Changing student attitudes through interaction: Findings from an interprofessional workshop

Healthcare professionals are increasingly expected to work in interprofessional teams. Students therefore need opportunities to learn and practise skills that will allow them to be effective team members when they enter the workforce. This article summarises an interprofessional learning experience for 289 undergraduate and graduate students representing 13 programmes in a College of Health Professions (CHP) at a US public university. The half-day workshop provided an opportunity for participants with no prior interprofessional education to collaborate in a problem-solving case study and to inform students of other professions about their professions. Faculty members from all CHP programmes collaborated in writing the case study and facilitating student discussions during the event. Attitudes related to interprofessional collaboration and professional roles were assessed prior to and after workshop participation. A paired t test showed a statistically significant difference in four attitude questions. Participants reported a significant increase in understanding the roles of other professionals in healthcare and community situations. They also reported an increased understanding of the benefits and challenges of working in interprofessional teams. This event successfully introduced participants to interprofessional collaboration and provided them the opportunity to share their professional expertise and understand the expertise of others.     

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.     

Exploring interprofessional education and collaborative practice in Australian rural health services

ABSTRACT

This article explores how work-based interprofessional education (IPE) influences collaborative practice in rural health services in Australia. Using a qualitative case study design, three rural hospitals were the focal point of the project. Marginal participant observations (98 hours) and semistructured interviews (n = 59) were undertaken. Participants were medical practitioners, nursing and midwifery professionals, physiotherapists, paramedics, social workers and administrative staff, who provided services in relation to each hospital. Data in the form of audio recordings and field notes, including researcher reflections were recorded over a three-year period. Whilst this study comprised of three phases, this article explores the extent to which collaborative practice was present or not before and after IPE. An inductive content analysis resulted in the following themes: Conceptualizing Collaborative Practice, Profession-Driven Education, and Professional Structures and Socialization. Community of practice theory is used to explore the barriers created through profession-based communities of practice.     

Evaluating the perceived impact of an interprofessional childhood obesity course on competencies for collaborative practice

Interprofessional education (IPE) is needed to prepare health professional students to address the complexities of childhood obesity in practice. This mixed-method study sought to evaluate the perceived impact of a childhood obesity IPE intervention on health professional students’ collaborative competency development within two domains: roles/responsibilities and teams/teamwork. Fourteen health professional students participated in this mixed-methods study. Quantitative data were collected through pre/post surveys, while qualitative data were collected through reflection assignments. Survey findings indicated that students reported significant increases in growth within both interprofessional competency domains. Qualitative data elaborated on the types of learning students experienced relative to each domain. Implications of this study for research and practice related to IPE to address complex health issues, such as childhood obesity, are shared.     

The implementation of multiple interprofessional integrated modules by health sciences faculty in Chile

Multiple interprofessional integrated modules (MIIM) 1 and 2 are two required, cross-curricular courses developed by a team of health professions faculty, as well as experts in education, within the Faculty of Medicine of the University of Chile. MIIM 1 focused on virtual cases requiring team decision-making in real time. MIIM 2 focused on a team-based community project. The evaluation of MIIM included student, teacher, and coordinator perspectives. To explore the perceptions of this interprofessional experience quantitative data in the form of standardised course evaluations regarding teaching methodology, interpersonal relations and the course organisation and logistics were gathered. In addition, qualitative perceptions were collected from student focus groups and meetings with tutors and coordinators. Between 2010 and 2014, 881 students enrolled in MIIM. Their evaluation scores rated interpersonal relations most highly, followed by organisation and logistics, and then teaching methodology. A key result was the learning related to interprofessional team work by the teaching coordinators, as well as the participating faculty. The strengths of this experience included student integration and construction of new knowledge, skill development in making decisions, and collective self-learning. Challenges included additional time management and tutors’ role. This work requires valuation of an alternative way of learning, which is critical for the performance of future health professionals.     

