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.     

Getting on the same page: an interprofessional common reading program as foundation for patient-centered care

A primary goal of interprofessional education is to produce clinicians who practice collaboratively to provide patient-centered care. This exploratory study evaluated whether students’ attitudes about a literary account of an illness experience endured after a year of professional and clinical education and if students applied lessons learned from a common reading to the delivery of patient centered care. Six focus groups were completed with health professions students and five main themes emerged from the focus group data. Themes include: Seeing family members as stakeholders; Establishing common ground with peers and the larger reason for graduate school; Applying lessons to clinical practice that see the patient as a person; Experiencing an emotional connection with a story and its characters; and Taking alternative perspectives/stepping into the shoes of the patient. Study results are discussed in relation to the interprofessional education literature, with implications for educators and interprofessional curricula also presented. We conclude that a common reading program may provide an effective means for developing health professions students’ knowledge and attitudes in the tenets of patient-centered collaborative care. It has the potential to build community through shared intellectual experience, facilitating meaningful reflection and perspective-taking in interprofessional learners.     

Consensus group session of experts to describe interprofessional collaboration processes in team meetings

Abstract

Linking the outcomes from interprofessional education to improvements in patient care has been hampered by educational assessments that primarily measure the short-term benefits of specific curricular interventions. Competencies, recently published by the Interprofessional Education Collaborative (IPEC), elaborate overarching goals for interprofessional education by specifying desired outcomes for graduating health professions students. The competencies define a transition point between the prescribed and structured educational experience of a professional degree program and the more self-directed, patient-oriented learning associated with professional practice. Drawing on the IPEC competencies for validity, we created a 42-item questionnaire to assess outcomes related to collaborative practice at the degree program level. To establish the usability and psychometric properties of the questionnaire, it was administered to all the students on a health science campus at a large urban university in the mid-Atlantic of the United States. The student responses (n?=?481) defined four components aligned in part with the four domains of the IPEC competencies. In addition, the results demonstrated differences in scores by domain that can be used to structure future curricula. These findings suggest a questionnaire based on the IPEC competencies might provide a measure to assess programmatic outcomes related to interprofessional education. We discuss directions for future research, such as a comparison of results within and between institutions, and how these results could provide valuable insights about the effect of different curricular approaches to interprofessional education and the success of various educational programs at preparing students for collaborative practice.     

Anchoring interprofessional education in undergraduate curricula: The Heidelberg story

ABSTRACT

The ability of health professionals to collaborate effectively has significant potential impact on patient safety and quality-care outcomes, especially given the increasingly complex and dynamic clinical practice environments of today. Educators of the health professions are faced with an immediate challenge to adapt curricula and traditional teaching methods to ensure graduates are equipped with the necessary interprofessional competencies and (inter)professional values for their future practice. The World Health Organization’s “Framework for action in interprofessional education (IPE) and collaborative practice” promotes IPE as a key strategy to enhance patient outcomes by preparing a “collaborative practice-ready health workforce.” Logistical and attitudinal barriers can hinder integration of IPE into curricula. Lessons learned through the implementation of a planned change to establish four interprofessional seminars (team communication, medical error communication, healthcare English, and small business management) at Heidelberg University Medical Faculty, Germany, are described. A key factor in successfully anchoring IPE seminars in the undergraduate curricula was the structured approach drawing on change management concepts.     

Interprofessional socialization as a way to introduce collaborative competencies to first-year health science students

Abstract

Interprofessional education (IPE) is the cornerstone of preparing future health care providers but remains to be a challenge for many health science programs. We aimed to develop and evaluate an interprofessional conference for first-year health science students with goals to provide students with interprofessional socialization opportunity and introduce IPE principles. A half-day conference was based upon core competencies for health professionals and involved 277 first-year health sciences, nursing, pharmacy, physical therapy, and speech language pathology and audiology students. Alcohol and substance misuse was chosen as a topic for its relevance to college students and health professionals. Results from program evaluation revealed that the conference was successful in exposing students to core interprofessional competencies and provided useful information about alcohol and substance misuse. This study advocates for early inclusion of IPE in the health professions curricula in the form of interprofessional socialization.     

