Interprofessional education about shared decision making for patients in primary care settings

With an increasingly complex array of interventions facing healthcare professionals and patients, coupled with a potentially diverse number of professionals operating within the primary care team, the adoption of shared decision making (SDM) - with or without patients' decision aids - in an interprofessional manner is essential to ensure the highest quality of care for patients. In this article, we propose a framework for interprofessional education about SDM targeted to primary care settings. Five areas of knowledge and skills were agreed to be essential for all relevant stakeholders for interprofessional education in SDM to be successful: understanding the concept of SDM; acquiring relevant communication skills to facilitate SDM; understanding interprofessional sensitivities; understanding the roles of different professions within the relevant primary care group; and acquiring relevant skills to implement SDM. We suggest a series of teaching methods for the aforementioned areas, using principles from adult learning.     

Interprofessional education about patient decision support in specialty care

Specialty care involves services provided by health professionals who focus on treating diseases affecting one body system. In contrast to primary care – aimed at providing continuous, comprehensive care – specialty care often involves intermittent episodes of care focused around specific medical conditions. In addition, it typically includes multiple providers who have unique areas of expertise that are important in supporting patients’ care. Interprofessional care involves multiple professionals from different disciplines collaborating to provide an integrated approach to patient care. For patients to experience continuity of care across interprofessional providers, providers need to communicate and maintain a shared sense of responsibility to their patients. In this article, we describe challenges inherent in providing interprofessional patient decision support in specialty care. We propose ways for providers to engage in interprofessional decision support and discuss promising approaches to teaching an interprofessional decision support to specialty care providers. Additional evaluation and empirical research are required before further recommendations can be made about education for interprofessional decision support in specialty care.     

Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model

Most shared decision-making (SDM) models within healthcare have been limited to the patient–physician dyad. As a first step towards promoting an interprofessional approach to SDM in primary care, this article reports how an interprofessional and interdisciplinary group developed and achieved consensus on a new interprofessional SDM model. The key concepts within published reviews of SDM models and interprofessionalism were identified, analysed, and discussed by the group in order to reach consensus on the new interprofessional SDM (IP-SDM) model. The IP-SDM model comprises three levels: the individual (micro) level and two healthcare system (meso and macro) levels. At the individual level, the patient presents with a health condition that requires decision-making and follows a structured process to make an informed, value-based decision in concert with a team of healthcare professionals. The model acknowledges (at the meso level) the influence of individual team members' professional roles including the decision coach and organizational routines. At the macro level it acknowledges the influence of system level factors (i.e. health policies, professional organisations, and social context) on the meso and individual levels. Subsequently, the IP-SDM model will be validated with other stakeholders.     

Interprofessional education about patient decision support in specialty care

Specialty care involves services provided by health professionals who focus on treating diseases affecting one body system. In contrast to primary care - aimed at providing continuous, comprehensive care - specialty care often involves intermittent episodes of care focused around specific medical conditions. In addition, it typically includes multiple providers who have unique areas of expertise that are important in supporting patients' care. Interprofessional care involves multiple professionals from different disciplines collaborating to provide an integrated approach to patient care. For patients to experience continuity of care across interprofessional providers, providers need to communicate and maintain a shared sense of responsibility to their patients. In this article, we describe challenges inherent in providing interprofessional patient decision support in specialty care. We propose ways for providers to engage in interprofessional decision support and discuss promising approaches to teaching an interprofessional decision support to specialty care providers. Additional evaluation and empirical research are required before further recommendations can be made about education for interprofessional decision support in specialty care.     

Interprofessional postgraduate education in primary health care: is it making a difference?

This paper explores attitudes to, and perceptions of, the impact of interprofessional postgraduate education for primary health care professionals, based on a postal survey of 153 primary health care professionals undertaking postgraduate qualifications in New Zealand. The response rate was 75% (114/153 responses); comprising 79 doctors, 28 nurses, 7 other health professionals. As a result of their postgraduate education, 92% (104/113) reported improvement in their own practice; 68% (72/106) reported a positive influence on their workplace practice. Forty-eight percent (53/111) increased their understanding of their own professional role; 79% (77/98) increased their understanding of another professional groups' skills and competencies. Twenty-two percent (25/114) perceived increased career opportunities within a year; 56% (64/114) in the longer term. Only 12% (14/114) perceived future increases in income as a result of their study. Interprofessional postgraduate qualification study for primary health care professionals in New Zealand resulted in personal and professional benefit for individuals and their clinical practice, and increased understanding about their own and other health professionals' roles. The interprofessional nature of the education was seen as positive, contributing to a modest increase in collaboration between health professional groups. Barriers to furthering participation in interprofessional learning and increasing intersectorial collaboration in the workplace are identified and discussed.     

