Mainstreaming interprofessional education in the United Kingdom: a position paper

Interprofessional education (IPE) is being built into the mainstream of professional education for all health and social care professions throughout the United Kingdom (UK) driven by the Labour Government elected in 1997, coincidentally the year that this Journal hosted the first All Together Better Health conference in London. The incoming government prioritized pre-qualifying IPE to be provided in partnership by universities and service agencies supported regionally by workforce development confederations, later absorbed into strategic health authorities (SHAs), and centrally by educational, professional and regulatory bodies. Ambitious agenda for pre-qualifying IPE set by government are being tempered by realistic assessment of current outcomes borne of experience and corroborated by evidence. This paper suggests some ways to ease constraints and improve outcomes, but emphasizes the need to generate continuing interprofessional learning opportunities that build on the basics. It argues that accumulating experience and evidence must be brought to bear in formulating criteria for the approval and review of IPE within regulatory systems for professional education. Can IPE be sustained within mainstream professional education once initial enthusiasm ebbs and earmarked funds run dry? That is the issue.     

Assessing faculty attitudes after participation in an interprofessional teaching scholars programme

Promoting interprofessional education (IPE) and practice is a priority in academic health centres; however, implementation of IPE can be challenging. Recognizing the need for faculty development in teaching, and specifically IPE, the University of California, Davis Schools of Health launched the Interprofessional Teaching Scholars Program (ITSP) in 2014. Two cohorts of 11 faculty scholars each completed the nine-month programme and participated in this longitudinal comparative study in which pre- and post-assessments using a validated survey instrument were administered to measure changes in faculty attitudes towards IPE and collaborative practice. There was a statistically significant increase in the summated scores on all three of the subscales: Attitudes Towards Interprofessional Health Care Teams, Attitudes Towards IPE, and Attitudes Towards Interprofessional Learning in the Academic Setting. The results suggest that the ITSP was associated with positive changes in faculty attitudes related to interprofessional collaboration and teamwork.     

Mainstreaming interprofessional education in the United Kingdom: A position paper

Summary

Interprofessional education (IPE) is being built into the mainstream of professional education for all health and social care professions throughout the United Kingdom (UK) driven by the Labour Government elected in 1997, coincidentally the year that this Journal hosted the first All Together Better Health conference in London. The incoming government prioritized pre-qualifying IPE to be provided in partnership by universities and service agencies supported regionally by workforce development confederations, later absorbed into strategic health authorities (SHAs), and centrally by educational, professional and regulatory bodies. Ambitious agenda for pre-qualifying IPE set by government are being tempered by realistic assessment of current outcomes borne of experience and corroborated by evidence. This paper suggests some ways to ease constraints and improve outcomes, but emphasizes the need to generate continuing interprofessional learning opportunities that build on the basics. It argues that accumulating experience and evidence must be brought to bear in formulating criteria for the approval and review of IPE within regulatory systems for professional education. Can IPE be sustained within mainstream professional education once initial enthusiasm ebbs and earmarked funds run dry? That is the issue.     

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.     

Challenges and innovations in interprofessional education: Promoting a public health perspective

Public Health has been a key contributor in the Interprofessional Education Collaborative expert panel for Interprofessional Education (IPE) programs; however, limited programs have directly addressed population health concepts such as social determinants of health and health disparities in healthcare, which directly impact the health and well-being of patients. Thus, this study presents the development and implementation of population health concepts within a traditional, clinically focused IPE program. Within the IPE program conducted in 2016, more than 575 students from 12 health-related disciplines participated in a 4-month academic course. A new curriculum was developed that included a new module on social determinants of health. Previously developed sessions on roles and responsibilities, standardized patient interviewing, patient care planning, and patient safety were re-examined to incorporate the concepts of social determinants of health and health disparities. Course evaluations reported higher mean scores for each new session when compared to scores from previous years evaluation, when social determinants of health had not been addressed. Findings from this evaluation highlight the importance of developing innovative experiential learning experiences that include public health concepts within IPE in order to create a more fulfilling and enriched curriculum to better prepare healthcare students to address the social determinants of health that they will be encountering in their future practice.     

Key elements for interprofessional education. Part 1: the learner, the educator and the learning context

This paper is the first of two that highlights key elements needed for consideration in the planning and implementation of interprofessional educational (IPE) interventions at both the pre and post-licensure qualification education levels. There is still much to be learned about the pedagogical constructs related to IPE. Part 1 of this series discusses the learning context for IPE and considers questions related to the "who, what, where, when and how" related to IPE. Through a systematic literature review that was conducted for Health Canada in its move to advance Interprofessional Education for Patient Centred Practice (IECPCP), this paper provides background information that can be helpful for those involved in an interprofessional initiative. A historical review of IPE sets the international context for this area and reflects the work that has been done and is currently being initiated and implemented to advance IPE for health professional students. Much can be learned from the literature related to the pedagogical approaches that have been tried and the issues that need to be addressed related to the learner, the educator and the learning context which this paper examines.     

