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

An overview of continuing interprofessional education

Interprofessional education, continuing interprofessional education, interprofessional collaboration, and interprofessional care are moving to the forefront of approaches with the potential to reorganize the delivery of health professions education and health care practice. This article discusses 7 key trends in the scholarship and practice of interprofessional education: conceptual clarity, quality, safety, technology, assessment of learning, faculty development, and theory.

Multidisciplinary obstetric simulated emergency scenarios (MOSES): promoting patient safety in obstetrics with teamwork-focused interprofessional simulations

INTRODUCTION

We describe an example of simulation-based interprofessional continuing education, the multidisciplinary obstetric simulated emergency scenarios (MOSES) course, which was designed to enhance nontechnical skills among obstetric teams and, hence, improve patient safety. Participants' perceptions of MOSES courses, their learning, and the transfer of learning to clinical practice were examined.

METHODS

Participants included senior midwives, obstetricians, and obstetric anesthetists, including course faculty from 4 purposively selected delivery suites in England. Telephone or e-mail interviews with MOSES course participants and facilitators were conducted, and video-recorded debriefings that formed integral parts of this 1-day course were analyzed.

RESULTS

The team training was well received. Participants were able to check out assumptions and expectations of others and develop respect for different roles within the delivery suite (DS) team. Skillful facilitation of debriefing after each scenario was central to learning. Participants reported acquiring new knowledge or insights, particularly concerning the role of communication and leadership in crisis situations, and they rehearsed unfamiliar skills. Observing peers working in the simulations increased participants' learning by highlighting alternative strategies. The learning achieved by individuals and groups was noticeably dependent on their starting points. Some participants identified limited changes in their behavior in the workplace following the MOSES course. Mechanisms to manage the transfer of learning to the wider team were weakly developed, although 2 DS teams made changes to their regular update training.

DISCUSSION

Interprofessional, team-based simulations promote new learning.

Learning in interprofessional teams: AMEE Guide no 38

This guide is for health and social care professionals who teach or guide others' learning before and after qualification, in formal courses or the workplace. It clarifies the understanding of interprofessional learning and explores the concept of teams and team working. Illustrated by examples from practice, the practicalities of effective interprofessional learning are described, and the underlying concepts of patient-centred care, excellent communication, development of capacity and clarity of roles that underpin this explored.

Theories to aid understanding and implementation of interprofessional education

Multiple events are calling for greater interprofessional collaboration and communication, including initiatives aimed at enhancing patient safety and preventing medical errors. Education is 1 way to increase collaboration and communication, and is an explicit goal of interprofessional education (IPE). Yet health professionals to date are largely educated in isolation. IPE differs from most traditional continuing education in that knowledge is largely socially created through interactions with others and involves unique collaborative skills and attitudes. It requires thinking differently about what constitutes teaching and learning. The article draws upon a small number of social and learning theories to explain the rationale for IPE needing a new way of thinking, and proposes approaches to guide development and implementation of IP continuing education. Social psychology and complexity theory explain the influence of the dynamism and interaction of internal (cognitive) and external (environmental) factors upon learning and set the stage for IPE. Theories related to professionalism and stereotyping, communities of practice, reflective learning, and transformative learning appear central to IPE and guide specific educational interventions. In sum, IPE requires CE to adopt new content, recognize new knowledge, and use new approaches for learning; we are now in a different place.

Interprofessional education: Does it deliver on the claims?

Within the last 20 years the terms interprofessional working and collaborative care have become embedded within health-care vocabulary. The modern health-care student, while being socialized into their chosen profession, is constantly primed for team-working and interprofessional practice. Health policies (Department of Health, 2000) and reports (Laming, 2003; World Health Organization, 2006) have driven forward the concept that collaborative interprofessional care is the most effective way of meeting patients' needs and it is now widely accepted that a collaborative approach ensures both patient safety and the quality of care (Nisbet et al, 2008).

The effectiveness of self-assessment on the identification of learner needs, learner activity, and impact on clinical practice: BEME Guide no. 10

BACKGROUND

Health professionals are increasingly expected to identify their own learning needs through a process of ongoing self-assessment. Self-assessment is integral to many appraisal systems and has been espoused as an important aspect of personal professional behaviour by several regulatory bodies and those developing learning outcomes for clinical students. In this review we considered the evidence base on self-assessment since Gordon's comprehensive review in 1991. The overall aim of the present review was to determine whether specific methods of self-assessment lead to change in learning behaviour or clinical practice. Specific objectives sought evidence for effectiveness of self-assessment interventions to: a. improve perception of learning needs; b. promote change in learning activity; c. improve clinical practice; d. improve patient outcomes.

METHODS

The methods for this review were developed and refined in a series of workshops with input from an expert BEME systematic reviewer, and followed BEME guidance. Databases searched included Medline, CINAHL, BNI, Embase, EBM Collection, Psychlit, HMIC, ERIC, BEI, TIMElit and RDRB. Papers addressing self-assessment in all professions in clinical practice were included, covering under- and post-graduate education, with outcomes classified using an extended version of Kirkpatrick's hierarchy. In addition we included outcome measures of accuracy of self-assessment and factors influencing it. 5,798 papers were retrieved, 194 abstracts were identified as potentially relevant and 103 papers coded independently by pairs using an electronic coding sheet adapted from the standard BEME form. This total included 12 papers identified by hand-searches, grey literature, cited references and updating. The identification of a further 12 papers during the writing-up process resulted in a total of 77 papers for final analysis.

RESULTS

Although a large number of papers resulted from our original search only a small proportion of these were of sufficient academic rigour to be included in our review. The majority of these focused on judging the accuracy of self-assessment against some external standard, which raises questions about assumed reliability and validity of this 'gold standard'. No papers were found which satisfied Kirkpatrick's hierarchy above level 2, or which looked at the association between self-assessment and resulting changes in either clinical practice or patient outcomes. Thus our review was largely unable to answer the specific research questions and provide a solid evidence base for effective self-assessment. Despite this, there was some evidence that the accuracy of self-assessment can be enhanced by feedback, particularly video and verbal, and by providing explicit assessment criteria and benchmarking guidance. There was also some evidence that the least competent are also the least able to self-assess accurately. Our review recommends that these areas merit future systematic research to further our understanding of self-assessment.

CONCLUSION

As in other BEME reviews, the methodological issues emerging from this review indicate a need for more rigorous study designs. In addition, it highlights the need to consider the potential for combining qualitative and quantitative data to further our understanding of how self-assessment can improve learning and professional clinical practice.