Trying on the professional self: nursing students' perceptions of learning about roles, identity and teamwork in an interprofessional clinical placement

Exploring the "led" in health professional student-led experiences: a scoping review

To support a complex health system, students are expected to be competent leaders as well as competent clinicians. Intentional student leadership development is needed in health professional education programs. Student-led experiences such as student-run clinics and interprofessional training wards, are practice-based learning opportunities where learners provide leadership to clinical services and/or address a gap in the system. Given the absence of leadership definitions and concepts, this scoping review explored how student leadership is conceptualized and developed in student-led experiences. The review was conducted in accordance with best practices in scoping review methodology within the scope of relevant practice-based student-led experiences for health professional students. The research team screened 4659 abstracts, identified 315 articles for full-text review and selected 75 articles for data extraction and analysis. A thematic analysis produced themes related to leadership concepts/theories/models, objectives, facilitation/supervision, assessment and evaluation of curriculum. While responding to system gaps within health professional care, student-led experiences need to align explicit leadership theory/concepts/models with curricular objectives, pedagogy, and assessments to support health professional education. To support future student-led experiences, authors mapped five leadership student role profiles that were associated with student-led models and could be constructively aligned with theory and concepts. In addition to leveraging a student workforce to address system needs, student-led experiences must also be a force for learning through a reciprocal model of leadership and service to develop future health professionals and leaders.

Development of individual competencies and team performance in interprofessional ward rounds: results of a study with multimodal observations at the Heidelberg Interprofessional Training Ward

Introduction

Interprofessional training wards (IPTW) aim to improve undergraduates' interprofessional collaborative practice of care. Little is known about the effects of the different team tasks on IPTW as measured by external assessment. In Heidelberg, Germany, four nursing and four medical undergraduates (= one cohort) care for up to six patients undergoing general surgery during a four-week placement. They learn both professionally and interprofessionally, working largely on their own responsibility under the supervision of the medical and nursing learning facilitators. Interprofessional ward rounds are a central component of developing individual competencies and team performance. The aim of this study was to evaluate individual competencies and team performance shown in ward rounds.

Methods

Observations took place in four cohorts of four nursing and four medical undergraduates each. Undergraduates in one cohort were divided into two teams, which rotated in morning and afternoon shifts. Team 1 was on morning shift during the first (t0) and third (t1) weeks of the IPTW placement, and Team 2 was on morning shift during the second (t0) and fourth (t1) weeks. Within each team, a tandem of one nursing and one medical undergraduate cared for a patient room with three patients. Ward round observations took place with each team and tandem at t0 and t1 using the IP-VITA instrument for individual competencies (16 items) and team performance (11 items). Four hypotheses were formulated for statistical testing with linear mixed models and correlations.

Results

A total of 16 nursing and medical undergraduates each were included. There were significant changes in mean values between t0 and t1 in individual competencies (Hypothesis 1). They were statistically significant for all three sum scores: "Roles and Responsibilities", Patient-Centeredness", and "Leadership". In terms of team performance (Hypothesis 2), there was a statistically significant change in mean values in the sum score "Roles and Responsibilities" and positive trends in the sum scores "Patient-Centeredness" and "Decision-Making/Collaborative Clinical Reasoning". Analysis of differences in the development of individual competencies in the groups of nursing and medical undergraduates (Hypothesis 3) showed more significant differences in the mean values of the two groups in t0 than in t1. There were significant correlations between individual competencies and team performance at both t0 and t1 (Hypothesis 4).

Discussion

The study has limitations due to the small sample and some sources of bias related to the external assessment by means of observation. Nevertheless, this study offers insights into interprofessional tasks on the IPTW from an external assessment. Results from quantitative and qualitative analysis of learners self-assessment are confirmed in terms of roles and responsibilities and patient-centeredness. It has been observed that medical undergraduates acquired and applied skills in collaborative clinic reasoning and decision-making, whereas nursing undergraduates acquired leadership skills. Within the study sample, only a small group of tandems remained constant over time. In team performance, the group of constant tandems tended to perform better than the group of random tandems. The aim of IPTW should be to prepare healthcare team members for the challenge of changing teams. Therefore, implications for IPTW implementation could be to develop learning support approaches that allow medical and nursing undergraduates to bring interprofessional competencies to team performance, independent of the tandem partner or team.

