Model approaches for advancing interprofessional prevention education

Healthy People 2010 included an objective to "increase the proportion of … health professional training schools whose basic curriculum for healthcare providers includes the core competencies in health promotion and disease prevention." Interprofessional prevention education has been seen by the Healthy People Curriculum Task Force as a key strategy for achieving this objective and strengthening prevention content in health professions education programs. To fulfill these aims, the Association for Prevention Teaching and Research sponsored the Institute for Interprofessional Prevention Education in 2007 and in 2008. The institutes were based on the premise that if clinicians from different professions are to function effectively in teams, health professions students need to learn with, from, and about students from other professions. The institutes assembled interprofessional teams of educators from academic health centers across the country and provided instruction in approaches for improving interprofessional prevention education. Interprofessional education also plays a key role in implementation of Healthy People 2020 Education for Health framework. The delivery of preventive services provides a nearly level playing field in which multiple professions each make important contributions. Prevention education should take place during that phase of the educational continuum in which the attitudes, skills, and knowledge necessary for both effective teamwork and prevention are incorporated into the "DNA" of future health professionals. Evaluation of the teams' educational initiatives holds important lessons. These include allowing ample time for planning, obtaining student input during planning, paying explicit attention to teamwork, and taking account of cultural differences across professions.     

Optimizing the Roles of School Mental Health Professionals

ABSTRACT: Each mental health discipline offers unique contributions to the development and operation of school-based mental health programs. The collaboration of professionals from different disciplines with each other, as well as with health and educational staff, is essential for service delivery in school settings. Conversely, interprofessional conflicts and turf issues can impede the development of effective school-based mental health programs. The authors, who represent counseling, nursing, psychiatry, psychology, and social work, discuss the roles and competencies of each profession in providing school-based mental health services. Training requirements within each discipline that relate to school mental health are described. Barriers to effective interdisciplinary collaboration, and methods of overcoming them, are delineated     

Knowledge translation in interprofessional education: what difference does interprofessional education make to practice?

Cancer Care Nova Scotia developed an Interprofessional Core Curriculum for Nova Scotia health professionals, using a provincial educational needs assessment of health professionals caring for patients with cancer. This paper reports on the educational outcomes of the Interprofessional Core Curriculum programme, particularly the translation of learning into changes in practice and interprofessional interaction, and factors influencing change. The evaluation was guided by Kirkpatrick's model for assessing educational outcomes and Green and Kreuter's PRECEDE model of factors promoting and impeding change. In total, 411 participants attended the sessions, including nurses (54%), pharmacists (23%), and physicians (11%). We used self-report questionnaires to assess the transfer of learning into changes in practice and interprofessional interactions. High percentages of participants reported changes in both clinical practice and interprofessional interactions 3 months after the sessions. Frequently reported changes to interprofessional interactions were improved communication, increased confidence and assertiveness in interactions with other health professionals and being more respectful of other professions. Participants identified time and work-load as major barriers to change as well as lack of micro- and macro-system level support. The most common reported enabler of change was having attended the educational session. Overall, participants were highly supportive of interprofessional education, although when compared to nurses and pharmacists, physicians were less supportive and had proportionately lower attendance.     

Practical Strategies for Integrating Interprofessional Education and Collaboration into the Curriculum

Interprofessional collaboration is vital for the provision of quality patient care. Thoughtfully designed educational programs can help students of health professions develop interprofessional competencies and capacities, including values and ethics, roles and responsibilities, interprofessional communication, and teamwork (Interprofessional Education Collaborative Expert Panel, 2011). The authors were involved in developing Interprofessional Education (IPE) activities and simulations to be infused into the curriculums of the various health professions programs in their College. A review of the IPE experiences revealed students greatly benefited from involvement in a diverse set of IPE activities and simulations.     

Healthy People 2020 and Education for Health: What Are the Objectives?

