Shared learning in primary care: participants' views of the benefits of this approach

This is a study exploring participants' views regarding a series of shared or interprofessional learning sessions carried out in a primary care setting in Bradford, UK. One-hundred-and-twenty-four participants including doctors, practice nurses, nurse practitioners and health visitors attended six expert-led, case-based learning sessions on clinical topics relevant to their work. The evaluation of the sessions is presented, from questionnaire feedback including open responses. Participants had high expectations of shared learning, which was largely met in terms of sharing ideas regarding professional roles and sharing clinical knowledge and skills. Variations between professionals, and between sessions, are noted and discussed. It was concluded that shared or interprofessional learning in the workplace is valued by clinicians, can help improve understanding of professional roles and also enhance clinical learning.     

Interprofessional education and working in mental health: in search of the evidence base

Aim To explore interprofessional attitudes arising from shared learning in mental health. Background Inter‐professional education in healthcare is a priority area for improving team‐working and communication. Many studies have attempted to evaluate its benefits and challenges, although few emanate from the mental health arena. However, producing evidence to link educational input with clinical outcomes is notoriously difficult. This project attempted to produce evidence for changes in interprofessional attitudes and stereotypes. Method(s) Mental health nursing students and clinical psychology trainees participated in inter‐professional education. An evaluation tool was designed to evaluate the experience and outcomes, and to consider implications for interprofessional working. Results There was an increase in clarity regarding roles, approaches and resources, and how to collaborate in practice. There was no significant change in professional identity. Many challenges were identified, including differences in academic level, previous experience, expectations, assessment, motivation and effort. Conclusion Despite the challenges, it remains important to offer collaboration with future mental health colleagues as a foundation for effective team‐working. Recommendations are made for creating inter‐professional education opportunities for diverse student groups. Implications for Nursing Management Mental health professionals need to work effectively in multidisciplinary teams. Drawing on available guidance, managers should encourage and support team members to undertake shared learning where possible, both within clinical settings and through more formal educational provision. In this way, managers can facilitate collaborative relationships which will pay dividends for the provision of effective mental health care. This project adds to the limited knowledge currently available on interprofessional learning and attitudes within a mental health context.     

Roles,processes, and outcomes of interprofessional shared decision-making in a neonatal intensive care unit: A qualitative study

Shared decision-making provides an opportunity for the knowledge and skills of care providers to synergistically influence patient care. Little is known about interprofessional shared decision-making processes in critical care settings. The aim of this study was to explore interprofessional team members’ perspectives about the nature of interprofessional shared decision-making in a neonatal intensive care unit (NICU) and to determine if there are any differences in perspectives across professional groups. An exploratory qualitative approach was used consisting of semi-structured interviews with 22 members of an interprofessional team working in a tertiary care NICU in Canada. Participants identified four key roles involved in interprofessional shared decision-making: leader, clinical experts, parents, and synthesizer. Participants perceived that interprofessional shared decision-making happens through collaboration, sharing, and weighing the options, the evidence and the credibility of opinions put forward. The process of interprofessional shared decision-making leads to a well-informed decision and participants feeling valued. Findings from this study identified key concepts of interprofessional shared decision-making, increased awareness of differing professional perspectives about this process of shared decision-making, and clarified understanding of the different roles involved in the decision-making process in an NICU.     

International service learning and interprofessional education in Ecuador: Findings from a phenomenology study with students from four professions

Abstract

Combined international service learning (ISL) and interprofessional education (IPE) experiences can move health professional student learning beyond the traditional confines of the classroom and outside uniprofessional ethos. The purpose of this transcendental phenomenological study was to describe the shared experience of health professional students participating in an ISL trip to a small community in Ecuador. The study focused on the learning and collaboration that occurred among students from multiple health professions during the trip and the cross-cultural exchange between the students and the patients in Ecuador. Participants included 15 students from 4 health professional programmes (pharmacy, medicine, physical therapy, and nursing). Data included interviews, focus groups, observation, and written documents. The essential meaning that emerged from this study was that the ISL/IPE learning opportunity created a practical opportunity for demystifying other healthcare professions in the context of a resource-limited international patient care setting, while supporting students’ personal and professional development. Four structural themes emerged to describe the student experiences. Students had to negotiate the language barrier, limited resources, and unexpected diagnoses, while simultaneously learning about the roles and scope of other professions on the team and how to communicate effectively. Student’s perseverance when facing the challenges resulted in their personal growth. The interprofessional component strengthened the students’ knowledge of interprofessional collaboration and communication through real-world application.     

