In and out of the curriculum: an historical case study in implementing interprofessional education

Abstract

Although international reports have called for making interprofessional education an integral part of health professions education, most interprofessional learning activities remain voluntary and occur a single time. Barriers to implementing comprehensive interprofessional education come from forces both internal and external to institutions. Understanding the historical context for how one graduate health professions school attempted to overcome these barriers will provide a longitudinal perspective that may assist other institutions with their interprofessional education efforts. The case of the Massachusetts General Hospital Institute of Health Professions shows that, despite being founded with a mission to educate students from different professions together, interprofessional education does not emerge naturally. An analysis of archival documents, academic catalogs and oral history interviews revealed that early attempts focused on requiring students to take common courses. Later, the faculty created voluntary interprofessional learning activities. Neither approach achieved its intended goals until the Institute developed deliberate strategies to counter the internal and external barriers to integrating interprofessional education. This historical case study suggests that sustainable interprofessional education initiatives require both an organizational home and a permanent place in the curriculum.     

An integrative systematic review of interprofessional education on diabetes

ABSTRACT

Interprofessional education (IPE) aims at enhancing the ability of healthcare professionals from different disciplines to work together effectively, improving the quality of patient care. An interprofessional approach is essential in diabetes management, but there is only limited evidence of the effects of diabetes-specific IPE. The aim of this integrative review is to gather all relevant recent data on the outcomes of IPE on diabetes management. The search in the CINAHL, Medline and PsycINFO databases resulted in 1136 potential studies. An inductive content analysis was used to synthesize the key findings of the 14 studies found to fulfill the inclusion criteria of the systematic review. Two main categories and four subcategories of findings were identified. Firstly, the achieved outcomes included individual gain (e.g., learner´s confidence and motivation to treat patients with diabetes) and external benefits (e.g., benefits for the patient). Secondly, the experiences of IPE included both challenges (e.g., competing interests of different professions) and strengths (e.g., practical approach to diabetes management). In conclusion, the findings indicate that both learners and patients with diabetes benefit from IPE on diabetes management. Educators are encouraged to adopt practical IP approaches in diabetes education. However, it is necessary to estimate the resources available. More research is needed on the cost-effectiveness, long-term effects, and patient perspective of IPE on diabetes management.     

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.     

Competences for enhancing interprofessional collaboration in a paediatrics setting: Enabling and hindering factors

In 2011 an interprofessional educational programme called “Pediatric systematic assessment and communication for preventing emergencies” designed to increase clinical staff’s competence in treating sick children was introduced in one paediatrics department in Norway. To elicit an in-depth understanding of the perceptions of clinical staff about the programme and enact adjustments according to identified enabling and hindering factors for learning, nurses and paediatricians were invited to participate in focus group interviews. The interviews were analysed by content analysis. Enabling factors for learning included improved interprofessional collaboration and positive feedback on performance. Hindering factors included perceptions that the programme was redundant and the fact that collaborating departments, such as the surgical departments, were not familiar with the programme. Peer learning, more interprofessional learning activities, and the fostering of a learning organization were suggestions for sustained learning. Based on the results of the study we have now included collaborating departments in the programme.     

Interaction in online interprofessional education case discussions

This study investigated online interaction within a curriculum unit at the University of Toronto, Canada that included an interprofessional case study discussion in a mixed-mode (face-to-face and online) format. Nine of the 81 teams that completed the four-day curriculum were selected for detailed review based on the attitudes students expressed on a survey about the value of collaborating online for enhancing their appreciation of other health care professions. Five of the teams selected were ‘positive’ and four were ‘negative’. The responses to other survey items by members of these teams were then compared, as well as their message posting patterns and the content of their online discussions. Differences between the two sets were situated within a theoretical framework drawn from the contact theory, social interdependence theory, and the Community of Inquiry model. Institutional support in the form of facilitator involvement, individual predispositions to online and group learning, the group composition, the learning materials, task and assignment, and technical factors all affected the levels of participation online. Discourse and organizational techniques were identified that related to interactivity within the online discussions. These findings can help curriculum planners design interprofessional case studies that encourage the interactivity required for successful online discussions.     

