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.     

Transforming primary care: improving on the medical home model

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.     

Interprofessional Education and Practice Guide No. 8: Team-based interprofessional practice placements

Whilst interest in interprofessional learning (IPL) in practice contexts has grown in recent years, the complexities involved have led many universities to rely on IPL in the classroom, online, and/or simulated contexts. Curtin University’s Faculty of Health Sciences has successfully implemented a multi-award winning, large-scale Interprofessional Practice Programme. This programme, which began with five small pilots in 2009, provides team-based interprofessional practice placements for over 550 students from nine professions per annum. Drawing on both the literature and Curtin University’s experience, this Interprofessional Education and Practice Guide aims to assist university and practice-based educators to “weigh the case” for introducing team-based interprofessional placements. The key lessons learned at Curtin University are identified to offer guidance to others towards establishing a similar programme for students during their prequalifying courses in health, social care, and related fields.     

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.     

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.     

Interprofessional education and collaboration: A simulation-based learning experience focused on common and complementary skills in an acute care environment

The purpose of this mixed-methods study was to explore from the participant’s perspective the influence of an interprofessional simulation-based learning experience on understanding the roles and responsibilities of healthcare professionals in the acute care setting, interprofessional collaboration, and communication. Participating students from two professional programs completed the Readiness for Interprofessional Learning Scale (RIPLS) prior to and following the simulation experience to explore the influence of the simulation experience on students’ perceptions of readiness to learn together. A Wilcoxon signed rank analysis was performed for each of the four subscales of the RIPLS: shared learning (<.001), teamwork and collaboration (<.001), professional identity (.042), and roles and responsibilities (.001). In addition, participating students were invited to participate in focus group interviews to discuss the effectiveness of the simulation experience. Three key themes were discovered: interprofessional teamwork, discovering roles and responsibilities, and increased confidence in treatment skills. The integration of interprofessional education through a simulation-based learning experience within the nursing and physical therapy professional programs provided a positive experience for the students. Simulation-based learning experiences may provide an opportunity for institutions to collaborate and provide additional engagement with healthcare professions that may not be represented within a single institution.     

Interprofessional service-learning definition

ABSTRACT

In 2010, the World Health Organization (WHO) published the WHO’s Framework for Action on Interprofessional Education and Collaborative Practice recognizing the significance of improved quality of patient care, lower healthcare costs and decrease medical errors through the use of interprofessional teams. This concept was embraced by the Midwest Interprofessional Practice Education and Research Center (MIPERC) and its Service-Learning workgroup, through the development of multiple interprofessional service-learning experiential opportunities for area health and medical students. Throughout MIPERC’s journey of developing and providing interprofessional service-learning opportunities, we have unsuccessfully sought to find a definition of interprofessional service-learning to assist us in better framing our work. We have found definitions of service-learning and interprofessional learning as well as case examples of service-learning, interprofessional learning, and interprofessional service-learning but, no definition of interprofessional service-learning. Following a review of the relevant literature, we have developed a definition of interprofessional service-learning that we believe is comprehensive and will be of use to other interprofessional service-learning organizations in framing and developing interprofessional service-learning opportunities for their health and medical students.     

An evaluation of an interprofessional practice-based learning environment using student reflections

The 12th Street Health and Wellness Center is an interprofessional, student-led, community-based clinic. Students from all University of Arkansas for Medical Sciences colleges work together to provide healthcare services for residents of an underserved community. Interprofessional student teams assess patients and present to an interprofessional preceptor team. At the conclusion of clinic, teams reflect on their experience. The objective of this study is to generate key themes from the end of clinic reflections to describe learning outcomes in an interprofessional practice environment. Student teams were asked to reflect on what they learned about patient care and interprofessional practice while volunteering at the clinic. Three hundred eighty reflection statements were assessed using the constant comparative approach with open coding by three researchers who identified and categorised themes by selecting key phrases from reflections. Eight themes emerged from this process which illuminated students’ self-perceived development during practice-based learning and interprofessional collaboration. Key phrases were also coded to the four core Interprofessional Education Collaborative competency domains. These results suggest learners’ perception that the Center is a practice-based environment that provides an opportunity to learn, integrate, and apply interprofessional curricular content.     