Interprofessional education day – an evaluation of an introductory experience for first-year students

Interprofessional health care teams have been shown to improve patient safety and reduce medical errors, among other benefits. Introducing interprofessional concepts to students in full day events is an established model that allows students to learn together. Our group developed an academic day for first-year students devoted to an introductory interprofessional education (IPE) experience, ‘IPE Day’. In total, 438 students representing medicine, dentistry, pharmacy and optometry gathered together, along with 25 facilitators, for IPE Day. Following the day’s program, students completed the evaluation consisting of the Interprofessional Collaborative Competencies Attainment Survey and open-ended questions. Narrative responses were analyzed for content and coded using the Canadian Interprofessional Health Collaborative competency domains. Three hundred and eight evaluations were completed. Students reported increased self-ratings of competency across all 20 items (p < 0.05). Their comments were organized into the six domains: interprofessional communication, collaborative leadership, role clarification, patient-centred care, conflict resolution, and team functioning. Based on these findings, we suggest that this IPE activity may be useful for improving learner perceptions about their interprofessional collaborative practice competence.     

A scoping review to improve conceptual clarity of interprofessional interventions

Interprofessional education (IPE) and interprofessional collaboration (IPC) have been identified in health education and health care as playing an important role in improving health care services and patient outcomes. Despite a growth in the amount of research in these areas, poor conceptualizations of these interprofessional activities have persisted. Given the conceptual challenges, a scoping review of the interprofessional field was undertaken to map the literature available in order to identify key concepts, theories and sources of evidence. The objective of this review was to develop a theoretically based and empirically tested understanding of IPE and IPC. A total of 104 studies met the criteria and were included for analysis. Studies were examined for their approach to conceptualization, implementation, and assessment of their interprofessional interventions. Half of the studies were used for interprofessional framework development and half for framework testing and refinement. The final framework contains three main types of interprofessional interventions: IPE; interprofessional practice; and interprofessional organization; and describes the nature of each type of intervention by stage, participants, intervention type, interprofessional objectives, and outcomes. The outcomes are delineated as intermediate, patient, and system outcomes. There was very limited use of theory in the studies, and thus theoretical aspects could not be incorporated into the framework. This study offers an initial step in mapping out the interprofessional field and outlines possible ways forward for future research and practice.     

A scoping review to improve conceptual clarity of interprofessional interventions

Interprofessional education (IPE) and interprofessional collaboration (IPC) have been identified in health education and health care as playing an important role in improving health care services and patient outcomes. Despite a growth in the amount of research in these areas, poor conceptualizations of these interprofessional activities have persisted. Given the conceptual challenges, a scoping review of the interprofessional field was undertaken to map the literature available in order to identify key concepts, theories and sources of evidence. The objective of this review was to develop a theoretically based and empirically tested understanding of IPE and IPC. A total of 104 studies met the criteria and were included for analysis. Studies were examined for their approach to conceptualization, implementation, and assessment of their interprofessional interventions. Half of the studies were used for interprofessional framework development and half for framework testing and refinement. The final framework contains three main types of interprofessional interventions: IPE; interprofessional practice; and interprofessional organization; and describes the nature of each type of intervention by stage, participants, intervention type, interprofessional objectives, and outcomes. The outcomes are delineated as intermediate, patient, and system outcomes. There was very limited use of theory in the studies, and thus theoretical aspects could not be incorporated into the framework. This study offers an initial step in mapping out the interprofessional field and outlines possible ways forward for future research and practice.     

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.     

Indonesian students’ participation in an interprofessional learning workshop

Abstract

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

Examining the perceived impact of an ethics workshop on interprofessional values and teamwork

Interprofessional education (IPE) is a vital component of healthcare education yet challenges to implementation persist. This study aimed to evaluate the perceived impact of an ethics-based IPE workshop designed for professional phase healthcare students enrolled in athletic training, health management systems, occupational therapy, physical therapy, physician assistant studies, and speech-language pathology programmes at one university. A pre/post-test cohort study was conducted to evaluate the impact of the workshop on interprofessional values and teamwork. Findings from the 61 students who completed both pre- and post-programme evaluation surveys suggest that the ethics-based workshop was successful in improving perceived confidence as related to the workshop objectives and strengthened positive perceptions of IPE as evaluated by the Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R). Analysis of responses to open-ended reflection questions after the workshop suggest that student participants perceived changes in understanding related to multiple areas of IPE. These results suggest that an ethics-based workshop using case-based collaborative pedagogy may be an effective mechanism for delivery of IPE-oriented information resulting in greater student confidence and understanding of IPE competencies.     