[Measuring individual competencies and team performance in clinical learning settings of interprofessional collaborative practice: Empirical development of the Interprofessional Ward Round Individual and Team Assessment Tool (IP-VITA)]

BACKGROUND

Interprofessional training wards (IPTW) can contribute to the development of interprofessional competencies. In order to evaluate the acquisition of competencies, instruments are needed that record both team performance and individual competencies in the clinical teaching setting in third-party assessment. This paper describes the Interprofessional Ward Round Individual and Team Assessment-Tool, IP-VITA ("Interprofessionelle Visiten Individual und Team Assessment Tool") and its development.

METHOD

Based on the empirical exploration of the three observation instruments "Teamwork Assessment Scale" (TAS), "McMaster-Ottawa Scale" and "Individual Teamwork Observation and Feedback Tool" (iTOFT) in at least four rounds each at the HIPSTA (with n=8 students and trainees each), a preliminary version of the IP-VITA was created. This preliminary version was then refined in subsequent empirical steps: a consensual validation in the research team was followed by a "member check" with the clinical colleagues of the HIPSTA, the input from external experts and an empirical test in an alternative setting.

RESULTS

The IP-VITA is an empirically developed multimodal instrument to assess the interprofessional competencies of trainees and students as well as their team performance in clinical settings with patient interaction. It comprises three parts. In part A, structural data, the persons involved and the essential patient characteristics are recorded. Part B consists of 12 items and a free-text field for recording behaviour at the individual level. Part C also consists of 12 items and evaluates behaviour at team level.

DISCUSSION

The IP-VITA instrument was developed specifically for the context of evaluating interprofessional ward rounds in a clinical educational setting. The instrument takes into account the ambiguous position of the assessment of interprofessional collaboration between individual competence and team performance. Beyond the HIPSTA, it can be used as a formative assessment instrument, and it may also be useful for summative assessments.

["That One Can See How it is Supposed to be." Conception, Piloting and Evaluation of an Interprofessional Rehabilitation-Related Module for the Training Courses in Medicine, Nursing, and Physiotherapy]

BACKGROUND

Considering the growing rehabilitative care requirements, good interprofessional cooperation is of central relevance for health care professions and is increasingly demanded. Interprofessional cooperation does not yet play a significant role in health professions' education, despite the fact that it is considered an important element of success in outcome- and patient-centered health care. The field of rehabilitation lacks interprofessional teaching concepts and material.

METHODS

An interprofessional team of instructors developed the didactic and thematic concept for the module. The module focuses on rehabilitation and discharge management. The learning objectives were developed based on the National Competency-Based Catalogue of Learning Objectives for Medicine. The formative evaluation was based on a questionnaire filled out by the students and the learning guides.

RESULTS

47 participants took part in three runs. The results of the formative evaluation demonstrate that the module was overall well received. The trainees rated the module more favorably than the medical students. While participants emphasized the good practical eye-to-eye interaction between the professions and the honest feedback conversation, they also pointed to the contrast they perceived to their everyday practice. They also wished for more time having verbal interprofessional exchange. The medical students criticized that interprofessional modules were only offered in their final year.

CONCLUSION

To the author's knowledge, this is the first publication of an interprofessional module on rehabilitation and discharge management including piloting and positive evaluation for the three professional groups of medicine, nursing and physical therapy. Improvement suggestions of the participants led to modifications that will be realized in the next version of the module. The course sets important impulses for the further development of interprofessional cooperation and the teaching of rehabilitation-related skills. The modular package is available to other lecturers in a free online platform for rehabilitation-related teaching materials.

The impact of university-based education on nursing professional identity: a qualitative examination of students' experiences

OBJECTIVES

To examine graduate students' perceptions of their nursing professional identity within the university-based educational system.

METHODS

A qualitative phenomenological approach was adopted involving the completion of in-depth interviews and focus groups among master's degree students in Morocco.

RESULTS

The shift to university-based nursing education system was associated with the development of a positive self-image, sense of empowerment, and attachment to professional values in addition to role extension and involvement in research.

CONCLUSIONS

The perceived external barriers such as negative social image, role ambiguity, and unsupportive work environments, limit the reach of the positive influence of the educational shift and may lead to doubts in integrating the clinical workspace.

Evaluation of interprofessional student teams in the emergency department: opportunities and challenges

BACKGROUND

Interprofessional education opportunities are commonly university-based and require further development during clinical practice. Many clinical contexts offer the potential for meaningful learning of both collaborative and discipline-specific practice. The emergency department (ED) demands efficient teamwork, so presents a logical location for interprofessional learning.

