Faculty development to support interprofessional education in healthcare professions: A realist synthesis

Interprofessional collaboration is expected of healthcare providers to effect positive patient care experiences, reduce healthcare costs, and improve population health. While interprofessional education (IPE) is essential to graduate collaboration-ready healthcare professionals, faculty have limited experience and expertise in facilitating IPE, slowing adoption of this strategy. Faculty who are expected to develop, implement, and facilitate IPE activities in health professions need support and training to be successful. Faculty development programmes specific to IPE are examined through a comprehensive realist synthesis. The review began by identification of the mechanisms underpinning the intervention and then continued through a search for evidence relevant to the identified mechanisms. From 1,749 citations reviewed, 15 articles and book chapters were synthesised. The findings demonstrate that through the mechanisms—roles and role modelling, valuing diversity, reflection, group process, and knowledge, skills, and attitudes for IPE—positive outcomes can be achieved. Outcomes of increasing capacity and sustainability of IPE programmes, forming networks of individuals concerned with IPE, and evaluating and assessing of outcomes of IPE, may all be achieved through these mechanisms. The contextual factors include attitudes and expectations, programme logistics, leadership, and commitment, which interact with the mechanisms to impact the outcomes. Multiple context-mechanism-outcome configurations were revealed and analysed which help to explain how faculty development for IPE works in varying settings.     

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.     

Using the critical incident technique to measure long-term outcomes of interprofessional education

There is a critical need to develop methods that capture long-term trainee outcomes and link these outcomes to interprofessional education (IPE) to establish the value added from IPE. This article describes the use of the critical incident technique (CIT) to evaluate long-term trainee outcomes attributed to IPE. Critical incidents (CIs) are specific examples of behaviours that occurred within the recent past. Trainees of an IPE programme (n = 24) were interviewed using CIT. Across the trainees, 41 CIs were reported, of which 9 were collapsed due to similarity in theme. A final total of 32 CIs were mapped along the Kirkpatrick/Barr Model of Learner Outcomes. The mapping process revealed that all of the CIs reported described incidents at Levels 3, 4a, and 4b, indicating changes in trainees’ own professional behaviour and improvements in patient outcomes related to their IPE experience. Implications for evaluating IPE using the CIT method are discussed.     

Health Care Team Challenges: an international review and research agenda

Abstract

Academic institutions worldwide have been tasked with embedding interprofessional education (IPE) into the curricula of health and human service professions. There are few internationally shared examples of interprofessional (IP) learning activities reported in the literature. This report describes the formation of an international IPE research network and provides a summary of the implementation and evaluation of one such shared IPE example, the Health Care Team Challenge? (HCTC?). We outline the format, key features and evaluation strategies of the HCTC? IPE. An international research agenda to test cases and assess learning processes are described, and directions for dissemination and sustainability are proposed.     

Examining semantics in interprofessional research: A bibliometric study

While experts in the field provide clarity between terms such as interprofessional and multidisciplinary, the published literature may not be offering this preciseness. A bibliometric analysis was conducted on 1,148 studies that examined terms such as interprofessional, multidisciplinary, and teamwork in order to examine patterns of indexing, overlap in how terms and phrases are used by authors, and consistencies in the definitions of terminology. A small number of relevant indexing terms are available in PubMed but were not regularly applied to the studies in this subject area. Our findings indicate that relying on indexing terms to locate this body of literature will not reliably identify all relevant studies when searching the literature. Definitions for these terms were typically not offered by authors, references were not regularly provided when definitions were included, and clear distinctions between the different terms were not reliably provided, thus creating further difficulties. Poor indexing, lack of consistent definitions being used in the research literature, and some authors using phrases and terms as synonyms make it challenging for educators, scholars, and researchers to search, find, and use this body of literature.     

Interprofessional collaboration: An exploration of possible prerequisites for successful implementation

Poor collaboration among professional groups may be a major cause of incoherent patient pathways in hospital settings. For over a decade, interprofessional collaboration (IPC) have been stressed as an effective method to enhance the delivery of patient care. This article presents a theory-based stakeholder evaluation of the implementation of an intervention aiming to implement the concept of IPC in a Danish regional hospital from 2012 to 2015. Involving five departments and eight professions, the intervention aimed at developing coherent practices across health professions by optimising patient pathways with the establishment of interprofessional teams as a core element. The evaluation assessed the professionals’ views of the intervention. Data were collected through focus group interviews and document analysis. We found that a strengthened focus on patient pathways, well-trained instructors, and an evidence-based strategy for implementation facilitates the success of interventions with a focus on IPC in hospital settings. We furthermore found that cultural and organisational factors are barriers to the implementation of IPC practices, that interruptions of uni-professional work may hamper coordination across professions, and that the interprofessional teams may form new isolated organisational structures.     