How can student experience enhance the development of a model of interprofessional clinical skills education in the practice placement setting?

The practice placement setting offers opportunities and challenges for engaging students in high-quality interprofessional learning. The Fife Interprofessional Clinical Skills Model for Education was established to develop structured interprofessional learning opportunities for students during their clinical attachments in NHS Fife. This short report describes the delivery and evaluation of the model, which was piloted with students from the nursing, medicine and allied health professions. Scheduled workshops were delivered within primary and secondary care locations. The learning activities involved exploring and comparing their professional identities, discussing roles and responsibilities within the healthcare team and practicing nontechnical clinical skills. Students who participated in the workshops reported that they developed a better understanding of each other's roles and responsibilities and also identified that this would be transferable knowledge to their future practice. Exploring the student experience has assisted in developing relevant and accessible interprofessional learning opportunities within the practice placement setting.     

Teamwork,collaboration and networking: self-reported behavioural change following pre-licensure interprofessional clinical learning

ABSTRACT

The majority of studies exploring the impact of interprofessional education (IPE) for pre-licensure health professionals have focused on IPE experiences in the classroom, online or through simulation. Research into IPE in clinical settings has been carried out, however, to date most studies have focused on short-term outcomes related to learner reaction, attitudes and perceptions, and knowledge and skills. This study adds to the literature investigating IPE in clinical settings for pre-licensure health professionals by investigating the experiences of learners who, following their IPE clinical placement, had moved into other clinical (workplace) environments. To understand what, if any, influence the clinical IPE experience had on their subsequent professional practice, 13 participants (students and graduates) from five professions were interviewed. Inductive thematic analysis identified that, following their IPE placement, participants engaged in interprofessional practice by seeking and sharing information, embedding other professional goals into patient sessions and conducting joint sessions. Several factors influenced the ability and capacity to collaborate at the individual and organisation level. Findings from this study suggest that the dedicated IPE placements enhanced both student and graduate openness and ability to collaborate with other professions in subsequent clinical workplace settings.     

Persistent isolationist or collaborator? The nurse’s role in interprofessional collaborative practice

orchard ca . (2010) Journal of Nursing Management 18 , 248–257
Persistent isolationist or collaborator? The nurse’s role in interprofessional collaborative practice Aim The present study explores current understanding about interprofessional collaborative client-centred practice and nursing’s role in this form of care delivery. Background A profession-only focus on nursing practice has been challenged at professional, national governmental and World Health Organization levels stressing for more interprofessional patient-centred collaborative teamwork. Evaluation Moving to patient-centred collaborative practice is fraught with barriers. Enablers can result in building trust, power sharing and shared decision-making. Changing current workplace environments requires institutional commitments to support collaborative team development. Key issue(s) Nurses can become collaborative members of teams through: (1) re-socialize; (2) understanding and articulating nurses roles, knowledge and skills to others; (3) other health providers sharing the same to nurses; (4) identifying where shared roles, knowledge and skills exist; and (5) learning to work in collaborative teams. Nurses must address some fundamental issues about practice that negate collaboration and patient-centred care. Conclusions All professionals, including nurses, must move away from a service-oriented delivery to a patient-centred collaborative approach to care. Implications for nursing management The values within health organizations need to be underpinned by collaborative interprofessional patient-centred practice. To accomplish this goal, administrators and managers must support assessment of employees and visiting physicians as to their conformance with agency established expectations for such practice.     