Development of an interprofessional competency framework in Japan

This article presents a project that aimed to identify a set of competencies (domains and statements) to prepare Japanese students and healthcare practitioners for collaborative practice. The Japan Association for Interprofessional Education (JAIPE) has started a government-funded project to formulate its interprofessional competency framework, in cooperation with professional organisations (e.g. Japan Society for Medical Education) in healthcare and social sciences. This three-year project is underway as part of the Initiative to Build up the Core Healthcare Personnel programme of Mie University. This project consists of five stages: literature review, data collection, prototype development, consensus formation, and finalisation. Our efforts will culminate in Japan’s first interprofessional competency framework, with consensus from relevant academic societies and other stakeholders. We hope that the involvement of stakeholder participation will improve the usability of the final interprofessional competency framework.     

Grounding theories of W(e)Learn: A framework for online interprofessional education

Interprofessional care (IPC) is a prerequisite for enhanced communication between healthcare team members, improved quality of care, and better outcomes for patients. A move to an IPC model requires changing the learning experiences of healthcare providers during and after their qualification program. With the rapid growth of online and blended approaches to learning, an educational framework that explains how to construct quality learning events to provide IPC is pressing. Such a framework would offer a quality standard to help educators design, develop, deliver, and evaluate online interprofessional education (IPE) programs. IPE is an extremely delicate process due to issues related to knowledge, status, power, accountability, personality traits, and culture that surround IPC. In this paper, a review of the pertinent literature that would inform the development of such a framework is presented. The review covers IPC, IPE, learning theories, and eLearning in healthcare.     

Treating diabetes in underserved populations using an interprofessional care team

Abstract

Community Health Centers that provide diabetic care for underserved patients have unique challenges. This study describes how interprofessional care improves outcomes and results in cost savings. Interprofessional diabetes education and structured team building are discussed. The team consisted of a physician, nurse practitioner, clinical pharmacist, and a number of pre-medicinal, nursing, and pharmacy students. The outcomes were measured at one year intervals for a total of three years. During the two year period with the interprofessional care team, the diabetic patients in this study achieved a 10% improvement in HgA1c, and 9% improvement in systolic blood pressure, a 5% improvement in diastolic blood pressure, and a 62.6% reduction in triglycerides. These findings suggest that this interprofessional care model in a free clinic significantly improved the HgA1c, triglycerides, and blood pressure.     

The intersection of professionalism and interprofessional care: development and initial testing of the interprofessional professionalism assessment (IPA)

Valid assessment of interprofessional education and collaborative practice (IPECP) is challenging. The number of instruments that measure various aspects of IPECP, or in various sites is growing, however. The Interprofessional Professionalism Assessment (IPA) measures observable behaviors of health care professionals-in-training that demonstrate professionalism and collaboration when working with other health care providers in the context of people-centered care. The IPA instrument was created by the Interprofessional Professionalism Collaborative (IPC), a national group representing 12 entry-level health professions and one medical education assessment organization. The instrument was created and evaluated over several years through a comprehensive, multi-phasic process: 1) development of construct and observable behaviors, 2) instrument design, expert review and cognitive interviews, and 3) psychometric testing. The IPA contains 26 items representing six domains of professionalism (altruism and caring, excellence, ethics, respect, communication, accountability), and was tested by 233 preceptors rating health profession learners in the final year of their practical training. These preceptors represented 30 different academic institutions across the U.S., worked in various types of practice sites, and evaluated learners representing 10 different entry-level health professions. Exploratory factor analysis suggested four factors (communication, respect, excellence, altruism and caring) using 21 items with the least amount of missing data, and confirmed, for the most part, a priori expectations. Internal consistency reliability coefficients for the entire instrument and its four subscales were high (all greater than 0.9). Psychometric results demonstrate aspects of the IPA’s reliability and validity and its use across multiple health professions and in various practice sites.     