A systematic review and meta-analysis of outcomes of interprofessional education for healthcare students from seven countries

AimThis study aimed to analyze the effectiveness of the learning outcomes of the interprofessional education (IPE) model for healthcare students.BackgroundInterprofessional education (IPE) is an important teaching and learning model that involves two or more professions engaging or working together to improve the knowledge of healthcare students. However, the specific outcomes of IPE for healthcare students are unclear as only a few studies have reported them.DesignA meta-analysis was conducted to draw broad conclusions on the impact of IPE on healthcare students’ learning outcomes.MethodsThe CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, Web of Science, and Google Scholar databases were searched for relevant articles in the English language. To investigate the effectiveness of IPE, a pooled estimate of knowledge, readiness for and attitude toward interprofessional learning, and interprofessional competence were analyzed using a random effects model. The methodologies of the studies evaluated were assessed using the Cochrane risk-of-bias tool for randomized trials, version 2. Sensitivity analysis was performed to ensure the rigor of the findings. STATA 17 was used to perform the meta-analysis.ResultsEight studies were reviewed. IPE had a significant positive impact on healthcare students’ knowledge (Standardized Mean Difference [SMD]: 0.43; 95% Confidence Interval [CI]: 0.21–0.66). However, its impact on readiness for and attitude toward interprofessional learning and interprofessional competence was nonsignificant and needs further investigation.ConclusionIPE enables students to develop their knowledge of healthcare. This study provides evidence that IPE is a better strategy for enhancing healthcare students’ knowledge than traditional/discipline-specific teaching techniques.     

Exploring physiotherapy students' experiences of interprofessional collaboration in the clinical setting: a critical incident study

Effective interprofessional collaboration is considered essential for optimum healthcare delivery. Studies have investigated interprofessional education (IPE) as a means for improving collaborative practice, and evidence suggests that the clinical setting offers opportunities for interprofessional learning (IPL). Little is known, however, about the aspects of clinical practice that students perceive as meaningful to their IPL. This study explores physiotherapy students' experiences of collaborative working, and identifies their perceptions of the skills used and factors affecting interprofessional interactions in the clinical setting. Twenty second-year physiotherapy students studying in London provided written critical incident reports describing good and poor interprofessional collaborative encounters in the clinical setting. The data were subjected to thematic content analysis. Students identified communication and interprofessional relationships as the main factors affecting collaboration and perceived teamwork in formal contexts (e.g., team meetings) as generally effective with positive outcomes for professionals and patients. Informal collaboration was perceived to be poor and attributed primarily to insufficient direct contact and communication. The wide range of described experiences and learning outcomes indicate that clinical placements provide potentially valuable IPL opportunities. Facilitating the development of informal (ad hoc) collaborative teamwork skills is proposed as an important consideration when planning and implementing IPE in this setting.     

Graduate speech-language pathology students’ initial self-perceptions of skills critical for interprofessional practice

Interprofessional collaborative practice is critical for quality service delivery. Given the limited research on speech-language pathology (SLP) students’ interprofessional knowledge and skills, this investigation assessed graduate SLP students’ self-perceived interprofessional competence and their perceptions of roles of other professionals. Fifty-eight SLP students completed two validated surveys at the beginning of the first or second semester of graduate school. Collectively, the students rated themselves positively on communication, teamwork, attitudes toward interprofessional learning, and professional relationships. They rated the interactions of other professionals negatively. No significant differences were found between first- and second-semester students on communication, teamwork, and attitudes toward interprofessional learning. First-semester students rated interprofessional interactions and personal interprofessional relationships more positively than second-semester students. Overall, the students rated other professionals positively. These data describe the initial self-perceived interprofessional competencies of SLP students early in their master’s program, providing direction in designing interprofessional experiences for SLP students and practicing clinicians.     

