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.     

Perceived impact of an interprofessional education program on community resilience: an exploratory study

Abstract

The purpose of this study was to explore the perceived impact of an interprofessional education (IPE) program for health sciences students on two culturally diverse, underserved communities. A community resilience/capacity framework, consisting of catalysts (primarily the creation of awareness) and capital components: human (workforce development), social (networking and empowerment) and economic (volunteer labor and money spent by the program), provided the conceptual underpinnings for the study. Focus groups with stakeholders in two communities, one rural and one metropolitan, were audio-recorded, transcribed and analyzed by categorizing data according to each capital component. In addition to the concepts contained in the capacity framework a new category, informational capital (data specific to the community) emerged during the analysis. We suggest that by acting as a catalyst a community based interprofessional program can affect components of community resilience/capacity, primarily human, social, and informational capital. Using the community resilience/capacity framework facilitated exploration of the perceived impact of an educational program on one rural and one urban underserved community beyond assessing student outcomes or number of clients served.     

A cross-institutional examination of readiness for interprofessional learning

This paper examines the readiness for and attitudes toward interprofessional (IP) education in students across four diverse educational institutions with different educational mandates. The four educational institutions (research-intensive university, baccalaureate, polytechnical institute and community college) partnered to develop, deliver and evaluate IP modules in simulation learning environments. As one of the first steps in planning, the Readiness for Interprofessional Learning Scale was delivered to 1530 students from across the institutions. A confirmatory factor analysis was used to expand upon previous work to examine psychometric properties of the instrument. An analysis of variance revealed significant differences among the institutions; however, a closer examination of the means demonstrated little variability. In an environment where collaboration and development of learning experiences across educational institutions is an expectation of the provincial government, an understanding of differences among a cohort of students is critical. This study reveals nonmeaningful significant differences, indicating different institutional educational mandates are unlikely to be an obstacle in the development of cross-institutional IP curricula.     

Aligning interprofessional education collaborative sub-competencies to a progression of learning

In the United States, the Interprofessional Education Collaborative (IPEC) developed four core competencies for interprofessional collaborative practice. Even though the IPEC competencies and respective sub-competencies were not created in a hierarchal manner, one might reflect upon a logical progression of learning as well as learners accruing skills allowing them to master one level of learning and building on the aggregate of skills before advancing to the next level. The Louisiana State University Health-New Orleans Center for Interprofessional Education and Collaborative Practice (CIPECP) determined the need to align the sub-competencies with the level of behavioural expectations in order to simplify the process of developing an interprofessional education experience targeted to specific learning levels. In order to determine the most effective alignment, CIPECP discussions revolved around current programmatic expectations across the institution. Faculty recognised the need to align sub-competencies with student learning objectives. Simultaneously, a progression of learning existing within each of the four IPEC domains was noted. Ultimately, the faculty and staff team agreed upon categorising the sub-competencies in a hierarchical manner for the four domains into either a “basic, intermediate, or advanced” level of competency.     

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.     

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

Abstract

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

Evaluating learning environments for interprofessional care

Abstract

Many institutions have invested considerably in the provision of student facilities – lecture halls, tutorial rooms and classrooms – spaces we call collectively learning environments. In expending resources on such facilities, we have assumed that we have needed to create this range of spaces for such activities. However, how do we know we have invested wisely in support of learning for interprofessional care? In this article I review the literature to identify evidence in a range of fields, including health care, to consider the issues and difficulties of employing established approaches from practices of evidence-based design. Central in this article is the role of evidence in the assessment of learning environments. In particular, I argue that the evidence must include qualitative dimensions of the learning experience. To address the qualitative outcomes from education, with particular attention to the concerns of interprofessional education, a model is proposed to examine different levels of outcomes. By developing an interpretation of Kirkpatrick’s model, four levels are described for the effective evaluation of interprofessional learning environments.     

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.     

A multi-method evaluation of interprofessional education for healthcare professionals caring for women during and after pregnancy

This multi-method evaluation assessed the perceived impact of interprofessional workshops targeting enhanced collaboration between healthcare professionals who care for women during and after pregnancy. Current policy recommends partnership working to improve care for women and babies, however, there is little interprofessional education in this area. Five one-day workshops were delivered to 18 healthcare professionals (47.4% of the 38 healthcare professionals registered). The workshop was evaluated through questionnaires before and after the workshop measuring attitudes and willingness towards collaboration; observations of the workshops by a researcher and follow-up interviews 2 months’ post-workshop to explore changes in practice. Workshops were attended by midwives, health visitors (trained nurses specialising in community care for children 0–5 years), dietitians, nurses, a general practitioner and a breastfeeding specialist. Attitudes and willingness to participate in interprofessional collaborative practice improved after the workshop. Observations made at the workshop included engaged participants who reported numerous barriers towards collaboration. Follow-up contact with 12 participants identified several examples of collaboration in practice resulting from workshop attendance. These findings suggest that the workshops influenced attendees to change their practice towards more collaborative working. Future work needs to confirm these results with more participants.     