Interprofessional postgraduate education in primary health care: Is it making a difference?

This paper explores attitudes to, and perceptions of, the impact of interprofessional postgraduate education for primary health care professionals, based on a postal survey of 153 primary health care professionals undertaking postgraduate qualifications in New Zealand. The response rate was 75% (114/153 responses); comprising 79 doctors, 28 nurses, 7 other health professionals. As a result of their postgraduate education, 92% (104/113) reported improvement in their own practice; 68% (72/106) reported a positive influence on their workplace practice. Forty-eight percent (53/111) increased their understanding of their own professional role; 79% (77/98) increased their understanding of another professional groups' skills and competencies. Twenty-two percent (25/114) perceived increased career opportunities within a year; 56% (64/114) in the longer term. Only 12% (14/114) perceived future increases in income as a result of their study. Interprofessional postgraduate qualification study for primary health care professionals in New Zealand resulted in personal and professional benefit for individuals and their clinical practice, and increased understanding about their own and other health professionals' roles. The interprofessional nature of the education was seen as positive, contributing to a modest increase in collaboration between health professional groups. Barriers to furthering participation in interprofessional learning and increasing intersectorial collaboration in the workplace are identified and discussed.     

Education to achieve symptom control for patients with cancer

This project evaluated whether shared interprofessional education across primary and secondary care could improve symptom control for patients with cancer. An action learning group of 16 health care professionals and patients from the community and hospital took part in an initial three-month learning and change process and an evaluation at the end of one year. Both participants and facilitators developed skills in working with other health care settings, as well as experience of using a continuous quality improvement tool. Participants developed a greater understanding of how the NHS worked and what was required to enable patients to receive improved care. The project enabled professionals to work more effectively with both primary and secondary services, agencies, and helped patients to enhance symptom control.     

Designing an interprofessional training program for shared decision making

For implementation of patient-centered treatment in interprofessional health care units, such as rehabilitation teams, external participation (interaction between patient and health care professionals) and internal participation (communication, coordination and cooperation in the interprofessional team) need to be considered. The aim of this study is to identify the preferences of patients and health care professionals concerning internal and external participation in rehabilitation clinics, in order to develop an interprofessional shared decision-making (SDM) training program for health care professionals to enhance both types of participation. Therefore, a cross-sectional mixed-methods study was implemented in four rehabilitation clinics. The study consists of two parts: focus groups with patients and a survey of experts (senior health care professionals from medicine, psychotherapy, physical therapy and nursing). More time, more respect from the health care professionals and the desire for more participation in decision-making processes were mentioned most frequently by patients (n = 36) in the focus groups. The health care professionals (n = 32) saw most deficits in internal participation, e.g. management of feedback, talking with difficult team members and moderate conflict discussion. The results of both assessments have been used to develop an interprofessional SDM training program for implementing internal and external participation in interprofessional teams in medical rehabilitation.     

Undergraduate students’ perspectives of healthcare professionals’ use of shared decision-making skills

Essential for future healthcare professionals (HCPs) to delivering ethical and empathetic patient-centred care (PCC) as a team is the understanding of appropriate shared decision-making (SDM) responses when facilitating discussions with patients and family members. The purpose of this study was to evaluate undergraduate students’ perspectives about HCPs’ use of SDM as described in a case-study reflection assignment. An exploratory qualitative approach was used to analyse student-reflection assignments. The sample included 42 undergraduate students enrolled in an interprofessional education (IPE) course at a Midwest university based in the United States. Data consisted of student responses in a course reflection assignment that captured their perspectives about recommended SDM responses by HCPs. Student assignments were randomly selected using stratified sampling to provide representation of eight HCP roles. Analysis revealed two themes related to students’ use of SDM responses. Results provide evidence supporting the tenet that through IPE, healthcare students can develop an understanding of SDM and ethical principles related to PCC.     

Students’ perceptions of interprofessional collaboration on the care of diabetes: A qualitative study

Interprofessional education can promote healthcare professionals' competence to work in interprofessional collaboration, which is essential for the quality and safety of care. An interprofessional approach is particularly important in complex, chronic diseases like diabetes. This qualitative study evaluated changes in medical and nursing students' perceptions of interprofessional collaboration, induced by a novel interprofessional education course on diabetes care with practical elements. Data from focus-group interviews of 30 students before and after the course were analyzed by using inductive and deductive content analysis. The students’ perceptions were illustrated as Elements of Collaborative Care (e.g. Quality of professional care relationship) and Elements of Interprofessional Collaboration (e.g. Importance of communication and Valuation of collaboration). The post-course interviews added one subcategory (Need of resources) to the pre-course perceptions, and there was improvement in ten areas of self-perceived competence in performing or understanding interprofessional collaboration on diabetes care. The course improved the students' self-perceived competence and confidence in interprofessional collaboration on the care of patients with diabetes, and their understanding of interprofessional collaboration changed towards a more patient-centred and holistic perspective. The findings support further implementation of IPE with practical elements in future health professionals’ education.     

