Online interprofessional education facilitation: A scoping review

Introduction: The use of online media to deliver interprofessional education (IPE) is becoming more prevalent across health professions education settings. Facilitation of IPE activities is known to be critical to the effective delivery of IPE, however, specifics about the nature of online IPE facilitation remains unclear.

Aim: To explore the health professions education literature to understand the extent, range and nature of research on online IPE facilitation.

Methods: Scoping review methodology was used to guide a search of four electronic databases for relevant papers. Of the 2095 abstracts initially identified, after screening of both abstracts and full-text papers, 10 studies were selected for inclusion in this review. Following abstraction of key information from each study, a thematic analysis was undertaken.

Results: Three key themes emerged to describe the nature of the IPE facilitation literature: (1) types of online IPE facilitation contributions, (2) the experience of online IPE facilitation and (3) personal outcomes of online IPE facilitation. These IPE facilitation themes were particularly focused on facilitation of interprofessional student teams on an asynchronous basis.

Discussion: While the included studies provide some insight into the nature of online IPE facilitation, future research is needed to better understand facilitator contributions, and the facilitation experience and associated outcomes, both relating to synchronous and asynchronous online environments.     

Integrating an interprofessional education initiative: Evidence from King Abdulaziz University

Abstract

Purpose: This paper examines current issues with interprofessional education (IPE) at King Abdulaziz University (KAU) and discusses initiatives for integrating IPE into the medical curricula at KAU.

Methods: We reviewed the current body of literature, studied reports from IPE conferences and workshops organized at KAU, and synthesized participants' feedback from the IPE programs, including an online survey.

Results: A total of 506 participants responded to the online survey. Respondents rated Interprofessional Collaborative Learning as the highest category of IPE, followed by Interprofessional Self-Improvement and Interprofessional Relationship. A hybrid conceptual framework is proposed, to tackle the issue of role clarification across all healthcare colleges at KAU. This proposition was found to be necessary due to the current state of the undergraduate curriculum which does not prepare students properly for professional collaboration.

Conclusions: The hybrid model may narrow the gap in IPE by emphasizing professional identity while reducing autonomy. Recommendations toward IPE are presented. Challenges toward IPE reform are discussed in the context of implementation at KAU and at other medical schools in the region.     

Theoretical insights into interprofessional education

This article argues for the need for theory in the practice of interprofessional education. It highlights the range of theories available to interprofessional educators and promotes the practical application of these to interprofessional learning and teaching. It summarises the AMEE Guides in Medical Education publication entitled Theoretical Insights into Interprofessional Education: AMEE Guide No. 62, where the practical application of three theories, social capital, social constructivism and a sociological perspective of interprofessional education are discussed in-depth through the lens of a case study. The key conclusions of these discussions are presented in this article.     

A best evidence systematic review of interprofessional education: BEME Guide no. 9

BACKGROUND AND REVIEW CONTEXT: Evidence to support the proposition that learning together will help practitioners and agencies work better together remains limited and thinly spread. This review identified, collated, analysed and synthesised the best available contemporary evidence from 21 of the strongest evaluations of IPE to inform the above proposition. In this way we sought to help shape future interprofessional education and maximize the potential for interprofessional learning to contribute to collaborative practice and better care. OBJECTIVES OF THE REVIEW: To identify and review the strongest evaluations of IPE. To classify the outcomes of IPE and note the influence of context on particular outcomes. To develop a narrative about the mechanisms that underpin and inform positive and negative outcomes of IPE. SEARCH STRATEGY: Bibliographic database searches as follows: Medline 1966-2003, CINAHL 1982-2001, BEI 1964-2001, ASSIA 1990-2003 which produced 10,495 abstracts. Subsequently, 884 full papers were obtained and scrutinized. In addition, hand searching (2003-5 issues) of 21 journals known to have published two or more higher quality studies from a previous review. TOPIC DEFINITION AND INCLUSION CRITERIA: Peer-reviewed papers and reports included in the review had to be formal educational initiatives attended by at least two of the many professional groups from health and social care, with the objective of improving care; and learning with, from and about each other. DATA COLLECTION, ANALYSIS AND SYNTHESIS: Standard systematic review procedures were applied for sifting abstracts, scrutinizing full papers and abstracting data. Two members of the team checked each abstract to decide whether the full paper should be read. A third member was consulted over any discrepancies. Similarly, each full paper was read by at least two members of the team and agreement sought before passing it to one member of the team (SR) for data abstraction. Other members of the team checked 10% of the abstraction records. Coding into a Statistical Package for Social Scientists (SPSS) data base led to collection of different outcome measures used in the primary studies via the common metric of an adapted Kirkpatrick's four-level model of educational outcomes. Additionally, a narrative synthesis was built after analysis of primary data with the 3-P model (presage-process-product) of education development and delivery. HEADLINE RESULTS: Government calls for enhanced collaboration amongst practitioners frequently leads to IPE that is then developed and delivered by educators, practitioners or service managers. Staff development is a key influence on the effectiveness of IPE for learners who all have unique values about themselves and others. Authenticity and customization of IPE are important mechanisms for positive outcomes of IPE. Interprofessional education is generally well received, enabling knowledge and skills necessary for collaborative working to be learnt; it is less able to positively influence attitudes and perceptions towards others in the service delivery team. In the context of quality improvement initiatives interprofessional education is frequently used as a mechanism to enhance the development of practice and improvement of services.     