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.     

Examining interprofessional learning perceptions among students in a simulation-based operating room team training experience

High-fidelity simulation (HFS) operating room (OR) inter-professional team training improves healthcare students’ team-based attitudes and behaviours. Such improvements can diminish tribalism among the professions in the OR by overcoming entrenched perceptions of team members. We investigated whether simulation-based interprofessional student OR team training impacts students differently based on their professional background. From 2010 to 2013, HFS OR interprofessional student team training sessions were conducted involving senior medical students, senior undergraduate nursing students, and nurse anaesthesia students. The training involved a two-scenario format, each followed by a structured debriefing focusing on team-based competencies. Before and after each session, students completed a 15-item teamwork competencies self-efficacy survey as well as, from 2012–2013, the Readiness for Interprofessional Learning Scale (RIPLS). At the end of each session, they also completed a 6-item rating scale assessing overall team function during the session. Mean scores were calculated for each student professional group, post/pre mean differences were determined, and student t-test and ANOVA analyses were employed to compare within and between-group differences, respectively. Response rates were over 80% for each scale used. Medical students and undergraduate nursing students had significant improvements in team-based attitudes post- to pre-session. Medical students and nurse anaesthesia students had significant improvements in RIPLS scores. Statistically significant improvements from post- to pre-session were seen overall for both team-based attitudes (effect size = 0.83) and RIPLS (effect size = 0.37). The difference between the team-based scores between professions was significant; RIPLS differences were not. No significant difference existed between professions related to overall teamwork scores. HFS OR team training of healthcare students has beneficial but variable benefits for each professional group.     

Toward better care of delirious patients at the end of life: A pilot study of an interprofessional educational intervention

Symptom distress with end-of-life delirium (EOLD) is complex and multidimensional, and interprofessional (IP) teams require knowledge and skill to effectively care for these patients and their families. The purpose of this pilot study was to test an educational intervention about EOLD for IP teams at a long-term care facility and a hospice. The intervention included a comprehensive self-learning module (SLM) on EOLD and IP teamwork; a modified McMaster–Ottawa team objective structured clinical encounter (TOSCE) and a didactic “theory burst” on the principles of delirium assessment, diagnosis and management. Evaluation tools completed by participants included the interprofessional collaborative competencies attainment survey (ICCAS) and the W(e) Learn. Two groups at each site participated in 1-hour sessions, repeated 2 weeks later. Only one group from each site received the SLM after the first session. Researchers scored EOLD knowledge and IP team functioning in both sessions. Results suggest that the intervention improved EOLD knowledge and perceptions of IP competence and supports the value of the TOSCE as an IP teaching method. The module does not appear responsible for the changes. Future studies are required to evaluate the effectiveness of the individual components used in this study, and to tailor the intervention to individual care contexts.     

Interprofessional Education and Practice Guide No. 2: Developing and implementing a center for interprofessional education

Abstract

The complexity of implementing interprofessional education and practice (IPEP) strategies that extend across the learning continuum requires that institutions create a structure to support effective and organized coordination among interested administrators, faculty and staff. The University of Virginia Center for Academic Strategic Partnerships for Interprofessional Research and Education (UVA Center for ASPIRE) was formally established in 2013 following five years of dramatic growth in interprofessional education at the School of Nursing, School of Medicine and the UVA Health System. This guide briefly describes the steps that led to the creation of the Center and the key lessons learned that can guide other institutions toward establishing their own IPE centers.     

Assessing students’ and health professionals’ competency learning from interprofessional education collaborative workshops

Interprofessional education (IPE) is a key element in preparing current and future health professionals to function in a collaborative practice-ready workforce. California State University, Fresno’s College of Health and Human Services and Valley Children’s Healthcare have partnered together to create an IPE collaborative that organizes and provides interagency-sponsored workshops that align learning objectives of relevant healthcare topics with 2016 IPEC core competencies for university students and health professionals. Using a pre/post design with the IPEC Competency Self-Assessment Tool, two cross-sectional studies were conducted to measure whether interprofessional learning of core competencies improved after participation in IPE workshops, and if such improvements were different between students and health professionals. In Study 1, 67 participants attended a Pediatric Head Injury IPE workshop. Of these, 19 students and 22 health professionals consented to participate and complete the IPEC survey. In Study 2, 99 participants attended an Error Disclosure IPE workshop. Of these, 26 students and 29 health professionals consented to participate and complete the IPEC survey. This investigation showed that the IPEC Competency Self-Assessment Tool discriminated competency ratings between students and health professionals in both studies and demonstrated a positive impact of IPE workshops on students’ and health professionals’ self-assessment of interprofessional competencies.     