Reply to Manthorpe & Iliffe

Effective interprofessional collaboration is considered essential for optimum healthcare delivery. Studies have investigated interprofessional education (IPE) as a means for improving collaborative practice, and evidence suggests that the clinical setting offers opportunities for interprofessional learning (IPL). Little is known, however, about the aspects of clinical practice that students perceive as meaningful to their IPL. This study explores physiotherapy students' experiences of collaborative working, and identifies their perceptions of the skills used and factors affecting interprofessional interactions in the clinical setting. Twenty second-year physiotherapy students studying in London provided written critical incident reports describing good and poor interprofessional collaborative encounters in the clinical setting. The data were subjected to thematic content analysis. Students identified communication and interprofessional relationships as the main factors affecting collaboration and perceived teamwork in formal contexts (e.g., team meetings) as generally effective with positive outcomes for professionals and patients. Informal collaboration was perceived to be poor and attributed primarily to insufficient direct contact and communication. The wide range of described experiences and learning outcomes indicate that clinical placements provide potentially valuable IPL opportunities. Facilitating the development of informal (ad hoc) collaborative teamwork skills is proposed as an important consideration when planning and implementing IPE in this setting.     

Measuring students perceptions of interprofessional clinical placements: Development of the Interprofessional Clinical Placement Learning Environment Inventory

Pre-professional healthcare courses, including nursing, are increasingly focused on interprofessional learning and experimentation with clinical education in ‘training wards’. This involves students from at least two disciplines who, under supervision, are responsible for patients' care. There is no consensus on how students' clinical learning experiences in this context are evaluated. We report the development and testing of the Interprofessional Clinical Placement Learning Environment Inventory (ICPLEI) in the Australian context. A question set was developed to measure student's perceptions of key variables in an interprofessional clinical learning environment: orientation, supervision, roles, learning and autonomy. An expert nursing panel rated items for a Content Validity Index of .93. Reliability was tested with 38 students. After a 2-week interprofessional ward placement nursing, medical and allied health students (n = 38) rated their learning environment highly, with median responses 4 or 5 of five (mean total 83%). The scale was reliable with a Cronbach alpha of .80 and moderate item-to-total correlations for 22/26 items. The Interprofessional Clinical Placement Learning Environment Inventory is a reliable, feasible, fast to complete tool, suitable for use with pre-registration healthcare students in this setting. Further testing of the tool's psychometric properties is recommended.     

Family health teams: A new Canadian interprofessional initiative

Interprofessional learning (IPL) and interprofessional practice (IPP) are strategies for healthcare services' striving to improve patient care. While health professionals are enacting IPL and IPP, the capacity to understand and comprehensively map IPL and IPP activities has remained elusive. Additionally, understanding and accounting for the impact of organizational context and culture on IPL and IPP requires attention. This paper presents the “interprofessional praxis audit framework” (IPAF), which is a unique tool to address these two issues. The IPAF comprises five components: context, culture, conduct, attitudes and information. Conjoined, the components facilitate examination of an organization's enactment of IPL and IPP. Utilized within an action research methodology, the IPAF enables a synchronized inspection, whereby similarities and differences of the components are considered simultaneously, and the knowledge developed is used to promote change projects to improve patient care.     

Indonesian students’ participation in an interprofessional learning workshop

Abstract

Interprofessional learning activities, such as workshops allow students to learn from, with and about each other. This study assessed the impact on Indonesian health students’ attitudes towards interprofessional education (IPE) from participating in a workshop on medication safety. The students attended a two-day IPE workshop on medication safety. Thirty-five (48.6%) students completed pre-/post-workshop surveys using a modified Readiness for Interprofessional Learning Scale (RIPLS) survey. The post-workshop survey also had a series of open-ended questions. Students’ responses to each RIPLS statement pre-/post-workshop were compared, whilst their responses to open-ended questions in post-workshop survey were thematically analysed. Students reported positive attitudinal changes on statements of shared learning and teamwork sub-scale (Wilcoxon p value <0.05). Analysis of the open-ended questions indicated that students perceived the workshop as having improved their understanding on the importance of teamwork and communication skills. This study found that learning with other health students through an IPE workshop improved medical, nursing and pharmacy students’ attitudes towards the importance of shared learning, teamwork and communication in healthcare service.     