Taking the long view: Exploring the development of interprofessional education

Interprofessional education (IPE) in health and social care has been well documented regarding student outcomes. Less has been written from the perspective of those who actually developed IPE. This study explores IPE within the context of a university partnership working with service providers in Southwest London (UK). We focused on the experiences and perspectives of 19 key players who were interviewed about the inception, implementation and development of IPE over 15 years. Our aim was to understand their views of IPE and its evolution over time. Interviewees provided different understandings of IPE, as well as contrasting views regarding its purpose and optimum delivery. Problems such as lack of central planning and the logistics of implementation were also discussed. Paradoxically, however, the participants highlighted positive outcomes and conveyed optimistic messages for the future. Despite various challenges and setbacks, a strong belief in the importance of IPE and a commitment to carrying it through were strong motivators contributing to finding solutions, as were building trust and positive relationships across professional and disciplinary boundaries.     

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.     

Simplicity: The Ultimate Sophistication of Collaborative Practice

The past decade has seen significant attention to and investment in the realm of collaborative practice (CP). Interprofessional Collaboration (IPC) and its scholarly precursor Interprofessional Education (IPE) have been hot ticket items for learning institutions, governments and healthcare organizations. Full integration into the healthcare delivery model, however, has not been fully actualized. For CP to be sustainable in the clinical practice setting the application of IPC needs to be simple, specific and practical. This paper discusses barriers to integration and forwards that two simple principles are necessary for collaborative practice—personal investment and collective engagement.     

Faculty development to support interprofessional education in healthcare professions: A realist synthesis

Interprofessional collaboration is expected of healthcare providers to effect positive patient care experiences, reduce healthcare costs, and improve population health. While interprofessional education (IPE) is essential to graduate collaboration-ready healthcare professionals, faculty have limited experience and expertise in facilitating IPE, slowing adoption of this strategy. Faculty who are expected to develop, implement, and facilitate IPE activities in health professions need support and training to be successful. Faculty development programmes specific to IPE are examined through a comprehensive realist synthesis. The review began by identification of the mechanisms underpinning the intervention and then continued through a search for evidence relevant to the identified mechanisms. From 1,749 citations reviewed, 15 articles and book chapters were synthesised. The findings demonstrate that through the mechanisms—roles and role modelling, valuing diversity, reflection, group process, and knowledge, skills, and attitudes for IPE—positive outcomes can be achieved. Outcomes of increasing capacity and sustainability of IPE programmes, forming networks of individuals concerned with IPE, and evaluating and assessing of outcomes of IPE, may all be achieved through these mechanisms. The contextual factors include attitudes and expectations, programme logistics, leadership, and commitment, which interact with the mechanisms to impact the outcomes. Multiple context-mechanism-outcome configurations were revealed and analysed which help to explain how faculty development for IPE works in varying settings.     

Top priorities for the next decade of nursing health services research

BackgroundThe U.S. health care system faces increasing pressures for reform. The importance of nurses in addressing health care delivery challenges cannot be overstated.PurposeTo present a Nursing Health Services Research (NHSR) agenda for the 2020s.MethodA meeting of an interdisciplinary group of 38 health services researchers to discuss five key challenges facing health care delivery (behavioral health, primary care, maternal/neonatal outcomes, the aging population, health care spending) and identify the most pressing and feasible research questions for NHSR in the coming decade.FindingsGuided by a list of inputs affecting health care delivery (health information technology, workforce, delivery systems, payment, social determinants of health), meeting participants identified 5 to 6 research questions for each challenge. Also, eight cross-cutting themes illuminating the opportunities and barriers facing NHSR emerged.DiscussionThe Agenda can act as a foundation for new NHSR – which is more important than ever – in the 2020s.     

Investigating online interprofessional learning and communication using social network analysis: a study protocol

ABSTRACT

Interprofessional education (IPE) via the use of online learning environments (OLEs) can help improve patient outcomes, interprofessional attitudes, and behaviors while providing education at a distance. Studies of interprofessional learning often examine communication and its relation to learning outcomes qualitatively. OLEs allow researchers to examine these communication patterns quantitatively, through social network analysis (SNA), and answer questions regarding the nature of communication between interprofessional learners and how this may impact interprofessional attitudes and behaviors. In this paper, we present a study that aims to track interprofessional communication within a cancer care course using SNA and examine how it relates to professional attitudes and collaboration. Using pre and post-course surveys as well as numerous SNA metrics derived from course discussion board posts, we hope to show how communication between interprofessional learners may mediate outcomes. This work will add to the existing IPE literature by providing an added quantitative layer to a largely qualitative literature and encourage future studies in this area.     

Ageing and global boundaries

Interprofessional education (IPE) involves learning, and learning requires reflection. Educators need to “reflect more on reflection” if they are to be effective teachers in ensuring the learning outcomes essential for teamwork and interprofessional practice (IPP), including incorporating both theory and practice into the development of educational interventions. First, this discussion surveys the IPE-relevant literature on reflection, and then defines and refines the multidimensional concept of reflection as it relates to IPE in developing and implementing teamwork learning programs and experiences. Second, specific methods to promote reflection are presented and explored, including self-assessments, journaling, and written papers. Actual samples from student journals and assignments provide examples of the impacts of using these methods on participant reflection and learning. Finally, implications for an expanded understanding and application of reflection for IPE will be discussed, and recommendations made for educational practice and research in this area.