A comparison of student attitudes and perceptions before and after an introductory interprofessional education experience

Abstract

There is increasing acknowledgement that interprofessional education (IPE) holds promise for preparing health professionals as collaborative-ready practitioners. The effects of IPE on learning outcomes are critical in determining the value of such programs. Attitudes are recognized as a significant element in developing behaviors. This study was designed to determine attitudes and perceptions of students toward collaborative learning in an interprofessional context. Three hundred and five students completed a questionnaire regarding attitudes and perceptions toward interprofessional collaboration before and after an introductory IPE course. Also 202 graduating health professional students without IPE completed the same questionnaire. The questionnaire included questions from the University of West England Interprofessional Questionnaire (UWE IQ) and Readiness for Interprofessional Learning Scale (RIPLS). Independent samples t-tests revealed significant positive changes before and after the IPE course for UWEIQ IP-Learning subscale (p?=?0.012) and RIPLS (p?=?0.05). This study provides some evidence that students who participate in an introductory IPE course early in their professional preparation not only keep positive attitudes toward interprofessional learning, but improve them. As a result, they are expected to be more engaged in learning this important knowledge that should help them to become interprofessional collaborative-ready practitioners.     

Interprofessional education and practice guide No. 4: Developing and sustaining interprofessional education at an academic health center

Abstract

Increasingly health professions schools and academic health centers are required to include interprofessional education (IPE) as a standard part of their core curricula to maintain accreditation. However, challenges continue to surface as faculty struggle to develop and participate in IPE activities while balancing increasing workloads and limited resources, and also trying to keep current in the changing profession-specific accreditation and standards. This guide shares lessons learned from developing and sustaining IPE activities at the University of Washington (UW) based in the United States. In 2008, the UW Schools of Nursing and Medicine were awarded funds to develop, implement, and evaluate an interprofessional program focused on team communication. This funding supported the creation of two annual large-scale IPE events, provided infrastructure support for the Center for Health Sciences Interprofessional Education, Research and Practice (CHSIERP), and supported numerous interprofessional activities and initiatives in the health professions curricula. Our experiences over the years have yielded several key lessons that are important to consider in any IPE effort. In this guide we report on these lessons learned and provide pragmatic suggestions for designing and implementing IPE in order to maximize long-term success.     

Using learning theory,interprofessional facilitation competencies,and behavioral indicators to evaluate facilitator training

Abstract

Despite the increasing need for faculty and preceptors skilled in interprofessional facilitation (IPF), the relative novelty of the field poses a challenge to the development and evaluation of IPF programs. We use learning theory and IPF competencies with associated behavioral indicators to develop and evaluate six key messages in IPF training and experience. Our mixed methods approach included two phases: quantitative data collection with embedded qualitative data, followed by qualitative data collection in explanatory sequential fashion. This enabled triangulated analyses of both data types and of facilitation behaviors from facilitator and student perspectives. Results indicate the competency-based training was effective. Facilitators felt comfortable performing behaviors associated with IPF competencies; student observations of those behaviors supported facilitator self-reported performance. Overall, students perceived more facilitation opportunities than facilitators. Findings corroborate the importance of recruiting seasoned facilitators and establishing IPF guidelines that acknowledge variable team dynamics and help facilitators recognize teachable moments.     

Supporting health system transformation through an interprofessional education experience focused on population health

The purpose of the study was to determine the impact of an interprofessional education (IPE) experience on first year students across all schools of a health sciences center on the topic of pediatric immunizations. The authors conducted a pre-/post-test at Louisiana State University Health Sciences Center-New Orleans with 731 first year students from 25 academic programs encompassing all six schools (Allied Health, Dentistry, Graduate Studies, Medicine, Nursing and Public Health). In the four questions related to the Interprofessional Education Collaborative (IPEC) sub-competencies and the three questions related to professional role regarding immunizations, there was a statistically significant difference in the pre-/post-test survey results (P < 0.0001). Student learning related to the collaboration needed to make a larger impact on patient outcomes was demonstrated through assessment of an open-ended question. IPE experiences can improve first-year students’ perceptions of IPEC sub-competencies regarding the importance of population health and teamwork. By utilizing a population health focus with IPE activities, novice learners are equipped to learn and apply collaborative practice skills along with recognizing the importance of promoting overall health and well-being instead of just health care.     

Citizen social science: a methodology to facilitate and evaluate workplace learning in continuing interprofessional education

Abstract

Workplace learning in continuing interprofessional education (CIPE) can be difficult to facilitate and evaluate, which can create a number of challenges for this type of learning. This article presents an innovative method to foster and investigate workplace learning in CIPE – citizen social science. Citizen social science involves clinicians as co-researchers in the systematic examination of social phenomena. When facilitated by an open-source online social networking platform, clinicians can participate via computer, smartphone, or tablet in ways that suit their needs and preferences. Furthermore, as co-researchers they can help to reveal the dynamic interplay that facilitates workplace learning in CIPE. Although yet to be tested, citizen social science offers four potential benefits: it recognises and accommodates the complexity of workplace learning in CIPE; it has the capacity to both foster and evaluate the phenomena; it can be used in situ, capturing and having direct relevance to the complexity of the workplace; and by advancing both theoretical and methodological debates on CIPE, it may reveal opportunities to improve and sustain workplace learning. By describing an example situated in the youth health sector, this article demonstrates how these benefits might be realised.