The Education for Health framework is designed as an educational roadmap for Healthy People 2020. It aims to connect the educational phases and suggests overall educational strategies needed to educate health professionals and the public to achieve a healthier America. The framework seeks to develop a seamless approach to prevention and population health education from Pre-K through graduate school. The framework is built on national movements in health literacy, undergraduate public health education and evidence-based thinking. It envisions a coordinated set of learning objectives divided into Pre-K through Grade 12, 2-year and 4-year colleges, and graduate education in the health professions as well as for health education for the community-at-large. The Healthy People Curriculum Task Force, a consortium of eight health professions education associations, has developed the framework and connected the framework with new and revised educational objectives of Healthy People 2020. The Task Force envisions a decade-long process to define and implement specific learning outcomes that can be integrated across the educational continuum. Interprofessional prevention education, in which health professionals learn and practice together, is seen by the Task Force as a key method for implementation. Understanding the roles played by a range of clinical health professions is also essential to communication and understanding. Healthy People 2020 and its new and revised educational objectives provide a vehicle for promoting the discussion and experimentation that will be needed to achieve an integrated and seamless approach to education for health for the American public as well as for health professionals.     

The definition and deployment of differential core professional competencies and characteristics in multiprofessional health and social care teams

There has been an increasing focus on delivering health and social care services through multiprofessional and inter‐agency teams. This study, undertaken in 2011, explores how different professionals within multiprofessional teams define their own and other professions’ core professional competencies, characteristics and contributions. It then compares these definitions with how different professionals deploy their time and what tasks they undertake. Sixty‐four workers in four multiprofessional teams in England, within four different health and local authority areas, participated in the study. Using role repertory grids to generate constructs, which were then converted into Likert scales, and with diaries recording activities undertaken, the study compares the deployment of time and task with the views about the differential core competencies and characteristics of each profession. The study highlights important issues for consideration by multidisciplinary teams, the managers and commissioners of these teams, and by professional associations.     

Continuing competence in selected health care professions

Health services professionals are confronting the challenge of maintaining and improving competence over the course of lengthy careers in diverse practice specialties. This article reviews the efforts of a selection of health care professions to ensure lifetime competence and reviews some of the challenges encountered in these efforts. Although each profession has its own issues, significant generic questions are common to all.     

Health Literacy Practices and Educational Competencies for Health Professionals: A Consensus Study

Health care professionals often lack adequate knowledge about health literacy and the skills needed to address low health literacy among patients and their caregivers. Many promising practices for mitigating the effects of low health literacy are not used consistently. Improving health literacy training for health care professionals has received increasing emphasis in recent years. The development and evaluation of curricula for health professionals has been limited by the lack of agreed-upon educational competencies in this area. This study aimed to identify a set of health literacy educational competencies and target behaviors, or practices, relevant to the training of all health care professionals. The authors conducted a thorough literature review to identify a comprehensive list of potential health literacy competencies and practices, which they categorized into 1 or more educational domains (i.e., knowledge, skills, attitudes) or a practice domain. The authors stated each item in operationalized language following Bloom's Taxonomy. The authors then used a modified Delphi method to identify consensus among a group of 23 health professions education experts representing 11 fields in the health professions. Participants rated their level of agreement as to whether a competency or practice was both appropriate and important for all health professions students. A predetermined threshold of 70% agreement was used to define consensus. After 4 rounds of ratings and modifications, consensus agreement was reached on 62 out of 64 potential educational competencies (24 knowledge items, 27 skill items, and 11 attitude items), and 32 out of 33 potential practices. This study is the first known attempt to develop consensus on a list of health literacy practices and to translate recommended health literacy practices into an agreed-upon set of measurable educational competencies for health professionals. Further work is needed to prioritize the competencies and practices in terms of relative importance.     