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.     

Recognizing, responding to and reporting patient deterioration: transferring simulation learning to patient care settings

Background

A simulation program was implemented in a pre-registration nursing curriculum for developing nursing students’ performances in assessing, managing and reporting in relation to patients with physiological deterioration.

Aim

To explore nursing students’ experiences of how a simulation programme has prepared them to transfer their performance to clinical practice, in their encounters with deteriorating patients in ward.

Method

A qualitative study using a critical incident technique was conducted. After they had undertaken a simulation program, fifteen undergraduate nursing students, who had encountered deteriorating patients in their clinical practicum in wards were interviewed using semi-structured questionnaires. Content analysis was used to analyse the data.

Results

Four main themes emerged describing key factors influencing the transfer of simulation learning to clinical practice; memory, involving simulation learning enhanced storage and retrieval of knowledge; mnemonics as transfer tools for performing systematic physical assessment and reporting a patient's deterioration to a doctor; recognizing similar situations, where students used experiences from similar simulation situation to identify problems and initiate nursing interventions for their patients; and finally, emotional responses, that have both negative and positive impacts on transferring their simulation learning. Two other main themes emerged regarding strategies to facilitate transfer; self-directed learning for promoting the retention of simulation learning; and, realism, where simulated patients could be used to provide real-life clinical experiences.

Conclusion

The findings provide an understanding of how a simulation program may impact on the nursing students’ performances in clinical practice, which is useful information for future improvement of programmes to optimize learning and transfer effective care to patient care settings.     

Interdisciplinary teamwork: is the influence of emotional intelligence fully appreciated?

AIM: The purpose of this study is to discuss how emotional intelligence affects interdisciplinary team effectiveness. Some findings from a larger study on interdisciplinary teamworking are discussed. BACKGROUND: Teams are often evaluated for complementary skill mix and expertise that are integrated for specialist service delivery. Interactional skills and emotional intelligence also affect team behaviour and performance. An effective team needs both emotional intelligence and expertise, including technical, clinical, social and interactional skills, so that teamwork becomes greater or lesser than the whole, depending on how well individuals work together. KEY ISSUES: Team diversity, individuality and personality differences, and interprofessional safety are analysed to raise awareness for nurse managers of the complexity of interdisciplinary working relationships. CONCLUSION: If nursing input into interdisciplinary work is to be maximized, nurse managers might consider the role of emotional intelligence in influencing team effectiveness, the quality of client care, staff retention and job satisfaction.     

Leadership of interprofessional health and social care teams: a socio-historical analysis

reeves s., macmillan k. & van soeren m. (2010) Journal of Nursing Management 18, 258–264
Leadership of interprofessional health and social care teams: a socio-historical analysis Aim The aim of this paper is to explore some of the key socio-historical issues related to the leadership of interprofessional teams. Background Over the past quarter of a century, there have been repeated calls for collaboration to help improve the delivery of care. Interprofessional teamwork is regarded as a key approach to delivering high-quality, safe care. Evaluation We draw upon historical documents to understand how modern health and social care professions emerged from 16th-century crafts guilds. We employ sociological theories to help analyse the nature of these professional developments for team leadership. Key issues As the forerunners of professions, crafts guilds were established on the basis of protection and promotion of their members. Such traits have been emphasized during the evolution of professions, which have resulted in strains for teamwork and leadership. Conclusions Understanding a problem through a socio-historical analysis can assist management to understand the barriers to collaboration and team leadership. Implications for nursing management Nursing management is in a unique role to observe and broker team conflict. It is rare to examine these phenomena through a humanities/social sciences lens. This paper provides a rare perspective to foster understanding – an essential precursor to effective change management.     

Informal interprofessional learning: Visualizing the clinical workplace

Daily collaboration of senior doctors, residents and nurses involves a major potential for sharing knowledge between professionals. Therefore, more attention needs to be paid to informal learning to create strategies and appropriate conditions for enhancing and effectuating informal learning in the workplace. The aim of this study is to visualize and describe patterns of informal interprofessional learning relations among staff in complex care. Questionnaires with four network questions – recognized as indicators of informal learning in the clinical workplace – were handed out to intensive and medium care unit (ICU/MCU) staff members (N = 108), of which 77% were completed and returned. Data were analyzed using social network analysis and Mokken scale analysis. Densities, tie strength and reciprocity of the four networks created show MCU and ICU nurses as subgroups within the ward and reveal central but relatively one-sided relations of senior doctors with nurses and residents. Based on the analyses, we formulated a scale of intensity of informal learning relations that can be used to understand and stimulate informal interprofessional learning.     