Interprofessional undergraduate clinical learning: Results from a three year project in a Danish Interprofessional Training Unit

On entering higher education students become professionally socialized, and parallel with this, stereotyping takes place, students developing a more positive assessment of their own roles than those of other professions. This difference between the view of their own and other professions can contribute to creating cognitive and social boundaries between professions that hinder sharing of knowledge, which can result in poor cooperation. Interprofessional training can provide students with good clinical expertise in their own profession as well as teach them about other professions encouraging more positive attitudes between the professions. This project has taken place from 2004 to 2007 in a Danish Interprofessional Training Unit manned with students from the professions occupational therapy, physiotherapy, medicine and nursing. As part of an evaluation of the project, four focus group interviews and two in-depth interviews were analysed using the technique of Systematic Text Condensation. Results show that the goals of the Interprofessional Training Unit were fulfilled because the students learned interprofessional teamwork, strengthened their own professional role and worked together in an organization for the benefit of the patient. All this took place in a secure learning environment in which new methods of coordinating and integrating clinical and theoretical interprofessional learning were developed and tested.     

Medical student perceptions of an initial collaborative immersion experience

Recent reviews of interprofessional education (IPE) highlight the need for innovative curricula focused on longitudinal clinical learning. We describe the development and early outcomes of the initial clinical experience (ICE), a longitudinal practice-based course for first-year medical students. While IPE courses focus on student-to-student interaction, ICE focuses on introducing students to interprofessional collaboration. Students attend 14 sessions at one of 18 different clinical sites. They work directly with different health professionals from among 17 possible professions, including nurses, pharmacists, social workers, and respiratory, occupational, and physical therapists. Between 2015 and 2016, 167 students completed the course, and 81 completed the end-of-course evaluation. Students agreed or strongly agreed that ICE meaningfully contributed to their understanding of healthcare teams and different professional roles (86%), improved their understanding of healthcare systems (84%), improved their ability to communicate with healthcare professionals (61%), and improved their ability to work on interprofessional teams (65%). Select themes from narrative comments suggest that clinical immersion improves understanding of professional roles, helps students understand their own future roles in healthcare teams, and increases awareness of and respect for other professionals, with the potential to change future practice. ICE may be a template for other schools wishing to expand their current educational offerings, by engaging learners in more authentic, longitudinal clinical experiences with practicing healthcare professionals.     

Scottish healthcare student's perceptions of an interprofessional ward simulation: An exploratory,descriptive study

The most memorable learning occurs during placement. Simulated interprofessional learning is a logical learning opportunity to help healthcare professionals work beyond their professional silos. In this qualitative study, we investigated the perceived learning of students from six health professions (adult nursing, diagnostic radiography, occupational therapy, physiotherapy, dietetics, and pharmacy) from their participation in a 45 min interprofessional ward simulation. Semistructured focus groups were undertaken, and data were analyzed using framework analysis. Two overarching themes were evident, each of which had subthemes: (i) the ward simulation as an interprofessional education opportunity (subthemes: reality of situations and interactions); and (ii) the perceived learning achieved (subthemes: professional roles, priorities, respect, communication, teamwork, and quality of care). The results indicated that a short interprofessional ward simulation, unsupported by additional learning opportunities or directed study, is a useful and engaging interprofessional learning opportunity. Students appear to have learnt important key messages central to the interprofessional education curricula to help develop practitioners who can effectively work together as an interprofessional team, and that this learning is partly due to simulation allowing things to go wrong.     

Interprofessional supervision in an intercultural context: A qualitative study

Our understanding of the qualities and value of clinical supervision is based on uniprofessional clinical education models. There is little research regarding the role and qualities needed in the supervisor role for supporting interprofessional placements. This paper reports the views and perceptions of medical and allied heath students and supervisors on the characteristics of clinical supervision in an interprofessional, international context. A qualitative case study was used involving semi-structured interviews of eight health professional students and four clinical supervisors before and after an interprofessional, international clinical placement. Our findings suggest that supervision from educators whose profession differs from that of the students can be a beneficial and rewarding experience leading to the use of alternative learning strategies. Although all participants valued interprofessional supervision, there was agreement that profession-specific supervision was required throughout the placement. Further research is required to understand this view as interprofessional education aims to prepare graduates for collaborative practice where they may work in teams supervised by staff whose profession may differ from their own.     