Exploring the perceived effect of an undergraduate multiprofessional educational intervention

CONTEXT: Improved teamwork and greater collaboration between professions are important factors in effective health care. These goals may be achieved by including interprofessional learning in the undergraduate medical curriculum. The Faculty of Medicine at the University of Liverpool organized a pilot two-day multiprofessional course involving all the health care related disciplines. OBJECTIVE: The present study examined the perceived effect of the multiprofessional course on the work practice of these newly qualified health care professionals. METHOD: The views of former students who took part in the pilot course were collected using a semi-structured interview schedule and analysed using a qualitative data analysis software package QSR NU*DIST. RESULTS: Two main themes emerged. These centred around role knowledge and interprofessional attitudes. Data indicated that participants perceived the course to have increased their knowledge of the other professions and that this effect had persisted. Reported benefits to their working practice included facilitating appropriate referrals, increasing professional empathy and awareness of other professionals' skills, raising confidence and heightening awareness of the holistic nature of patient treatment. Participants reported forming negative attitudes towards other professions during their undergraduate education. They believed these had been partly encouraged by course tutors. The pilot course was perceived to have had had little effect on these attitudes. Changes occurred once the newly qualified professionals started work. CONCLUSIONS: The results support the idea that interprofessional educational interventions must be tailored to specific learning goals to be implemented successfully, and that interprofessional education should be prolonged and widespread to have a real impact.     

The Shrinking of Formalized Nutrition Education in Health Professions Curricula and Postgraduate Training

The quantity of formalized nutrition education is shrinking in curricula of health professions, such as physicians, nurses, dietitians, and pharmacists. The current nutrition education being taught in U.S. schools of healthcare professionals does not appropriately prepare students for identification of patients at nutrition risk or management of undernourished hospitalized patients with specialized nutrition therapies. In U.S. schools of pharmacy, parenteral nutrition is considered a highly specialized and advanced practice so little time is devoted to this area and more attention is focused on chronic disease state management (ie, hypertension, diabetes mellitus, and congestive heart failure). Nutrition support fellowships for physicians and nutrition support residency programs for pharmacists have dwindled in number over the years so that only a handful of these healthcare professionals are produced each year from the remaining formalized programs. Physicians, nurses, pharmacists, and dietitians can positively affect patient care, but each profession must first determine how best to integrate basic and applied nutrition concepts into their professional curricula and training programs. There must also be consensus among the healthcare professions as to the depth of nutrition education and the stage of training at which these integrations should occur. Only by having these crucial conversations among all disciplines will we be able to develop new strategies to expand nutrition education in the training of future medical practitioners.     

The institutional and professional benefits of housing athletic training education programs in schools of health professions

Accredited Athletic Training Education programs (ATEPs) are sponsored by over 350 universities and are housed in a variety of academic units ranging from schools of education to schools of health professions. There are advantages to all stakeholders housing ATEPs in schools of health professions. Formed in the 1960s, many of the early ATEPs were housed in schools of education, when most program faculty and staff were employed by athletics departments and the profession had a distinct curricular connection to coaching. Athletic training has since evolved to a health care profession, and its educational processes need to reflect this model. By housing ATEPs in units that educate other health care providers, many efficiencies and collaborative opportunities are introduced with a resulting overall improvement in the quality of the professional education of athletic trainers. The authors, directors of ATEPs housed in schools of health professions, provide examples of these benefits, which include opportunities for participation in interprofessional initiatives; opportunities for faculty development and collaborative teaching among like-minded faculty; improved mechanisms for scholarship, support and funding mechanisms; and economies of scale in terms of program delivery requirements.     

Interprofessional training in the context of clinical practice: goals and students' perceptions on clinical education wards

AIMS: This paper describes the context of interprofessional training on clinical education wards (CEWs) and reports students' perceptions of this type of interprofessional and professional training. CONTEXT: A 2-week interprofessional clinical course was designed for medical students in their surgical eighth term, and nursing, occupational therapy and physiotherapy students, all in their sixth term. Clinical tutors were responsible for the patients and also supervised the students. The goals for the students included: to provide the patients with good medical care, nursing and rehabilitation; to develop their own professional roles; to enhance their level of understanding of the other professions; to stress the importance of good communication for teamwork and for patient care; to enhance understanding of the role of the patient, and to become more aware of ethical aspects of health care. MATERIAL AND METHODS: A questionnaire developed by teachers from the 4 educational departments was used. A total of 962 students responded (78%). RESULTS: The CEWs provided the students with good clinical practice in terms of training in their own professions as well in learning more about the other professions. The importance of good communication for teamwork and for patient care was recognised. The quality of supervision and students' perception of their own professional roles were important factors regarding satisfaction with the CEW course. CONCLUSIONS: The CEW course seemed to provide the students with an opportunity to develop their own professional roles and their functions as team members.     