Making space: Integrating meaningful interprofessional experiences into an existing curriculum

Many health professional education programs have instituted, or are in the process of developing, structures for implementing interprofessional education (IPE). Professional organizations are also adopting IP competencies for their respective memberships and accreditations. Our IPE design and educational framework was informed by evidence gathered from professional organizations; the students' lived experience with traditional approaches and evolving IPE designs and data from our school's longitudinal curriculum evaluation study. This paper briefly describes the evolution and design of an embedded IPE program within an existing master's level curriculum – which meets not only curriculum competencies but also nationally recognizes IPE competencies. In addition, the embedded program articulates with a mandatory faculty-wide IPE initiative. The creation of embedded IPE within existing courses allowed for enriched learning opportunities for both discipline-specific and IPE knowledge without changing the overall curriculum structure.     

Developing common learning: the new generation project undergraduate curriculum model

This paper describes the curriculum model developed for an ambitious interprofessional education programme for health and social care professions implemented in two universities in the south of England (the New Generation Project). An outline of how the New Generation Project has interpreted the meaning of interprofessional learning is presented first. This is followed by an outline of the structure of the programme, describing both learning in common and interprofessional learning components. The pedagogies underpinning this curriculum initiative are presented and an integrated pedagogical model, facilitated collaborative interprofessional learning, is proposed. The New Generation Project curriculum is then discussed as an extension of an established typology of interprofessional education.     

Evaluation of an interprofessional educational curriculum pilot course for practitioners working with post-stroke patients

Abstract

This report describes the design and evaluation of an interprofessional pilot training course aimed at pre-licensure practitioners working with post-stroke patients in community-based settings. The course was developed by community-based practitioners from nine health professions. Course learning activities included traditional methods (lectures) and interactive modules (problem-based learning and exchange-based learning). The study’s aim was to assess the program’s effectiveness in adapting and incorporating knowledge, skills and self-confidence when delivering tertiary care in therapeutic pool environments; gauge adoption of course principles into practice, and assess overall course satisfaction. Methods of evaluation included conceptual mapping of course format, pre- and post-questionnaires, daily reflection questionnaires, course satisfaction survey and adoption survey, 10 weeks follow-up. Overall, the findings indicate students’ knowledge, skills and self-confidence in delivering effective post-stroke care increased following the training. Students reported adopting clinical practices in 10 weeks follow-up. Implications for designing interprofessional curricula are discussed.     

Anchoring interprofessional education in undergraduate curricula: The Heidelberg story

ABSTRACT

The ability of health professionals to collaborate effectively has significant potential impact on patient safety and quality-care outcomes, especially given the increasingly complex and dynamic clinical practice environments of today. Educators of the health professions are faced with an immediate challenge to adapt curricula and traditional teaching methods to ensure graduates are equipped with the necessary interprofessional competencies and (inter)professional values for their future practice. The World Health Organization’s “Framework for action in interprofessional education (IPE) and collaborative practice” promotes IPE as a key strategy to enhance patient outcomes by preparing a “collaborative practice-ready health workforce.” Logistical and attitudinal barriers can hinder integration of IPE into curricula. Lessons learned through the implementation of a planned change to establish four interprofessional seminars (team communication, medical error communication, healthcare English, and small business management) at Heidelberg University Medical Faculty, Germany, are described. A key factor in successfully anchoring IPE seminars in the undergraduate curricula was the structured approach drawing on change management concepts.     

Translation and cultural adaptation of the Japanese version of the interprofessional facilitation scale