Observation of interprofessional collaboration in primary care practice: A multiple case study

Interprofessional collaboration (IPC) is known to improve and enhance care for people with complex healthcare and social care needs and is ideally anchored in primary care. Such care is complex, challenging, and often poorly undertaken. In countries such as Canada, the United Kingdom, the Netherlands, Australia, and New Zealand, primary care is provided predominantly via general practices, where groups of general practitioners and nurses typically work. Using a case study design, direct observations were made of interprofessional activity in three diverse general practices in New Zealand to determine how collaboration is achieved and maintained. Non-participant observation of health professional interaction was undertaken and recorded using field notes and video recordings. Observational data were subject to analysis prior to collection of interview data, subsequently gathered independently at each site. Case-specific themes were developed before determining cross-case themes. Cross-case themes revealed five key elements to IPC: the built environment, practice demographics and location, practice business models, shared goals, and team structure and climate. The combination of elements at each practice site indicated that strengths in one area helped offset challenges in others. The three practices (cases) collectively demonstrated the importance of an “all of practice” commitment to collaborative practice so that shared decision-making can occur.     

Fostering interprofessional collaborative practice in acute care through an academic-practice partnership

An interprofessional collaborative practice (IPCP) environment was implemented in four inpatient acute care unit accountable care teams (ACT) through an academic-practice partnership. An action research methodology was implemented to empower healthcare professionals and promote ownership and sustainment of the IPCP strategies. Healthcare professionals on the ACT units, students, and faculty engaged in the multi-year project. Interventions included staff engagement exercises and coaching and support of individual ACT unit IPCP strategies and education. Healthcare professional outcome data were collected in the form of participant surveys, measuring collaboration about care decisions and the extent to which professionals engaged in a culture of safety, collected at baseline and 6-month intervals. Healthcare outcome measures of the ACT units were also collected at baseline and 6-month intervals. Students had clinical learning experiences in the IPCP settings and completed post clinical surveys. Implementation of the interventions resulted in a positive trend in the healthcare professionals, although statistical significance was not observed. Student outcome data demonstrated statistically significant positive learning outcomes. Healthcare outcome measures demonstrated a significant decrease in readmissions and an overall decrease in catheter-associated urinary tract infections over time. Other measures were not significantly impacted. In conclusion, an academic – practice partnership can strengthen and support an IPCP environment by allowing healthcare clinicians to be directly involved in the selection and implementation of IPCP strategies and contribute to improved professional, healthcare and student outcomes.     

Strategic planning for future learning environments: an exploration of interpersonal,interprofessional and political factors

Abstract

This article, written from the stance of a public planner and a policy maker, explores the challenges and potential in creating future learning environments through the concept of a new learning landscape. It is based on the belief that physical planning can support the strategic goals of universities. In Denmark, a political focus on education as a mean to improve national capacity for innovation and growth are redefining the universities role in society. This is in turn changing the circumstances for the physical planning. Drawing on examples of physical initiatives in three different scales – city, building and room scale, the paper highlights how space and place matters on an interpersonal, an interprofessional and a political level. The article suggests that a wider understanding of how new learning landscapes are created – both as a material reality and a political discourse – can help frame an emerging community of practice. This involves university leaders, faculty and students, architects, designers and urban planners, citizens and policy makers with the common goal of creating future learning environments today.     

Neophyte facilitator experiences of interprofessional education: implications for faculty development

The facilitation of learners from different professional groups requires a range of interprofessional knowledge and skills (e.g. an understanding of possible sources of tension between professions) in addition to those that are more generic, such as how to manage a small group of learners. The development and delivery of interprofessional education (IPE) programs tends to rely on a small cohort of facilitators who have typically gained expertise through ‘hands-on’ involvement in facilitating IPE and through mentorship from more experienced colleagues. To avoid burn-out and to meet a growing demand for IPE, a larger number of facilitators are needed. However, empirical evidence regarding effective approaches to prepare for this type of work is limited. This article draws on data from a multiple case study of four IPE programs based in an urban setting in North America with a sample of neophyte facilitators and provides insight into their perceptions and experiences in preparing for and delivering IPE. Forty-one semi-structured interviews were conducted before (n == 20) and after (n == 21) program delivery with 21 facilitators. Findings indicated that despite participating in a three-fold faculty development strategy designed to support them in their IPE facilitation work, many felt unprepared and continued to have a poor conceptual understanding of core IPE and interprofessional collaboration principles, resulting in problematic implications (e.g. ‘missed teachable moments’) within their IPE programs. Findings from this study are discussed in relation to the IPE, faculty development and wider educational literature before implications are offered for the future delivery of interprofessional faculty development activities.     