Economic models for sustainable interprofessional education

ABSTRACT

Limited information exists on funding models for interprofessional education (IPE) course delivery, even though potential savings from IPE could be gained in healthcare delivery efficiencies and patient safety. Unanticipated economic barriers to implementing an IPE curriculum across programs and schools in University settings can stymie or even end movement toward collaboration and sustainable culture change. Clarity among stakeholders, including institutional leadership, faculty, and students, is necessary to avoid confusion about IPE tuition costs and funds flow, given that IPE involves multiple schools and programs sharing space, time, faculty, and tuition dollars. In this paper, we consider three funding models for IPE: (a) Centralized (b) Blended, and (c) Decentralized. The strengths and challenges associated with each of these models are discussed. Beginning such a discussion will move us toward understanding the return on investment of IPE.     

Educators working together for interprofessional education: From “fragmented beginnings” to being “intentionally interprofessional”

This article explores the development of interprofessional relationships between healthcare educators working together for interprofessional education (IPE). As part of a collaborative dialogical inquiry, data from 19 semi-structured interviews and 9 focus groups were used to explore how IPE educators develop shared purpose to help students learn to work with other health professions. Consistent with this methodology, the research group and study participants comprised educators from eight different professions. Questions asked of the data, using a lens of intersubjectivity, included: “What implicit assumptions are brought to interactions?” and “What happens to these assumptions as educators interact?” The emergent themes caution against assuming that all educators initially bring to interprofessional spaces only positive attitudes towards all professions. Educators beginning in a fragmented interprofessional space needed to reflect on earlier negative experiences with particular professions for reframing in a socially aware interprofessional space to enable collaborating in an intentional interprofessional space.     

Implementation of an electronic health records system within an interprofessional model of care

Abstract

Implementation of electronic health records (EHR) systems is challenging even in traditional healthcare settings, where administrative and clinical roles and responsibilities are clearly defined. However, even in these traditional settings the conflicting needs of stakeholders can trigger hierarchical decision-making processes that reflect the traditional power structures in healthcare today. These traditional processes are not structured to allow for incorporation of new patient-care models such as patient-centered care and interprofessional teams. New processes for EHR implementation and evaluation will be required as healthcare shifts to a patient-centered model that includes patients, families, multiple agencies, and interprofessional teams in short- and long-term clinical decision-making. This new model will be enabled by healthcare information technology and defined by information flow, workflow, and communication needs. We describe a model in development for the configuration and implementation of an EHR system in an interprofessional, interagency, free-clinic setting. The model uses a formative evaluation process that is rooted in usability to configure the EHR to fully support the needs of the variety of providers working as an interprofessional team. For this model to succeed, it must include informaticists as equal and essential members of the healthcare team.     

Interprofessional education: Lessons learned from conducting an electronic health record assignment

Abstract

Ineffective collaboration and communication contribute to fragmented patient care and potentially increase adverse events, clinical errors, and poor patient outcomes. Improving collaboration and communication is essential; however, interprofessional education (IPE) supporting this cause is not a common practice. Most often healthcare profession students are educated in profession-centered silos limiting opportunities to develop effective communication and collaboration practices. Students from nursing, health informatics, and radiologic technology collaboratively populated an academic electronic health record (AEHR) using fictitious case study data. The assignment was designed to address the Quality and Safety Education for Nurses and IPE Collaborative competencies. The objective was to evaluate students’ informatics competency, teamwork behaviors, and communication skills while exploring the different roles and responsibilities for collaborative practice after participating in an interprofessional case study assignment. Students gained experience using the AEHR for data entry, analysis, and application increasing their informatics competency. The assignment required students to communicate and actively collaborate as an interprofessional team to achieve the assignment objectives. Clinical errors often occur during care transitions, so simulating this process in the assignment was essential. Nursing and radiologic technology students had to analyze patient data and develop a hand-off communication template supporting patient safety and optimizing outcomes. The assignment required students to work as an interprofessional team and demonstrate how communication and collaboration is an essential component to quality and safe patient care.     