In and out of the curriculum: an historical case study in implementing interprofessional education

Abstract

Although international reports have called for making interprofessional education an integral part of health professions education, most interprofessional learning activities remain voluntary and occur a single time. Barriers to implementing comprehensive interprofessional education come from forces both internal and external to institutions. Understanding the historical context for how one graduate health professions school attempted to overcome these barriers will provide a longitudinal perspective that may assist other institutions with their interprofessional education efforts. The case of the Massachusetts General Hospital Institute of Health Professions shows that, despite being founded with a mission to educate students from different professions together, interprofessional education does not emerge naturally. An analysis of archival documents, academic catalogs and oral history interviews revealed that early attempts focused on requiring students to take common courses. Later, the faculty created voluntary interprofessional learning activities. Neither approach achieved its intended goals until the Institute developed deliberate strategies to counter the internal and external barriers to integrating interprofessional education. This historical case study suggests that sustainable interprofessional education initiatives require both an organizational home and a permanent place in the curriculum.     

The feasibility and acceptability of using virtual world technology for interprofessional education in palliative care: a mixed methods study

ABSTRACT

The objective of this mixed methods study was to evaluate the feasibility and acceptability of using a virtual world educational environment for interprofessional health professions students learning about palliative care. Graduate students (n = 35) from five different health professions programs (medicine, nursing, nutrition, physical therapy, and social work) across two educational institutions participated in a small-group immersive educational experience focused on palliative care in the virtual world of Second Life. Collected data included pre and post surveys of interprofessional attitudes using previously-published questionnaires as well as student reflective writing and photographs about their experience. We found it was feasible to create and deliver an interprofessional educational experience in palliative care in a virtual world environment. The educational experience was acceptable to participants, with an improvement in attitudes toward interprofessional education and interprofessional teamwork after a single virtual world educational session, based on both quantitative and qualitative results. Students found the virtual world environment acceptable for interprofessional education focused on palliative care, based on qualitative results. As health professions schools develop interprofessional education curricula, the use of virtual world technology may be an important modality to consider, to effectively and conveniently bring interprofessional learners together.     

Exploring the nature of facilitating interprofessional learning: findings from an exploratory study

Abstract

With the growing complexity in managing multiple disease and illness-related problems, increased attention is being paid to the importance of interprofessional education (IPE) in preparing students for working collaboratively with different professionals. Educational activities for mixed groups of health professional students are increasing, and facilitation of learning in interprofessional student groups is now acknowledged as an essential part of successful interprofessional learning activities. However, little is known about the strategies used by facilitators with students from different professions, and how they promote learning. Using data obtained through an analysis of videos taken as part of a large study of IPE and interprofessional practice, this study aimed to identify the pedagogical strategies and behaviours of facilitators participating in seven different learning activities with health care students from five different professions. The data captured student reactions and behaviours and provided insight into the dynamics of the interprofessional encounters. The findings showed that facilitating groups involved a complex interchange of three types of interaction between facilitators and students: facilitator-controlled interaction, facilitator-driven interaction and student-driven interactions. The findings also suggest that faculty development programs should assist facilitators to re-examine teaching approaches and encourage students to assume the responsibility for discussing issues and collaborating with others in all their interprofessional contacts. Continuity and stability in faculty development activities will better prepare clinical educators and young professionals to become interprofessional champions.     

Professionalism dilemmas experienced by health professions students: a cross-sectional study

ABSTRACT

Health professions students will invariably confront professionalism dilemmas. These early encounters significantly influence future professional attitudes and behaviours. Heretofore, studies concerning professionalism dilemmas experienced by health professions students across disciplines have been limited. To address this issue, we recruited 56 students with clinical experience from the National Taiwan University College of Medicine in the nursing, dentistry, pharmacy, medical technology, occupational therapy, and physiotherapy programs to participate in this research to compare health professions students’ understandings of professionalism and their experiences of professionalism dilemmas. We used group interviews to uncover students’ experiences of professionalism dilemmas. We identified the six most commonly reported professionalism dilemmas and found that interprofessional dilemmas were the dominant workplace professionalism dilemma for health professions students. We also identified significant disciplinary differences regarding dilemma types and frequencies. We employed the framework of dual identity development to better understand the role of professional and interprofessional identities in interprofessional dilemmas. The professionalism dilemmas that individual students encountered were shaped by disciplinary differences. Our findings suggest that the development of a sense of belonging to both their own profession and a broader interprofessional care team in health professions students can increase the effectiveness of interprofessional healthcare teams.     