LectureKeepr: A novel approach to studying in the adaptive curriculum

Abstract

As medical students search for ways to squeeze more hours of learning into their day, many have turned to technology for quick and efficient ways to study. Most commonly this includes based apps for purchase that involve visual tasks, mental review and repetition. Tasks involve flashcard creation, answering multiple choice questions (MCQs) and schedule planning. They typically require students to visually interact with a computer or smartphone screen. Alternatively, auditory apps may not only offer the benefit of enhanced learning through review and repetition, but also address convenience, portability, and metacognitive development without physical and temporal requirements of visual presentation. Auditory learning is eyes and “hands-free” allowing the learner to contiguously engage in other activities such as physical exercise, traveling, eating, etc. In this randomized, case-comparison study, half of the students were exposed to audio lecture content before class using a mobile application called LectureKeepr (LK) and half were exposed to lecture content before class via written material prepared by the professor. Pre- and post-MCQ quizzes were used to measure differences between groups in knowledge improvement. In addition, student perceptions of the auditory learning experience were assessed by an on-line survey. ANOVA with repeated measures revealed that students in the LK intervention group performed better on the postquiz than the students in the written materials group.     

Theoretical insights into interprofessional education: AMEE Guide No. 62

In this Guide, we support the need for theory in the practice of interprofessional education and highlight a range of theories that can be applied to interprofessional education. We specifically discuss the application of theories that support the social dimensions of interprofessional learning and teaching, choosing by way of illustration the theory of social capital, adult learning theory and a sociological perspective of interprofessional education. We introduce some of the key ideas behind each theory and then apply these to a case study about the development and delivery of interprofessional education for pre-registration healthcare sciences students. We suggest a model that assists with the management of the numerous theories potentially available to the interprofessional educator. In this model, context is central and a range of dimensions are presented for the reader to decide which, when, why and how to use a theory. We also present some practical guidelines of how theories may be translated into tangible curriculum opportunities. Using social capital theory, we show how theory can be used to defend and present the benefits of learning in an interprofessional group. We also show how this theory can guide thinking as to how interprofessional learning networks can best be constructed to achieve these benefits. Using adult learning theories, we explore the rationale and importance of problem solving, facilitation and scaffolding in the design of interprofessional curricula. Finally, from a sociological perspective, using Bernstein's concepts of regions and terrains, we explore the concepts of socialisation as a means of understanding the resistance to interprofessional education sometimes experienced by curriculum developers. We advocate for new, parallel ways of viewing professional knowledge and the development of an interprofessional knowledge terrain that is understood and is contributed to by all practitioners and, importantly, is centred on the needs of the patient or client. Through practical application of theory, we anticipate that our readers will be able to reflect and inform their current habitual practices and develop new and innovative ways of perceiving and developing their interprofessional education practice.     

Using a meta-ethnographic approach to explore the nature of facilitation and teaching approaches employed in interprofessional education

Background: Interprofessional facilitators and teachers are regarded as central to the effective delivery of interprofessional education (IPE). As the IPE literature continues to expand, most studies have focused on reporting learner outcomes, with little attention paid to IPE facilitation. However, a number of studies have recently emerged reporting on this phenomenon.

Aim: To present a synthesis of qualitative evidence on the facilitation of IPE, using a meta-ethnographic approach.

Methods: Electronic databases and journals were searched for the past 10 years. Of the 2164 abstracts initially found, 94 full papers were reviewed and subsequently 12 papers were included. Teams of two reviewers independently completed each step in the review process. The quality of these papers was assessed using a modified critical appraisal checklist.

Results: Seven key concepts embedded in the included studies were synthesized into three main factors which provided an insight into the nature of IPE facilitation. Specifically, the synthesis found that IPE facilitation is influenced by “contextual characteristics”; “facilitator experiences”; and the “use of different facilitation strategies”.

Conclusions: IPE facilitation is a complex activity affected by contextual, experiential and pedagogical factors. Further research is needed to explore the effects of these factors on the delivery of IPE.     

A BEME systematic review of the effects of interprofessional education: BEME Guide No. 39

Background: Interprofessional education (IPE) aims to bring together different professionals to learn with, from, and about one another in order to collaborate more effectively in the delivery of safe, high-quality care for patients/clients. Given its potential for improving collaboration and care delivery, there have been repeated calls for the wider-scale implementation of IPE across education and clinical settings. Increasingly, a range of IPE initiatives are being implemented and evaluated which are adding to the growth of evidence for this form of education.

Aim: The overall aim of this review is to update a previous BEME review published in 2007. In doing so, this update sought to synthesize the evolving nature of the IPE evidence.