A grounded theory study of the narrative behind Indian physiotherapists global migration

It is estimated that an additional 6.4 million allied health professionals are required to address India's health challenges. Physiotherapy is amongst the largest of these professions. Over the last decade, thousands of Indian physiotherapists have sought to study and work overseas. In this study, 19 physiotherapists from across India were interviewed. Data were collected and analysed using construct+ivist grounded theory methods. The findings indicate that the Indian physiotherapy profession faces many political and clinical hierarchical challenges within the Indian healthcare infrastructure. The profession's education provision has developed, and the private clinical sector has grown, but there are significant disparities in quality and standards across the sector. The profession in India has variable autonomy, is not nationally regulated, is poorly paid, and the leadership has been divided. The political, educational, and clinical context in Indian physiotherapy impacts upon physiotherapists' ability to practise effectively to their professional satisfaction. Individual physiotherapists are frustrated by their workplace and travel overseas where they hear that the physiotherapy profession and practice is different. Whilst the disjunctures influencing these factors continue, and overseas physiotherapy practice is perceived as different and superior, Indian physiotherapists will continue to seek to migrate overseas, and facilitating their return will be challenging.     

Community health screening programs for African-Americans and the medical anthropologist

Community health screening programs were originally designed: to stimulate change in family and community knowledge and behavior relating to the prevention of disease; to inform the use of available health resources; and to improve the environmental, economic, and educational factors related to health. Since their inception, however, community health screening programs have primarily used conventional approaches to health improvement for the African-American community. That is, the need is not merely for the provision of more preventative and curative health services or the distribution of services to passive recipients, but for the active involvement of local populations in ways which will preserve or repattern their knowledge, attitudes and motivation concerning major health care issues. Health care professionals such as the clinicians need to expand their biopsychosocial model to include specific sociocultural data concerning African-American health care seeking pattern. Collaborative efforts of this type will therefore enable health care professionals to design future community health screening programs for the African-American community that are practical and culturally-oriented.     

The AHEC contribution to social work education

The Area Health Education Center (AHEC) Program is a Federal initiative funded by the Public Health Service. The goal of the program is to improve the distribution and quality of training for health professionals. Funds are awarded to schools of medicine or osteopathy which in turn subcontract with at least two other health professional schools. Each project recipient must establish an AHEC center to plan and coordinate community-based educational experiences for health professions students in designated health shortage areas. The AHEC program fosters interdisciplinary training among health professionals. As part of the basic program thrust, some AHECs have included the social work profession in their program design. The Massachusetts AHEC, through Boston University's School of Social Work, established a health care concentration and interdisciplinary rotation that included students from social work, psychology, nursing, and medicine. Other examples of AHEC-sponsored training are presented from Baltimore, the eastern shore of Virginia, and several centers in Massachusetts. Through the AHEC training mechanism, social work students as well as practitioners in the field have the opportunity to encounter the most current and urgent issues in health care practice.     

A look at the educational preparation of the health-diagnosing and treating professions: do dietitians measure up?

Basic educational requirements for dietitians were developed almost 80 years ago and remain largely unchanged. In the interim, other health professions have increased their academic standards. A review of the educational preparation of 16 health-diagnosing and treating professions was undertaken to better understand the standards for dietetics education within a larger context. Educational standards for each profession were obtained and reviewed for types of degrees; duration of post-secondary, college-level education; division of didactic and clinical education; and presence of accredited post-professional education. Findings reveal that at least 11 of the professions studied offer first professional degrees. Differences were noted in duration and sequencing of undergraduate education, didactic or classroom education, and especially supervised practice. Models to facilitate comparison between educational standards were developed. The current educational model in dietetics is designed to prepare entry-level practitioners and academics who comprise less than 20% of the profession. This review supports the need to investigate educational opportunities for beyond-entry-level dietitians, and to develop educational programs that amplify the existing models for educating dietitians.     