Examining student perceptions of an inter-institutional interprofessional stroke simulation activity

Integration of interprofessional educational (IPE) activities into health professions’ curricula aims to promote collaborative practice with a goal of improving patient care. An interprofessional stroke simulation involving standardised patients was organised for IPE student learners from a number of different health professions programmes based across several different institutions. In this article, we describe the development of an inter-institutional IPE activity and examine the outcomes of this activity on student interprofessional growth. Using a pre-post-study design, all participants were invited to anonymously respond to the 16-question IPEC Competency Self-Assessment tool to examine self-assessed interprofessional interactions and values as a result of the simulation. The questionnaire was available to the students using an online platform, and paired t-tests were used to analyse the responses. Quantitative data revealed significant positive changes in both the values and interaction domains of the assessment from pre- to post-simulation experience (p < 0.0001 and p = 0.0003, respectively). Student reflections identified new realisations around the concepts of leadership and team member roles in the context of patient care. Results of this endeavour support the effectiveness of this activity for developing interprofessional competencies among students, suggest that the self-assessment tool may be used as a means to detect these changes, and lend support to our methods for establishing inter-institutional IPE partnerships.     

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.     

Studio-based learning in interprofessional education

Abstract

The recent growth of interprofessional education (IPE) in healthcare has been accompanied by exploration of teaching strategies to improve its effectiveness. Experts in IPE advise faculty to explore teaching models from other disciplines outside of healthcare. Studio-based learning (SBL) in design education embodies many of the features that are integral to effective IPE. Students work in teams to design new processes and products to solve complex and real-life problems. The purpose of this paper is to describe features of SBL that enhance IPE and examine student experiences of interprofessional learning from three healthcare design studios. Findings from an exploratory case study of these design studios involving students from a range of professions suggest that the students transition through learning stages in SBL that may enhance IPE. The paper goes on to discuss the unique features of SBL and how they offer new and complementary strategies for building interprofessional curricula.     

Development and evaluation of an interprofessional seminar pilot course to enhance collaboration between health professions at a student-run clinic for underserved populations

ABSTRACT

This report describes the development and evaluation of an interprofessional pilot course aimed at health science students. The course was developed through collaboration of three health professions: Dentistry, Kinesiology, and Pharmacy. The coursework comprised of traditional lecture-based learning, interprofessional experiential education through four on-site visits at two area clinics that participate in team-based care, four student self-reflections following each site visit, and demonstration of interprofessional education and collaboration (IPEC) competencies through student evaluation of current interprofessional care at those existing clinics with a component for key improvement intervention. The study aims include evaluating both the course’s effectiveness and quality in increasing student preparedness for interprofessional practice and its ability to enhance collaboration between health professions at two area clinics. Methods of evaluation include the Interprofessional Collaborative Competency Attainment Survey (ICCAS) instrument, pre- and post- course surveys, and course evaluation survey. The results show that students felt their knowledge and skills increased across the four IPEC core competency domains: interprofessional communication, values and ethics, roles and responsibilities, and team and teamwork. We suggest that using an integrated course framework is an effective measure in enhancing interprofessional education (IPE) outcomes.     

Debating evidence-based health policy in an interprofessional classroom: an exploratory study

ABSTRACT

Model United Nations (MUN) debates enable students to engage in policy debate in simulated UN councils, and are regularly held in schools and colleges, globally. In developing countries where leadership and teamwork in ‘evidence-based policy and practice’ is needed to overcome health inequities and strengthen health systems, few curricula teach these skills using simulation-based, participatory learning approaches. Do MUN debates have something to offer for health professions education in low-resource settings? Since MUN debates are novel in health profession education, we aimed to identify the skill domains for selection of outcome measures in future evaluations. We employed an exploratory, qualitative approach to identify relevant competency domains. The 8 students (4 medical, 1 dental, and 3 pre-med) who volunteered to participate in the MedMUN initiative were interviewed, responses were thematically analyzed and a conceptual framework was developed. Leadership (subthemes: confidence and public-speaking), teamwork (subthemes: student integration and interprofessional education), and social responsibility (subthemes: democracy and a global outlook) were dominant themes. MUN debates are useful, interprofessional simulation exercises for providing students a window into global health policy, while engendering leadership and teamwork skills.     

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.     

Evaluation of an interprofessional educational curriculum pilot course for practitioners working with post-stroke patients

Abstract

This report describes the design and evaluation of an interprofessional pilot training course aimed at pre-licensure practitioners working with post-stroke patients in community-based settings. The course was developed by community-based practitioners from nine health professions. Course learning activities included traditional methods (lectures) and interactive modules (problem-based learning and exchange-based learning). The study’s aim was to assess the program’s effectiveness in adapting and incorporating knowledge, skills and self-confidence when delivering tertiary care in therapeutic pool environments; gauge adoption of course principles into practice, and assess overall course satisfaction. Methods of evaluation included conceptual mapping of course format, pre- and post-questionnaires, daily reflection questionnaires, course satisfaction survey and adoption survey, 10 weeks follow-up. Overall, the findings indicate students’ knowledge, skills and self-confidence in delivering effective post-stroke care increased following the training. Students reported adopting clinical practices in 10 weeks follow-up. Implications for designing interprofessional curricula are discussed.     