Methods: Medline, CINAHL, BEI, and ASSIA were searched from May 2005 to June 2014. Also, journal hand searches were undertaken. All potential abstracts and papers were screened by pairs of reviewers to determine inclusion. All included papers were assessed for methodological quality and those deemed as “high quality” were included. The presage–process–product (3P) model and a modified Kirkpatrick model were employed to analyze and synthesize the included studies.

Results: Twenty-five new IPE studies were included in this update. These studies were added to the 21 studies from the previous review to form a complete data set of 46 high-quality IPE studies. In relation to the 3P model, overall the updated review found that most of the presage and process factors identified from the previous review were further supported in the newer studies. In regard to the products (outcomes) reported, the results from this review continue to show far more positive than neutral or mixed outcomes reported in the included studies. Based on the modified Kirkpatrick model, the included studies suggest that learners respond well to IPE, their attitudes and perceptions of one another improve, and they report increases in collaborative knowledge and skills. There is more limited, but growing, evidence related to changes in behavior, organizational practice, and benefits to patients/clients.

Conclusions: This updated review found that key context (presage) and process factors reported in the previous review continue to have resonance on the delivery of IPE. In addition, the newer studies have provided further evidence for the effects on IPE related to a number of different outcomes. Based on these conclusions, a series of key implications for the development of IPE are offered.     

Student voices on an interprofessional course

Investigations of outcomes of interprofessional education as a component of the basic preparation of health and human service professionals have lacked a strong focus on student perceptions, the student voice. This qualitative study examined students' insights regarding the interprofessional component of an elective course offered to 23 students; five from medicine and six from each of pharmaceutical sciences, nursing and social work. Fourteen students participated in focus group interviews at the conclusion of the course and 12 participated in telephone interviews six months later. The interviews explored perceptions regarding learning, including insights about the effectiveness of teaching-learning strategies, and improvements required. Experiential components of the course were more meaningful to students than theoretical components. Students perceived the use of practice-based learning, student interprofessional teams, and interprofessional collaboration in the classroom as particularly effective. The course contributed to students' development of their own professional voices and their understanding of those of other professions. Additional interpretive studies of students' experiences and those of faculty and professionals in practice are needed, particularly regarding strategies for increasing the effectiveness of experiential learning.     

An exploration of teaching presence in online interprofessional education facilitation

Background: Although the prevalence of online asynchronous interprofessional education (IPE) has increased in the last decade, little is known about the processes of facilitation in this environment. The teaching presence element of the Community of Inquiry Framework offers an approach to analyze the contributions of online facilitators, however, to date it has only been used on a limited basis in health professions education literature.

Aim: Using an exploratory case study design, we explored the types of contributions made by IPE facilitators to asynchronous interprofessional team discussions by applying the notion of teaching presence.

Methods: Using a purposeful sampling approach, we analyzed 14 facilitators’ contributions to asynchronous team discussion boards in an online IPE course. We analyzed data using directed content analysis based on the key indicators of teaching presence.

Results: The online IPE facilitators undertook the three critical pedagogical functions identified in teaching presence: facilitating discourse, direct instruction, and instructional design and organization. While our data fitted well with a number of key activities embedded in these three functions, further modification of the teaching presence concept was needed to describe our facilitators’ teaching presence.

Conclusions: This study provides an initial insight into the key elements of online asynchronous IPE facilitation. Further research is required to continue to illuminate the complexity of online asynchronous IPE facilitation.     

A blueprint for interprofessional learning

Interprofessional education (IPE) has been promoted as a method to enhance the ability of health professionals to learn to work together. This article examines several approaches to learning that can help IPE fulfill its expectations. The first is aimed at the transfer of learning novel situations and involves two ideas. Students need to be challenged with progressively more complex tasks and those tasks need to reflect the reality in which they will be working. Second, the learning situation needs to be structured using the five elements of best-practice cooperative learning: positive interdependence, face-to-face promotive interaction, individual accountability, interpersonal and small-group skills, and group processing. Finally, the learning process itself needs to be approached from an experiential learning framework cycling through the four-stage model of planning, doing, observing and reflecting. By using increasingly complex and relevant cases in cooperative groups with an experiential learning process interprofessional education can be successful.     

Breaking bad news: qualitative evaluation of an interprofessional learning opportunity

This paper analyses the effects of bringing together a small group of nursing and medical students to learn the skills needed to break bad news to patients. It outlines the qualitative and quantitative methods used, to provide the reader with a comprehensive account of the teaching, learning and research strategies drawn on during the study. The paper examines the evaluation phase, as this aspect is of greatest import if such initiatives are to flourish. The facet of the study analysed in detail concerns the students' responses to the open-ended qualitative questionnaires. In coding the data, three researchers independently highlighted a series of themes associated with the benefits and hazards of nursing and medical students learning and working together. Finally, the paper closes by arguing that trust and mutual respect are vital ingredients if collaborative working is to become part of the medical and nursing curriculum.