METHODS

An interprofessional clinical placement program was implemented with the aim to enhance students' capacity and self-efficacy for collaborative practice. Fifty-five medical and nursing students participated as interdisciplinary pairs in a two-week clinical placement in the ED. Students' perceptions of the learning environment were measured pre- and post-placement with the Self-efficacy for Interprofessional Experiential Learning Scale and the Interprofessional Clinical Placement Learning Inventory was completed post-placement. Non-parametric tests were used to establish change differences.

RESULTS

The Placement Learning Inventory revealed positive outcomes; the majority (16/19) agreed/agreed strongly that the placement provided sufficient learning opportunities, was interesting, and made them feel as if they belonged and most (14/19) reported they achieved the discipline specific learning objectives set by the university. Self-efficacy improved significantly (p = 0.017), showing promise for future use of the placement model Challenges were identified in the organisation and supervision of students. In the absence of additional dedicated student supervision, this model of interprofessional student pairs in the ED was challenging.

CONCLUSIONS

Interprofessional clinical placements in ED are an effective clinical learning approach for final year undergraduate medicine and nursing students. Recommendations for improvements for students' clinical supervision are proposed for the placement model.

[Interprofessional socialization and collaboration on an interprofessional training ward - a reconstructive analysis]

Interprofessional education has gained relevance in German-speaking countries, and interprofessional training wards (IPTW) can contribute to the acquisition of interprofessional competencies and thereby improve interprofessional collaborative practice and patient care. Professional socialization and identity development have proven to be critical for future clinical practice in addition to competency development. According to Khalili (2013) socialization through interprofessional education can result in a dual identity, i. e., a sense of belonging to one's own profession as well as to the interprofessional health care team. The aim of this study was to analyse to which extent interprofessional socialization takes place on the Interprofessional Training Ward in Heidelberg (HIPSTA) and how medical students in their practical year and nursing trainees in their third year of training experience their placement there. For this purpose, five semi-structured group discussions were conducted with undergraduates at the end of their placement on HIPSTA and analysed using the documentary method. Typification resulted in two types that differ with regard to interprofessional socialization. The type interprofessional responsiblepersons is characterized by the joint assumption of responsibility for patient care, open communication with each other and joint structuring of collaboration, which contributed to a removal of barriers and interprofessional role learning; the type interprofessional learners is characterized by their focus on learning processes and their anticipation of barriers between the professional groups, which would be relevant for future collaboration. All groups experienced a sense of belonging to their peer-student/learner group, regardless of their different professional background. Their professional identity underwent further development. These results show that placement on an IPTW does not warrant interprofessional socialization processes and the development of a dual identity. However, it can be a first step in the right direction.

Gaining interprofessional knowledge and interprofessional competence on a training ward

BACKGROUND

Since 2017, interprofessional training wards have been established in Germany. On these wards, different health professions collaboratively provide patient care supervised by facilitators from the background. We investigated the gains in interprofessional knowledge and interprofessional competence reported after the mandatory placements on Mannheim's Interprofessional Training Ward MIA. We also compared these levels of knowledge and competence at the end of the placement with control groups.

METHODS

In a quasi-randomized controlled study, we used a questionnaire to collect self-reported data on the interprofessional learning outcome. We used t-tests to compare (a) pretest and posttest data in the experimental group and (b) the levels of interprofessional knowledge and competence between the experimental and control groups.

RESULTS

The results confirmed that the MIA participants perceived a significant increase in interprofessional knowledge and competence during the placement on the training ward. MIA participants also reported significantly higher levels of interprofessional knowledge and competence than the control groups.

CONCLUSIONS

Placements on an interprofessional training ward make it possible to experience and practise interprofessional collaboration in real patient care. They help to prepare all future health professionals to assume their professional role in an interprofessional team to provide the best possible patient care.

Pedagogical practices that influence professional identity formation in baccalaureate nursing education: A scoping review

OBJECTIVES

The purpose of this review was to identify pedagogical practices that contribute to professional identity formation in undergraduate nursing education and to map the components of professional identity described within these practices.

DESIGN

A scoping review using a six-stage methodological framework was used to capture a range of evidence describing how professional identity has been conceptualized and integrated into nursing curriculum.

DATA SOURCES

Databases searched included: Ovid MEDLINE: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE® Daily and Ovid MEDLINE® 1946-Present, EBSCO CINAHL (1981 to present), OVID PsycINFO (1806 to Present), ProQuest ERIC, ASSIA, and Sociological Abstracts. Additional studies were identified by scanning the reference lists of relevant articles.

REVIEW METHODS

The study team collaboratively designed the data charting table and two coauthors independently screened the studies using Covidence software. Qualitative content analysis was used to categorize learning outcomes into five components of professional identity that were associated with pedagogical practices identified in the studies.