Case-based interprofessional learning for undergraduate healthcare professionals in the clinical setting

Interprofessional learning (IPL) within the healthcare setting has well documented positive outcomes for patients, yet it is not widely offered at the undergraduate level, particularly in a clinical setting. We set up case-based teaching scenarios involving a real patient, aimed at small groups of four students representing two or more healthcare professions. The aim of the sessions was to give students a greater awareness of the roles of all the different healthcare professions involved in patient care in a hospital setting. Weekly sessions were offered on six wards covering different clinical specialties. Three hundred and twenty-nine undergraduate students from different healthcare professions (nursing, medicine, pharmacy, midwifery, physician associate, physiotherapy, occupational therapy, speech, and language therapy) each attended one IPL session during the current academic year. Students were given an evaluation sheet at the end of each session to be filled out anonymously. Forty per cent of the students reported experiencing interprofessional case-based learning for the first time. Over 90% of students agreed or strongly agreed with a list of statements promoting the advantages and benefits of case-based IPL for undergraduate students and many of them requested more sessions. Seventy per cent of all respondents stated they would alter their future professional behaviour as a result of this session. We propose to introduce the sessions into the undergraduate curriculum across all healthcare related professions.     

Spreading the concept: an attempt to translate an interprofessional clinical placement across a Danish hospital

Abstract

In a Danish Interprofessional Training Unit (ITU), the clinical tutors have succeeded in developing a safe learning environment combined with challenging the students by giving them responsibility for the patient’s care and rehabilitation. In the ITU, students improved their uniprofessional and interprofessional knowledge and capability while strengthening their professional identity. It was, therefore, decided to make an attempt to transfer these interprofessional learning and teaching methods to another setting. The aims of this study were to evaluate whether the students learned about interprofessional collaboration and strengthened their professional identity and whether the clinical tutors could create a safe and challenging learning environment. Clinical tutors from the professions occupational therapy, physiotherapy, and nursing together planned the pedagogical approach and practical organization of two pilot studies in an orthopedic ward. After the intervention, focus group interviews of students and clinical tutors were performed and analyzed. The findings indicated that a one-week interprofessional clinical placement can contribute to students learning about interprofessional collaboration and to their development of professional identity. The data from the clinical tutors indicated that they needed to create a safe and challenging learning environment but emphasized that a thorough planning and continuous monitoring and adjusting of the clinical placement is necessary for success. The study documents that it is possible to create successful interprofessional learning opportunities in a normal ward environment in a restricted time frame. This knowledge can be applied to other ward settings where interprofessional clinical training is a natural possibility.     

Can sharing stories change practice? A qualitative study of an interprofessional narrative-based palliative care course

A series of six interprofessional palliative care meetings used narrative, with participants sharing stories from their professional experience in facilitated small groups. The course was attended by doctors, nurses, social workers and emergency care practitioners. The course was evaluated by telephone interview with 19 of the 28 participants. Respondents reported effects including changed behaviours and benefit to patients. The use of narrative, as a starting point for shared learning, discussion and evaluation is unusual. Five months after the end of the course, many participants described changed professional behaviour which they believed led to improved patient outcomes.     