Development and validation of a tool to assess self-efficacy for competence in interprofessional collaborative practice

ABSTRACT

Although interprofessional education and collaborative practice have gained increasing attention over the past five decades, development of rigorous tools to assess related competencies is still in infancy. The purpose of this study was to develop an instrument to evaluate health professions students’ self-efficacy in interprofessional collaborative competency and to assess the instrument’s psychometric properties. We developed a new instrument based on the Interprofessional Education Collaborative’s (IPEC) Core Competencies for Interprofessional Collaborative Practice. In a cross-sectional study design, 660 students from 11 health programmes at an urban university in the Midwest USA completed the Interprofessional Education Collaborative Competency Self Efficacy Tool (IPECC-SET). Rasch analysis evaluated the following: (1) functioning of the instrument; (2) fit of items within each subscale to a unidimensional construct; (3) person-response validity; (4) person-separation reliability; and (5) differential item functioning in relation to gender and ethnicity. After removing seven items with suboptimal fit, each subscale demonstrated high internal validity. Two items demonstrated differential item functioning (DIF) for “Gender” and none for “Race/Ethnicity.” Our findings provide early evidence of IPECC-SET as a valid measure of self-efficacy for interprofessional competence for health professions students. Additional research is warranted to establish external validity of the new instrument by conducting studies across institutions.     

An interprofessional socialization framework for developing an interprofessional identity among health professions students

Abstract

Although health professional educational programs have been successful in equipping graduates with skills, knowledge and professionalism, the emphasis on specialization and profession-specific education has enhanced the development of a uniprofessional identity, which has been found to be a major barrier to interprofessional collaborative person-centred practice (IPCPCP). Changes within healthcare professional education programs are necessary to enable a shift in direction toward interprofessional socialization (IPS) to promote IPCPCP. Currently, there is a paucity of conceptual frameworks to guide IPS. In this article, we present a framework designed to help illuminate an IPS process, which may inform efforts by educators and curriculum developers to facilitate the development of health professions students’ dual identity, that is, an interprofessional identity in addition to their existing professional identity, as a first step toward IPCPCP. This framework integrates concepts derived from social identity theory and intergroup contact theory into a dual identity model of IPS.     

Interprofessional education for delirium care: a systematic review

Abstract

Recent delirium prevention and treatment guidelines recommend the use of an interprofessional team trained and competent in delirium care. We conducted a systematic review to identify the evidence for the value of interprofessional delirium education programs on learning outcomes. We searched several databases and the grey literature. Studies describing an education intervention, involving two or more healthcare professions and reporting on at least one learning outcome as classified by Kirkpatrick’s evaluation framework were included in this review. Ten out of 633 abstracts reviewed met the study inclusion criteria. Several studies reported on more than one learning outcome. Two studies focused on learner reactions to interprofessional delirium education; three studies focused on learning outcomes (e.g. delirium knowledge); six studies focused on learner behavior in practice; and six studies reported on learning results (e.g. patient outcomes), mainly changes in delirium rates post-intervention. Studies reporting changes in patient outcomes following the delirium education intervention used an interprofessional practice (IPP) intervention in combination with interprofessional education (IPE). Our review of the limited evidence suggests that IPE programs may influence team and patient outcomes in delirium care. More systematic studies of the effectiveness of interprofessional delirium education interventions are needed.     

Student views of interprofessional education facilitator competencies: A cross-sectional study

ABSTRACT

Research attention has been paid to providing evidence on undergraduate/pre-licensure health sciences students’ interprofessional education competency requirements, placements, and attainment. Although interprofessional facilitator training has been identified as critical to interprofessional learner outcomes, scant research has examined student perceptions of valued facilitator competencies. This short report investigates students’ views of important attributes for interprofessional facilitation using a cross-sectional observation-survey design. A survey was conducted in a pre-licensure sample of n = 343 students (response rate 68%) from four health professions (nursing, midwifery, physical therapy, and occupational therapy). After completing a semester-long interprofessional education course, students completed a survey vis-à-vis rating the importance of interprofessional facilitator competency with regard to 25 abilities, 12 teacher profiles, and 10 characteristics. Taken together, results indicate the need for a multifaceted view of interprofessional facilitator competencies. Our findings will inform training targeted to specific facilitator competencies, as needed for optimizing the delivery of interprofessional education.