Continuing professional development for interprofessional teams supporting patients in healthcare decision making

Healthcare professionals and organizations, policy makers, and the public are calling for safe and effective care that is centered on patients’ needs, values, and preferences. The goals of interprofessional shared decision making and decision support are to help patients and professionals agree on choices that are effective, health promoting, realistic, and consonant with patients’ and professionals’ values and preferences. This requires collaboration among professionals and with patients and their family caregivers. Continuing professional development is urgently needed to help healthcare professionals acquire the knowledge, skills, and attitudes necessary to create and sustain a culture of collaboration. We describe a model that can be used to design, implement, and evaluate continuing education curricula in interprofessional shared decision making and decision support. This model aligns curricular goals, objectives, educational strategies, and evaluation instruments and strategies with desired learning and organizational outcomes. Educational leaders and researchers can institutionalize such curricula by linking them with quality improvement and patient safety initiatives.     

Utilising Medicare annual wellness visits to implement interprofessional education in the primary care setting

Interprofessional education (IPE) is an important component of healthcare professional curriculum in order to optimally prepare students for their roles as part of the healthcare team. Integrating IPE activities into direct patient care in the primary care clinic setting can help improve perceptions and student understanding of other healthcare professionals’ responsibilities in this ever-evolving practice setting. This report describes the implementation of an interprofessional clinic including a variety of healthcare professionals and students in the context of the Medicare Annual Wellness Visits (AWV). Design of the clinic and general roles of the professionals in optimising preventive care are described. Student perceptions of IPE and their knowledge of other healthcare professionals were also surveyed. Student knowledge of other professionals mildly improved. Student perception of actual cooperation and interprofessional interaction statistically improved, while perception of interprofessional learning slightly worsened. Utilising Medicare AWVs can be a way for various professionals to improve IPE in the primary care setting.     

Learning to work collaboratively: nurses' views of their pre-registration interprofessional education and its impact on practice

One of the challenges of contemporary health care is the need for health and social care professionals to work differently to meet the complex needs of patients/clients. However it cannot be assumed that these professionals have been prepared with the skills and confidence to collaborate effectively, outside of traditional professional boundaries. Interprofessional education (IPE) is well established as an effective learning and teaching approach to prepare practitioners for collaborative practice at the point of qualification (DOH 2001; Hale 2003; Morison et?al., 2003; Department of Health 2006; Hammick et?al., 2007). The phenomenological study reported in this paper sought to follow up a group of newly qualified adult nurses at six months post-qualification. These nurses had undertaken a pre-registration curriculum in which classroom-based interprofessional learning was well embedded and formally assessed within their three year programme. Data from eight in depth interviews were analysed and five key themes were emerged: common understanding of IPE; teaching and learning; understanding of professional roles; stereotypes; influence of the practice environment. The outcome of the study suggested IPE should be as practice focused as possible to improve its relevance to nursing practice. This study contributed to the development of an innovative curriculum which provides the opportunity for nurses to integrate IPE theory within their collaborative working practice.     

Continuing professional development for interprofessional teams supporting patients in healthcare decision making

Healthcare professionals and organizations, policy makers, and the public are calling for safe and effective care that is centered on patients' needs, values, and preferences. The goals of interprofessional shared decision making and decision support are to help patients and professionals agree on choices that are effective, health promoting, realistic, and consonant with patients' and professionals' values and preferences. This requires collaboration among professionals and with patients and their family caregivers. Continuing professional development is urgently needed to help healthcare professionals acquire the knowledge, skills, and attitudes necessary to create and sustain a culture of collaboration. We describe a model that can be used to design, implement, and evaluate continuing education curricula in interprofessional shared decision making and decision support. This model aligns curricular goals, objectives, educational strategies, and evaluation instruments and strategies with desired learning and organizational outcomes. Educational leaders and researchers can institutionalize such curricula by linking them with quality improvement and patient safety initiatives.     