RESULTS

A total of 114 peer-reviewed journal articles were initially charted. Articles were categorized as intervention studies (46, 40%), perspective studies (40, 35%), theoretical papers (17, 15%), or reviews (11, 10%). To ensure feasibility in collating and reporting the results, the review focused on the 46 empirical intervention studies that described associations between pedagogical practices and professional identity formation learning outcomes for students.

CONCLUSIONS

This scoping review illustrates the range of contexts in which nursing students learn, the multidimensional nature of identity formation, as well as the breadth of pedagogical practices and learning outcomes that guide course design. The results can be used to inform future curriculum planning and to identify focused research questions to extend our understanding of evidence-based teaching practices supporting professional identity formation.

Nursing staff's and physicians' acquisition of competences and attitudes to interprofessional education and interprofessional collaboration in pediatrics

BACKGROUND

Interprofessional education (IPE) is deemed essential for interprofessional collaboration (IPC) in healthcare systems. IPC has positive effects for both patients and healthcare professionals. Especially in pediatrics, IPC is paramount for adequate care of patients and their families though there is a lack of data on the attitudes towards IPE and IPC and acquisition of respective competences in pediatric nursing and medical staff.

METHODS

Frequencies of interactions and attitudes towards IPE and IPC, with a focus on acquisition of competences for IPE and IPC, of nurses (N = 79) and physicians (N = 70) in a large pediatric university hospital were evaluated with an online questionnaire.

RESULTS

All participants worked as part of interprofessional teams, mostly consisting of nurses and physicians. The majority (94.9% (n = 75) of nurses and 100% (n = 70) of physicians) highly valued IPC. Medical doctors acquired most competences important for IPC during day-to-day work and reported a substantial lack of IPE. Nursing staff on the other hand did report significant interprofessional education during their training as well as ongoing interprofessional learning during day-to-day work. Nurses also appreciated IPE more.

CONCLUSIONS

Even though IPC is commonly reported in nurses and physicians working at a large pediatric university hospital there is a lack of structured IPE. A focus should be on IPE for nurses and physicians to enable them to effectively collaborate together. Political and local initiatives for IPE are gaining momentum but still need to be established nationally and internationally.

The influence of culture, structure, and human agency on interprofessional learning in a neurosurgical practice learning setting: a case study

The World Health Organization supports the notion that interprofessional learning (IPL) improves healthcare outcomes and contributes to safe, effective, and high-quality care. Consequently, IPL is an integral component within most UK undergraduate healthcare programs. Although much is written about IPL, research to date has mainly focused on the classroom or simulation lab as a setting for IPL. Less is known about how the practice learning environment influences the experiences and outcomes for those involved. A case study research design, situated within a critical realist framework, was undertaken which aimed to better understand how IPL was facilitated for undergraduate healthcare students within a neurosurgical practice learning setting. Interviews, non-participatory observations, and secondary documentary data were used as the methods of data collection to inform the case. Thematic analysis was undertaken, and the findings clustered into overarching themes of culture, structure, and human agency, facilitating a more in-depth exploration of the complex interplay between the factors influencing IPL in the study setting. IPL was supported within the setting which operated as an 'interprofessional community of practice,' facilitating student engagement and investing in its staff for the benefit of the patients who had complex neurological needs. A practice-based IPL Multi-Dimensional Assessment Tool was also created to enable colleagues in practice learning environments worldwide to better understand their capability and capacity for the facilitation of practice-based IPL.

Forging a new identity: a qualitative study exploring the experiences of UK-based physician associate students

OBJECTIVE

To explore student physician associates' (PAs) experiences of clinical training to ascertain the process of their occupational identity formation.

SETTING

The role of the PA is relatively new within the UK. There has been a rapid expansion in training places driven by National Health Service (NHS) workforce shortages, with the Department of Health recently announcing plans for the General Medical Council to statutorily regulate PAs. Given such recent changes and the relative newness of their role, PAs are currently establishing their occupational identity. Within adjacent fields, robust identity development improves well-being and career success. Thus, there are implications for recruitment, retention and workplace performance. This qualitative study analyses the views of student PAs to ascertain the process of PA occupational identity formation through the use of one-to-one semistructured interviews. A constructivist grounded theory approach to data analysis was taken. Research was informed by communities of practice and socialisation theory.

PARTICIPANTS

A theoretical sample of 19 PA students from two UK medical schools offering postgraduate PA studies courses.