Integration of systematic clinical interprofessional training in a student-faculty collaborative primary care practice

The changing healthcare environment and movement toward team-based care are contemporary challenges confronting health professional education. The primary care workforce must be prepared with recent national interprofessional competencies to practice and lead in this changing environment. From 2012 to 2014, the weekly Beth Israel Deaconess Crimson Care Collaborative Student-Faculty Practice collaborated with Northeastern University to develop, implement and evaluate an innovative model that incorporated interprofessional education into primary care practice with the goal of improving student understanding of, and ability to deliver quality, team-based care. In the monthly interprofessional clinic, an educational curriculum empowered students with evidence-based, team-based care principles. Integration of nursing, pharmacy, medicine, and masters of public health students and faculty into direct patient care, provided the opportunity to practice skills. The TeamSTEPPS® Teamwork Attitudes Questionnaire was administered pre- and post-intervention to assess its perceived impact. Seventeen students completed the post-intervention survey. Survey data indicated very positive attitudes towards team-based care at baseline. Significant improvements were reported in attitudes towards situation monitoring, limiting personal conflict, administration support and communication. However, small, but statistically significant declines were seen on one team structure and two communication items. Our program provides further evidence for the use of interprofessional training in primary care.     

An interprofessional train-the-trainer evidence-based practice workshop: Design and evaluation

Abstract

Evidence-based practice (EBP) is a core skill of health professionals and one that is regularly taught in health sciences programs. This report covers the design and results of an interprofessional EBP workshop at a large university aimed at improving faculty’s confidence in practicing and teaching EBP. The two-day workshop was designed by the University’s Health Sciences Libraries and emphasized small-group work, with the first day focused on critical appraisal and searching and the second on effective teaching strategies. Twenty-five faculty from the schools and colleges of Medicine, Nursing, Pharmacy, Dentistry, and Veterinary Medicine and the Center for Allied Health Programs attended this study. Nine faculty and librarians served as instructors. Attendees rated the workshop and individual lectures highly and reported that it improved their ability to both practice and teach EBP. In addition, they reported a preference for learning in an interprofessional environment. This report suggests that a short EBP workshop can improve faculty members’ self-reported confidence and ability to practice and teach core EBP skills.     

An interprofessional exploration of nursing and social work roles when working jointly with families

Ngala, an early parenting not-for-profit organisation in Western Australia, has provided services to families with young children since 1890. Child health nurses and mothercraft nurses were the primary workforce until the 1980s when a social worker was employed and a new era of interprofessional collaboration began. Evidence to date has focused on nursing workforce, interprofessional education, and interprofessional teams. Little is known about the roles of nursing and social work when working jointly with families. A new service commenced in 2012 for families with children with developmental delays. Social workers and child health nurses were employed for this service model. Our study aim was to explore the perceptions of how nurses and social workers work together with a family providing psychosocial support across a new service. The study was conducted alongside implementation of this new service. An exploratory case study approach was adopted to generate an in-depth understanding of the roles of nurses and social workers. In total, 22 semi-structured interviews and one focus group across the first year of implementing the new service were undertaken. Analysis of these data revealed four major themes. Findings presented in this article will inform further reflection and consideration into the future interprofessional workforce priorities and requirements for Early Parenting Services.     

Setting a research agenda for interprofessional education and collaborative practice in the context of United States health system reform

Interprofessional education (IPE) and collaborative practice (CP) have been prolific areas of inquiry exploring research questions mostly concerned with local program and project assessment. The actual sphere of influence of this research has been limited. Often discussed separately, this article places IPE and CP in the same conceptual space. The interface of these form a nexus where new knowledge creation may be facilitated. Rigorous research on IPE in relation to CP that is relevant to and framed by health system reform in the U.S. is the ultimate research goal of the National Center for Interprofessional Practice and Education at the University of Minnesota. This paper describes the direction and scope for a focused and purposive IPECP research agenda linked to improvement in health outcomes, contextualized by health care reform in the U.S. that has provided a revitalizing energy for this area of inquiry. A research agenda articulates a focus, meaningful and robust questions, and a theory of change within which intervention outcomes are examined. Further, a research agenda identifies the practices the area of inquiry is interested in informing, and the types of study designs and analytic approaches amenable to carrying out the proposed work.     