Case-based learning in cross-professional groups – the development of a pre-registration interprofessional learning programme

This paper describes the development and evaluation of an interprofessional learning (IPL) programme at the pre-registration level. The principal aim of the study was to investigate whether case-based learning in cross-professional groups is a feasible and an effective way to conduct interprofessional education (IPE). Student volunteers from five different health professional training programmes were allocated to two groups: an intervention group and a control group. Interprofessional attitudes of all students were measured at the beginning and at the end of the study. Group members fed back their views about their learning experience after the 9-week long intervention. The study reports significant effects of the intervention on students' attitudes to different health professions. For example, students in the intervention group tended to view each profession as more ‘caring’ when compared to the control group. Student feedback was positive, with the main message to integrate the programme in the timetable and to introduce an opportunity for IPE in future years. The initial findings reported in this paper show that this is a feasible and an effective way to deliver IPE across the wide range of professions in the study and that the learning programme was viewed positively by the students who took part.     

Training students as interprofessional learning facilitators: An exploratory study highlighting the need to build confidence

Interprofessional learning (IPL) aims to equip students for future interprofessional and collaborative practice. Involving students as IPL facilitators is becoming increasingly commonplace as an attempt to catalyse the necessary transformation of our workforce needed to deliver truly integrated and person-centred care. Evidence in the literature highlights the key role of trained facilitators in reaching successful IPL outcomes. Some guidelines are available as to how we train staff facilitators, but little evidence is available that describes how to appropriately prepare student IPL facilitators. The aim of this exploratory study was to investigate whether student IPL facilitators felt that they were sufficiently prepared for their role. Data in the form of open-ended text-based responses from student facilitators (n = 9) were collated after an intervention where student facilitators had been given the role of supporting IPL. Data were analysed using principles of thematic analysis. Three main themes emerged: i) building confidence; ii) purpose of IPL; iii) learning moments. Student IPL facilitators who took part in this study felt that they were adequately prepared for their role. Findings show that preparing students for IPL facilitation has similar, yet unique, components compared to the training staff. In particular, this study highlighted a need for student facilitators to receive further preparation to help build their confidence. Involving students as IPL facilitators has great potential in staff and students joining forces to equip students for future interprofessional and collaborative practice that can deliver high-quality care.     

Interprofessional learning in an international context: the unfamiliar as impetus for learning,also about oneself

ABSTRACT

Studying experiences of interprofessional learning (IPL) in international contexts can contribute to better understand its nature. The aim of this study was to evaluate students’ IPL in the context of a two-week study-abroad program. There were 28 health-care students from Tokyo Metropolitan University, Japan, who participated in a two-week interprofessional education program provided by Karolinska Institutet, Sweden, from 2013 to 2016. The program consisted of classroom-based activities, a literature study (since 2015) and study-visits to health-care facilities. The data were two pre-course questionnaires with open-ended questions that inquired about students’ motivation, expectations and goals, and one post-course questionnaire that inquired about their learning. A qualitative KJ-method analysis of students’ completed questionnaires revealed two understandings about the nature of IPL. Namely, the ‘unfamiliar’, presented by both interprofessional and international contexts, provided students’ with unique learning, with the international context reinforcing interprofessional learning. Secondly, developing one’s individual collaborative skills and one’s professional expertise was important aspects of their learning. International context can add value to students’ IPL by affording learning opportunities considered unique to the different socio-cultural context. IPL may also pertain to ‘learning about oneself’, in addition to ‘learning with, about and from each other’.     

Developing sustainable models of interprofessional learning in practice--the TUILIP project

This paper will describe the background and development of the Trent Universities Interprofessional Learning in Practice Project (TUILIP). It will review some of the contributing literature on recent policy initiatives for interprofessional learning (IPL) and in particular the literature that supports the case for IPL to be embedded in the practice learning environment. The impact of IPL on health outcomes is discussed and on team working in practice.The modernisation of the National Health Service in the UK is explained and how the East Midlands Strategic Health Authority has commissioned the TUILIP project that will promote and facilitate the interprofessional skills of students through collaborative working within the practice setting.The TUILIP project is described, in particular, staff development for practitioners, the centrality of service users and the innovative approach of IPL Facilitators in pilot sites across the Trent region.