A problem-based nutrition care model that is diagnostic driven and allows for monitoring and managing outcomes

The provision of quality food and nutrition services is at the core of dietetic practice. It is exciting to have the profession engaged in discussions regarding the development of a standardized care process/model to further enhance the quality of nutrition services. Educators, consultants, and practitioners have already spoken on behalf of such a tool. This article demonstrates how a systematic model, when incorporated into education and practice contributes to improved provision of MNT and adds value to the unique contributions of dietetic professionals. The authors hope that the discussion will continue and that more ideas and suggestions will be forthcoming.     

The International Eye Foundation/Kenya Rural Blindness Prevention Project

This paper outlines briefly the background of the International Eye Foundation and the origins of the Kenya Rural Blindness Prevention Project (KRBPP). It examines in some detail the major objectives of the project and the activities which have contributed toward the achievement of those objectives. Objectives of the KRBPP include the strengthening of therapeutic services in rural areas, motivating a re-orientation toward preventive education and away from exclusively curative services and the development of appropriate educational and promotional materials on primary eye care and blindness prevention. The activities of the project have included the development of mobile rural blindness prevention units, the provision of training to health workers at all levels, curricula development for use in health training institutions and the development of a variety of educational and promotional materials for use by health workers, school teachers, students and the general public. It is suggested that the KRBPP can serve as a model for the development of similar national blindness prevention projects throughout the developing world.     

Explanations in consultations: the combined effectiveness of doctors' and nurses' communication with patients

BACKGROUND: Multidisciplinary and interprofessional working is currently a priority in health care policy, in caring for patients and in health professional education. Realising multidisciplinary approaches presents challenges in the context of changes in doctors' and nurses' roles and the increased emphasis placed on communication with patients. In communication in consultations, explanations are employed in the service of numerous activities, including decision making, diagnosis and physical examination, but they have been little studied. SETTING: This paper presents findings from a comparative study of doctors' and nurses' communication with patients in multidisciplinary health care, focusing on diabetes in primary care. METHODS: Video- and audio-recorded consultations were subjected to conversation analysis. Output from discussion groups with patient representatives and health professionals underwent qualitative analysis. FINDINGS: Distinctive features of explanations in nurses' and doctors' consultations with patients were identified. These can be understood by reference to patterns of communication. Nurses' communication was mediated by patients' contributions; doctors' communication gave an overarching direction to the consultation as a whole. While nurses' explanations began from the viewpoint of a patient's responsibility and behaviour, doctors' explanations began from the viewpoint of biomedical intervention. Their consultations lent different opportunities for patients' involvement. CONCLUSION: Nurses' and doctors' communications each exhibit their own distinct features. Specification of these features, when considered in the context of a particular consultation activity such as explanations, allows both recognition of the distinct contributions each profession can offer and identification of ways of combining these to maximum effect. This has implications for policy, for practice and for interprofessional education.     

Suitable but requiring support: How the midwifery model of care offers opportunities to counsel the vaccine hesitant pregnant population

Uptake of vaccination during pregnancy in Canada is lower than comparator countries. A recommendation from a trusted perinatal healthcare provider is a key opportunity to promote vaccine uptake and improve confidence. This study aims to identify barriers and opportunities to vaccination in midwifery care. Seventeen semi-structured telephone interviews with practicing midwives, educators and public health professionals with immunization training experiences were conducted. Documents pertaining to the midwifery profession (approx. 50) were reviewed. Inductive thematic analysis identified logistical, interprofessional, and information barriers preventing Canadian midwives from administering vaccines and counseling clients about vaccination, as well as opportunities to address each barrier. Key interventions at the level of logistics, training, and client information materials would help address barriers to the integration of midwives into the provision and recommendation of vaccines in perinatal care across Canada.