Effective interaction in interprofessional collaboration requires skills in interprofessional facilitation. The need for interprofessional learning and practice in Japan is highlighted by Japan’s status as one of the most rapidly aging societies because good care for elderly people with complex needs requires effective collaboration between different professional groups. The development of interprofessional facilitation skills (including management of the additional complexities) among learners or professionals enhances interprofessional learning and consensus building and empowers them to make appropriate commitments when faced with difficult challenges. The 18-item interprofessional facilitation scale (IPFS) can be used to enhance interprofessional facilitation skills. Here, we aimed to develop a Japanese adapted version of the IPFS and to validate it for use with Japanese healthcare professionals. Consistent with guidelines for cross-cultural adaptation, three translators translated the original IPFS from English into Japanese, and an expert and all authors confirmed its face and content validity. The translated items were amended during backtranslation and expert reviews. Exploratory factor analysis was performed with 167 healthcare professionals to explore the underlying structure of the items. This analysis revealed two factors with good internal consistency (Cronbach’s alpha > 0.8), which were labelled as: (1) encouraging interprofessional interaction and (2) respect for each professional. The original factor ‘Encouraging interprofessional interaction’ was divided into two factors in the study. One reason for this division might be related to the behaviour of Japanese health professionals, that is, most Japanese might understand that ‘facilitation’ encourages relationships as contextual belonging that are distinct from relationships based on respect for others. This mindset is likely based on the notion of ‘relationalism’, which is fundamental in Japanese culture. Further investigation of this Japanese version of the IPFS will strengthen factor construction and improve scrutiny of the relationships between factors.     

Praxis and reflexivity for interprofessional education: towards an inclusive theoretical framework for learning

Abstract

While there is growing evidence of theoretical perspectives adopted in interprofessional education, learning theories tend to foreground the individual, focusing on psycho-social aspects of individual differences and professional identity to the detriment of considering social-structural factors at work in social practices. Conversely socially situated practice is criticised for being context-specific, making it difficult to draw generalisable conclusions for improving interprofessional education. This article builds on a theoretical framework derived from earlier research, drawing on the dynamics of Dewey’s experiential learning theory and Archer’s critical realist social theory, to make a case for a meta-theoretical framework enabling social-constructivist and situated learning theories to be interlinked and integrated through praxis and reflexivity. Our current analysis is grounded in an interprofessional curriculum initiative mediated by a virtual community peopled by health and social care users. Student perceptions, captured through quantitative and qualitative data, suggest three major disruptive themes, creating opportunities for congruence and disjuncture and generating a model of zones of interlinked praxis associated with professional differences and identity, pedagogic strategies and technology-mediated approaches. This model contributes to a framework for understanding the complexity of interprofessional learning and offers bridges between individual and structural factors for engaging with the enablements and constraints at work in communities of practice and networks for interprofessional education.     

New national curricula guidelines that support the use of interprofessional education in the Brazilian context: An analysis of key documents

The National Curricular Guidelines (NCGs) are important documents for understanding the history of academic health professions education in Brazil. Key policies within the NCGs have helped to reorient health professions education and have stimulated curricular changes, including active learning methodologies and more integrated teaching-service environments, and, more recently, have introduced interprofessional education (IPE) in both undergraduate and postgraduate sectors. This article presents the findings of a study that examined the NCGs for nursing, dentistry, and medicine courses as juridical foundations for adopting strategies that promote IPE across higher education institutions in Brazil. We employed a comparative and exploratory documentary analysis to understand the role of IPE and collaborative practices in NCGs for the three largest professions in Brazil. Following a thematic analysis of these texts, four key themes emerged: faculty development; competencies for teamwork; curricular structure; and learning metrics. Key findings related to each of these themes are presented and discussed in relation to the wider interprofessional literature. The article goes on to argue that the statements contained in the NCGs about adoption of IPE and collaborative practices will have an important influence in shaping the future of health professions education in Brazil.     

The interprofessional clinical experience: interprofessional education in the nursing home

Abstract

The interprofessional clinical experience (ICE) was designed to introduce trainees to the roles of different healthcare professionals, provide an opportunity to participate in an interprofessional team, and familiarize trainees with caring for older adults in the nursing home setting. Healthcare trainees from seven professions (dentistry, medicine, nursing, nutrition, occupational therapy, optometry and social work) participated in ICE. This program consisted of individual patient interviews followed by a team meeting to develop a comprehensive care plan. To evaluate the impact of ICE on attitudinal change, the UCLA Geriatric Attitudes Scale and a post-experience assessment were used. The post-experience assessment evaluated the trainees’ perception of potential team members’ roles and attitudes about interprofessional team care of the older adult. Attitudes toward interprofessional teamwork and the older adult were generally positive. ICE is a novel program that allows trainees across healthcare professions to experience interprofessional teamwork in the nursing home setting.     

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.     

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.