“Refreshed…reinforced…reflective”: A qualitative exploration of interprofessional education facilitators’ own interprofessional learning and collaborative practice

While there is extensive research examining the outcomes of interprofessional education (IPE) for students, minimal research has investigated how facilitating student learning influences the facilitators themselves. This exploratory case study aimed to explore whether and how facilitating IPE influences facilitators’ own collaborative practice attitudes, knowledge, and workplace behaviours. Sixteen facilitators of an online pre-licensure IPE unit for an Australian university participated in semi-structured telephone interviews. Inductive thematic analysis revealed three emergent themes and associated subthemes characterising participants’ reflexivity as IPE facilitators: interprofessional learning; professional behaviour change; and collaborative practice expertise. Participants experienced interprofessional learning in their role as facilitators, improving their understanding of other professionals’ roles, theoretical and empirical knowledge underlying collaborative practice, and the use and value of online communication. Participants also reported having changed several professional behaviours, including improved interprofessional collaboration with colleagues, a change in care plan focus, a less didactic approach to supervising students and staff, and greater enthusiasm impressing the value of collaborative practice on placement students. Participants reported having acquired their prior interprofessional collaboration expertise via professional experience rather than formal learning opportunities and believed access to formal IPE as learners would aid their continuing professional development. Overall, the outcomes of the IPE experience extended past the intended audience of the student learners and positively impacted on the facilitators as well.     

Interprofessional clinical education for occupational therapy and psychology students: a social skills training program for children with autism spectrum disorders

An interprofessional clinical learning experience was developed for pre-licensure occupational therapy (OT) and psychology graduate students. Students worked in interprofessional teams to plan and implement a social skills training program for children with autism spectrum disorders (ASD). The objectives were to provide a hands-on, student-led clinical experience; facilitate interprofessional collaborative learning through leadership partnerships and teach children with ASD to engage in appropriate social skill behaviors. Concurrently, faculty performed qualitative research to explore how the students worked together to provide intervention to the children. Data were collected via interview, direct observation of student planning sessions and student interprofessional interactions, and collection of posts from an online social network site used for session planning. There were six student participants and two faculty participants. Four themes emerged: learning who I am as a professional, learning to appreciate our professional differences, learning to communicate with each other and figuring it out, for the benefit of the kids. This interprofessional clinical learning experience and research helps ensure that students are adequately prepared to represent their profession as part of a diverse interprofessional health care team.     

Views from the field: Medical student experiences and perceptions of interprofessional learning and collaboration in rural settings

Exploring the perceived environment where students are educated, as well as where they practice, is particularly important for educators and practitioners working in situations of interprofessional rural and remote health. In this study, we explored the perceptions of undergraduate medical students regarding interprofessionalism across their four-year undergraduate program which focuses on rural health. A thematic content analysis of the text-data was conducted on a convenience sample of 47 student responses to essay questions across four cohorts of a four-year undergraduate medical program. The medical program has an explicit social accountability mandate for responsiveness to the needs of a rural population and thus students have multiple opportunities to experience interprofessional education and collaboration in rural contexts. Participants reported (a) blurring and flexibility of roles in a primarily positive manner, (b) participating in unstructured interprofessional learning and collaboration, (c) experiencing the importance of social connections to interprofessional collaboration and learning, and (d) realisations that interprofessional collaboration is a means of overcoming barriers in rural areas. We discuss our findings using the socio-material perspective of complexity theory. These findings may be used to inform undergraduate programs in re-defining, re-creating, developing, and fostering interprofessional learning opportunities for medical students in rural communities as well as to support clinical faculty through ongoing professional development.     

A passage to interprofessional learning: the benefits to students from an educational visit to India

An educational visit was made by a group of students representing all eight professional pathways on an interprofessional learning programme in health and social care at Canterbury Christ Church University to a hospital in Kerala, India. Interprofessional clinical supervision groups were organised in order to support the students, many of whom had little experience of foreign travel, in an environment they were anticipated to find emotionally challenging. At the close of the visit, following informal observation of a degree of interprofessional learning that had not been anticipated, qualitative data were collected by means of an opportunistically administered questionnaire that yielded insights into the quality of the learning – cultural, interprofessional and personal – that had resulted. This data indicated multiple benefits, some quite unexpected, for all involved; the aim of this paper is to present and discuss these. There are significant implications for health and social care education, including the value of international visits and interprofessional clinical supervision.