Cognitive continuum theory in interprofessional healthcare: A critical analysis

Effective clinical decision making is among the most important skills required by healthcare practitioners. Making sound decisions while working collaboratively in interprofessional healthcare teams is essential for modern healthcare planning, successful interventions, and patient care. The cognitive continuum theory (CCT) is a model of human judgement and decision making aimed at orienting decision-making processes. CCT has the potential to improve both individual health practitioner, and interprofessional team understanding about, and communication of, clinical decision-making processes. Examination of the current application of CCT indicates that this theory could strengthen interprofessional team clinical decision making (CDM). However, further research is needed before extending the use of this theoretical framework to a wider range of interprofessional healthcare team processes. Implications for research, education, practice, and policy are addressed.     

Identification of core ethical topics for interprofessional education in the intensive care unit: a thematic analysis

ABSTRACT

Medical educators have not identified effective approaches for interprofessional ethics education of clinicians who work in intensive care units (ICUs), in spite of the fact that ICUs have a high incidence of ethical conflicts. As a first step in designing an interprofessional ethics education initiative tailored to the needs of ICU team members, we interviewed 12 professionals from the medical and surgical ICUs of a tertiary care academic medical center to understand what they know about medical ethics. Respondents were interviewed between November 2016 and February 2017. We used the ‘think aloud’ approach and realist thematic analysis of the sessions to evaluate the extent and content of interprofessional team members’ knowledge of medical ethics. We found wide variation in their knowledge of and facility in applying the principles and concepts of biomedical ethics and ways of resolving ethical conflicts. Ethics education tailored to these areas will help equip critical care professionals with the necessary knowledge and skills to discuss and address ethical conflicts encountered in the ICU. Preventive ethics rounds are one approach for providing real-time, embedded interprofessional ethics education in the clinical setting.     

From students to professionals: Results of a longitudinal study of attitudes to pre-qualifying collaborative learning and working in health and social care in the United Kingdom

During a longitudinal evaluation of a pre-qualifying interprofessional curriculum, health and social care students completed questionnaires concerning communication and teamwork skills and interprofessional learning and working. Data were collected on entry to their educational programme, during the second year of study, at qualification and after 9–12 months' qualified practice. This paper presents results from practice data from 414 professionals; 275 were educated on the interprofessional curriculum, 139 on previous uniprofessional curricula. The former were more confident at qualification about their communicative skills, their interprofessional relationships and other professionals' interaction, and showed positive correlations between perceptions of their relevant skills and their interprofessional relationships. They were also more positive about their interprofessional relationships than practitioners educated on uniprofessional curricula. Age and previous experience of higher education influenced professionals' attitudes negatively: mature individuals may require more support when entering the workforce. Between qualification and practice, respondents from the interprofessional cohorts grew more critical of interprofessional education. However, experience of interprofessional education appears to produce and sustain positive attitudes towards collaborative working, suggesting that individuals' perceptions of their own educational experience are inadequate as an evaluative measure of interprofessional learning initiatives. This study reinforces the argument for including IPE in pre-qualifying curricula.     

Reflections from an interprofessional education experience: Evidence for the core competencies for interprofessional collaborative practice

The Core Competencies for Collaborative Practice identify the skills needed by every health care provider to be successful in implementing interprofessional practice. Health professions students need to build skills for interprofessional practice as emerging professionals. Reflection is a core skill needed for successful interprofessional practices. This study identifies themes from an interprofessional education research project and discusses their congruency with the Competencies.     

From students to professionals: results of a longitudinal study of attitudes to pre-qualifying collaborative learning and working in health and social care in the United Kingdom

During a longitudinal evaluation of a pre-qualifying interprofessional curriculum, health and social care students completed questionnaires concerning communication and teamwork skills and interprofessional learning and working. Data were collected on entry to their educational programme, during the second year of study, at qualification and after 9-12 months' qualified practice. This paper presents results from practice data from 414 professionals; 275 were educated on the interprofessional curriculum, 139 on previous uniprofessional curricula. The former were more confident at qualification about their communicative skills, their interprofessional relationships and other professionals' interaction, and showed positive correlations between perceptions of their relevant skills and their interprofessional relationships. They were also more positive about their interprofessional relationships than practitioners educated on uniprofessional curricula. Age and previous experience of higher education influenced professionals' attitudes negatively: mature individuals may require more support when entering the workforce. Between qualification and practice, respondents from the interprofessional cohorts grew more critical of interprofessional education. However, experience of interprofessional education appears to produce and sustain positive attitudes towards collaborative working, suggesting that individuals' perceptions of their own educational experience are inadequate as an evaluative measure of interprofessional learning initiatives. This study reinforces the argument for including IPE in pre-qualifying curricula.     

Interprofessional perceptions of health care students

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