Interprofessional 30-day readmission review novel curriculum

ABSTRACT

Planning and coordination among health-care professionals decrease readmission rates, yet workers have few opportunities to learn interprofessionally to improve transitions of care. An interprofessional readmission review curriculum engaged medical residents, pharmacy residents, nurse practitioner students, early-career nurses, and social work students in a critical analysis of readmissions. Learners (N = 98) participated in a 2 h, collaborative learning session to review health records from a patient readmitted within 30 days of discharge and determine plausible root causes for readmissions. A 5-item post-session survey completed by 83 (85%) evaluated knowledge and perceived competencies in transitions of care before and after participation. Significant improvements (p < .001) occurred in ratings for all five items. Two open-ended questions captured learners’ perceptions of understanding and appreciating the roles of other disciplines in the discharge process and importance of interprofessional communication. Several themes emerged including understanding gaps in the discharge process, improving interprofessional collaboration and communication, and paying more attention to discharge documentation. This innovative program helped build essential skills to ensure safe discharges by introducing learners to interprofessional perspectives in analyzing root causes for readmissions, strategies to improve discharge planning, and the value of team-based care.     

Family physicians’ perspectives on interprofessional teamwork: Findings from a qualitative study

The aim of this study was to describe family physicians’ perspectives of their role in the primary care team and factors that facilitate and hinder teamwork. A qualitative study was conducted employing individual interviews with 19 academic/community-based family physicians who were part of interprofessional primary care teams in Edmonton, Alberta, Canada. Professional responsibilities and roles of physicians within the team and the facilitators and barriers to teamwork were investigated. Interviews were audiotaped, transcribed and analysed for emerging themes. The study findings revealed that family physicians consistently perceived themselves as having the leadership role on in the primary care team. Facilitators of teamwork included: communication; trust and respect; defined roles/responsibilities of team members; co-location; task shifting to other health professionals; and appropriate payment mechanisms. Barriers to teamwork included: undefined roles/responsibilities; lack of space; frequent staff turnover; network boundaries; and a culture of power and control. The findings suggest that moving family physicians toward more integrative and interdependent functioning within the primary care team will require overcoming the culture of traditional professional roles, addressing facilitators and barriers to teamwork, and providing training in teamwork.     

International service learning in the Dominican Republic: An asynchronous pilot in interprofessional education

Despite the logistical barriers of asynchronous academic calendars, university students in nursing and physical therapy in one academic health centre piloted an international, interprofessional, service learning project in the Dominican Republic. Although the nursing students and physical therapy students were not able to be in-country at the same time, they provided care to a common caseload of traumatic injury patients and those with chronic, debilitating conditions. Interprofessional communication occurred with the development of SBAR (Situation, Background, Assessment, Recommendation) reports from the Team Training curriculum of the Agency for Healthcare Research and Quality. Students learned the depth of physical therapy and the breadth of nursing. The pilot led to a more refined design to pair nursing and PT students, requiring them to communicate via mobile phone regarding results of examinations, and suggestions for follow-up by the nursing students, to ensure continuity of care and a more comprehensive approach to services.     

Negotiation of interprofessional culture shock:The experiences of pharmacists who become physicians

Summary

Professions generally operate within a shared set of values, symbols, and norms; in short, professions may be characterized as having somewhat unique sub-cultures. As inter-professional teamwork and collaboration gain prominence, understanding the inter-cultural dimensions of professional interactions may be useful in explaining how and why such teams function. One way of examining the unique (and common) elements of professional sub-cultures is to study the experiences of professionals who have “migrated” from one field to another. In this paper, the “culture shock” experience of pharmacists who have become physicians is described and discussed. Results from interviews with 32 pharmacist-physicians were used to frame four major themes that depict salient and unique characteristics of the cultures of pharmacy and medicine.     

The challenge of achieving interprofessional collaboration: Should we blame Nightingale?

The goal of implementing true interprofessional collaboration within the health care system seems to be elusive. The historical role of medicine as primary clinical leader and decision maker is particularly entrenched in the Western health care system. Florence Nightingale, the acknowledged founder of modern, Western nursing, is often blamed for the subservient role of nursing and other female-dominated health and social care professions. Is it fair to lay the blame on Nightingale? This paper seeks to place Nightingale in context and to revisit her own words to explore the Victorian world in which she worked as a social reformer. It argues that Nightingale made pragmatic compromises to gain acceptance for the new profession of nursing; that these compromises had unanticipated consequences that persist – but are not unchangeable.