The role of interprofessional collaboration for intimate partner violence in psychiatric care: A research and development project

In Finland, policy requirements have demanded providers to work collaboratively together with regard to intimate partner violence (IPV). This research and development project seeks to identify efficient tools for stopping IPV. The project included staff training to recognize and respond to IPV, the development of a research-based guideline for use in the care situations of victims and perpetrators and the integration of the guideline into practices and staff development. Networking was developed during the project through interprofessional and multiagency collaboration, whereas appraisal information was collected at different stages of the process. This paper focuses on the issues of interprofessional collaboration, and uses psychiatric care as an example. There is some evidence that interprofessional interventions reduce the cost of patient care and improve the quality of IPV services. That is why it is important to discuss these issues and solve possible problems arising in interprofessional patient care.     

Leveraging a faculty fellowship programme to develop leaders in interprofessional education

This article reports findings from an interprofessional education (IPE) study of a longitudinal faculty fellowship that aimed to develop IPE leaders at an academic institution based in the United States. Eight applicants were competitively selected to participate in an IPE track of the fellowship, alongside 14 faculty members who entered through a separate selection process. One year after graduation, a survey of the IPE fellows was undertaken to evaluate programme outcomes using open-ended questions based on an adaptation of Kirkpatrick’s four-level training evaluation model. Results indicated that respondents valued participating in a longitudinal programme where they could learn about and practice teaching and leadership skills and conduct education scholarship. While learning on an interprofessional basis, the fellows reported establishing relationships that endured after graduation. This report suggests that adding IPE activities to existing faculty fellowship programmes can be an effective means of building faculty capacity to advance institutional IPE initiatives.     

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.     

Partnership to promote interprofessional education and practice for population and public health informatics: A case study

Abstract

Team-based healthcare delivery models, which emphasize care coordination, patient engagement, and utilization of health information technology, are emerging. To achieve these models, expertise in interprofessional education, collaborative practice across professions, and informatics is essential. This case study from informatics programs in the Academic Health Center (AHC) at the University of Minnesota and the Office of Health Information Technology (OHIT) at the Minnesota Department of Health presents an academic–practice partnership, which focuses on both interprofessionalism and informatics. Outcomes include the Minnesota Framework for Interprofessional Biomedical Health Informatics, comprising collaborative curriculum development, teaching and research, practicums to promote competencies, service to advance biomedical health informatics, and collaborative environments to facilitate a learning health system. Details on these Framework categories are presented. Partnership success is due to interprofessional connections created with emphasis on informatics and to committed leadership across partners. A limitation of this collaboration is the need for formal agreements outlining resources and roles, which are vital for sustainability. This partnership addresses a recommendation on the future of interprofessionalism: that both education and practice sectors be attuned to each other’s expectations and evolving trends. Success strategies and lessons learned from collaborations, such as that of the AHC-OHIT that promote both interprofessionalism and informatics, need to be shared.     

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.     

A strategic initiative to foster interprofessional collaboration: A case report using a men’s healthy living programme

Interprofessional collaboration (IPC) can be challenging, yet it has shown benefits for providers and patients. We examined the existing enablers and barriers to IPC at a local Community Health Center (CHC) and report on the existing types of IPC practice. We also report how implementing a men-sensitive healthy living programme united a team of health professionals/managers in attending to the needs of a population that to date had been largely underserved. A total of 16 employees were interviewed at the CHC. All respondents spoke positively of existing IPC and provided examples of existing collaborative practices. These CHC professionals (clinicians and managers) experienced greater intra- and extra-organisational collaborations as a result of experiencing a community-delivered programme. It also allowed the CHC professionals/managers to rethink the management and structure of collaborative practices and understand the needs and challenges of working with non-traditional partners (men and workplace-based managers). While our findings are context sensitive (case study design), they shed light on how uniting health professionals/managers around a challenging and non-traditional health issue (i.e., improving health in a hard-to-reach population subgroup) can strategically reduce resistance to collaborative practice development by strengthening team cohesion and fostering innovative interactions.