in students' perception of professional competence and autonomy, actual cooperation and resource sharing within and across professions, and an understanding of the value and contributions of other professionals from pretest to post-test.     

The Dalhousie Health Mentors Program: introducing students to collaborative patient/client-centered practice

The Dalhousie Health Mentors Program builds on a long history of interprofessional health education initiatives by introducing students in health and social care professions to chronic conditions and disabilities, patient/client-centredness, interprofessional learning, and team functioning. This large interprofessional education program (16 participating programs, 650 students) connects interprofessional student teams with Health Mentors, who are adult volunteers with chronic conditions, for a learning experience that extends over one academic year. Students explore their mentor's life story and chronic condition journey, the impact the condition has had on her/his life, and her/his experience with health care in general and interprofessional collaboration in particular. All aspects of the program planning, management, implementation, and evaluation have been interprofessional in nature. Lessons have been learned regarding.     

The Dalhousie Health Mentors Program: Introducing students to collaborative patient/client-centered practice

The Dalhousie Health Mentors Program builds on a long history of interprofessional health education initiatives by introducing students in health and social care professions to chronic conditions and disabilities, patient/client-centredness, interprofessional learning, and team functioning. This large interprofessional education program (16 participating programs, 650 students) connects interprofessional student teams with Health Mentors, who are adult volunteers with chronic conditions, for a learning experience that extends over one academic year. Students explore their mentor's life story and chronic condition journey, the impact the condition has had on her/his life, and her/his experience with health care in general and interprofessional collaboration in particular. All aspects of the program planning, management, implementation, and evaluation have been interprofessional in nature. Lessons have been learned regarding     

Team decision making: design,implementation and evaluation of an interprofessional education activity for undergraduate health science students

Abstract

An undergraduate health science student curriculum activity in interprofessional education (IPE) focused on team decision making was piloted. The IPE activity included a lecture, small group learning activity and an onsite observation of an interprofessional health care team (IPHCT) meeting. Measures included the Readiness for Interprofessional Learning scale, Interdisciplinary Education Perception scale and the Role Perception Questionnaires. The students completed a workbook to assess decision making capacity in IPHCTs. The results indicated that students (n?=?61) were willing to share their knowledge and skills as a way of understanding clinical problems in the workplace and had professionally oriented perceptions and related affective domains. They also showed a positive role perception of their own role and that of other professions. Analysis of the workbooks revealed that students were able to identify positive and negative impacts on effective team decision making and its effects on a patient centred approach to health care.     

Integration of systematic clinical interprofessional training in a student-faculty collaborative primary care practice

The changing healthcare environment and movement toward team-based care are contemporary challenges confronting health professional education. The primary care workforce must be prepared with recent national interprofessional competencies to practice and lead in this changing environment. From 2012 to 2014, the weekly Beth Israel Deaconess Crimson Care Collaborative Student-Faculty Practice collaborated with Northeastern University to develop, implement and evaluate an innovative model that incorporated interprofessional education into primary care practice with the goal of improving student understanding of, and ability to deliver quality, team-based care. In the monthly interprofessional clinic, an educational curriculum empowered students with evidence-based, team-based care principles. Integration of nursing, pharmacy, medicine, and masters of public health students and faculty into direct patient care, provided the opportunity to practice skills. The TeamSTEPPS® Teamwork Attitudes Questionnaire was administered pre- and post-intervention to assess its perceived impact. Seventeen students completed the post-intervention survey. Survey data indicated very positive attitudes towards team-based care at baseline. Significant improvements were reported in attitudes towards situation monitoring, limiting personal conflict, administration support and communication. However, small, but statistically significant declines were seen on one team structure and two communication items. Our program provides further evidence for the use of interprofessional training in primary care.     

Educational potential of using virtual patients for promoting interprofessional learning between medical and pharmacy students: A qualitative study

ABSTRACT

Interprofessional learning (IPL), involving various professions within healthcare, has been proven to improve the quality of patient care by encouraging collaboration between professionals. Careful consideration of appropriate educational tools and content is required in order to facilitate the effective IPL. This study aimed to explore medical and pharmacy students’ preconceptions of the role of virtual patients (VPs) as a learning tool for IPL within their education. A secondary aim was to elicit feedback to inform the development of new VP cases. Two focus groups (one with medical students and the other with pharmacy students), consisting of six students in each, were recruited. Participant perceptions regarding VP-based IPL were explored. Data were analysed using a thematic approach. Participants thought that there were some potential learning benefits of using VPs as part of their curriculum. Pharmacy students held increased value in VPs due to their limited access to patients during their education. Medical students challenged the role of VPs in their clinical development and concerned that VPs lack the flexibility required by doctors to use their judgement and work with uncertainty. Limited understanding of team members’ roles in patient care and self-reported ignorance of the overlap in curricula appear to be key barriers for students in valuing the knowledge base of each other’s profession and possible benefits of using VPs in joint learning. This study generated a number of key implications which need to be considered when introducing VP-based IPL.     

"Oh why didn't I take more notice?" Professionals' views and perceptions of pre-qualifying preparation for interprofessional working in practice

It is widely assumed that interprofessional learning (IPL) impacts positively on interprofessional working (IPW) in health and social care. However, there is no clear evidence that pre-qualifying IPL improves service delivery. The direct effect of pre-qualifying IPL on IPW and service delivery is difficult to demonstrate; researchers must rely on professionals' self-report in this regard. This paper presents findings from a qualitative study in which semi-structured interviews were used to collect individuals' views and perceptions about pre-qualifying IPL as preparation for practice. Two groups of participants came from four health and social care professions: adult nursing, midwifery, physiotherapy and social work. One group had experienced a substantial pre-qualifying IPL initiative, while the other group had not. Useful insights were gained from comparing the views and perceptions of individuals from these two groups. The total sample comprised 29 practitioners: 19 were educated on interprofessional curricula and 10 on traditional uniprofessional curricula. Thematic data analysis produced findings about pre-qualifying education as preparation for IPW. These findings suggest that pre-qualifying IPL can prepare individuals to work effectively as qualified professionals with colleagues from other disciplines and that effective IPW impacts positively on service delivery.