RESULTS

A conceptual model detailing student PA identity formation is proposed. Factors facilitating identity formation include clinical exposure and continuity. Barriers to identity formation include ignorance and negativity regarding the PA role. Difficulties navigating identity formation and lacking support resulted in identity dissonance.

CONCLUSIONS

Although similarities exist between PA and medical student identity formation, unique challenges exist for student PAs. These include navigating a new role and poor access to PA role models. Given this, PA students are turning to medicine for their identity. Educators must provide support for student PA identity development in line with this work's recommendations. Such support is likely to improve the job satisfaction and retention of PAs within the UK NHS.

Nursing Students Learn to Handle Stress and to Prioritize in a Complex Context During Workplace Learning in Acute Internal Medicine Care - An Ethnographic Study

INTRODUCTION

A common focus in many studies, in the short-term perspective, is to evaluate students' workplace learning and its outcome. However, the outcome can be perceived differently depending on when it was evaluated. The aim of this study was to explore student nurses' learning activities in an acute internal medicine unit and the nurses perceived learning outcome in a long-term perspective.

MATERIAL AND METHODS

Repetitive ethnographic observations were performed in an internal medicine care unit at a teaching hospital in Sweden between 2011 and 2013. Four student nurses and supervisors were repetitively observed. Two years later retrospective interviews were performed with four nurses who had performed workplace learning, as students, in this unit during the observation period. An inductive comparative analysis involving all interviews and observational data was applied.

RESULTS

Three themes were identified: To handle shifting situations - illustrating how student nurses learnt to adapt to shifting situations, to manage stress, to create structure and space for learning and to deal with hierarchies; To build relationships - illustrating how student nurses learnt to collaborate and to interact with patients; To act independently - illustrating how student nurses trained to act independently in the unit, took responsibility, and prioritized in this complex context.

CONCLUSION

Learning activities in a complex acute medical unit setting were characterized by a high workload and frequent stressful situations, and a demand on students to interact, to take responsibility, and to prioritize. To learn in such a stressful context, have in a long-term perspective, a potential to develop students' embodied understanding of and in practice, making them more prepared to work and independently apply their nursing expertise in similar contexts as graduated nurses.

Analyzing Patients' Complaints: Awakening of the Ethic of Belonging

Nursing ethics are fundamental principles to nursing practice. The purpose of this study is to analyze patients' complaints filed against nurses from a nursing ethics perspective. This is a qualitative study. The data source is the patients' complaints filed in a university-affiliated hospital in China. The complaints are categorized into 4 themes: uncompassionate attitudes, unprofessional communication, disrespect of patient rights, and unsatisfactory quality of nursing care. The ethic of belonging reflects nurse-patient relations. Patients expect to be treated with dignity. This study sends out a call for nurse leaders and educators to reevaluate the practice and education of the nursing professional identity.

Student and clinician identities: how are identities constructed in interprofessional narratives?

CONTEXT

Although the literature on professional identity formation in medical education is increasing, it is scant by comparison on student and clinician identities within interprofessional contexts. We therefore adopt a novel discursive approach to identities to explore how soon-to-become graduates and workplace-based clinicians construct their own and others' identities in interprofessional student-clinician (IPSC) interaction narratives.

METHODS

We conducted a qualitative narrative interview study with 38 students and 23 clinicians representing the fields of medicine, midwifery, nursing, occupational therapy, paramedicine and physiotherapy. Through framework analysis, we identified the breadth of student and clinician identity constructions across 208 IPSC interaction narratives, and explored how common constructions differed by narrative and narrator. Through in-depth positioning analysis, we explored how student and clinician identities are discursively positioned within two selected IPSC interaction narratives.

RESULTS

We identified 11 common constructions of student identities and eight common constructions of clinician identities across all 208 narratives. We found differences in identity constructions across positively versus negatively evaluated narratives, and student versus clinician narrators, highlighting the rhetorical nature of narratives. Our in-depth positioning analysis of two narratives illustrates how one student and one clinician discursively positioned theirs and others' identities during interprofessional interactions, and how identities vary depending on narrators' evaluations of their stories. Although both positioning analyses illustrate how the narrators' language serves to reproduce the common societal discourse of interprofessional conflict, the clinician narrative also draws on the competing discourse of interprofessional collaboration.

CONCLUSIONS

Although some of the identities support previous uniprofessional research, our findings illustrate greater breadth and depth in terms of student and clinician identities within interprofessional contexts. We encourage educators to embed identities curricula into existing workplace learning for students and clinicians to help them make sense of their developing professional and interprofessional identities. Workplace educators should facilitate meaningful IPSC interactions to promote interprofessional learning and collaboration.

Using an Intraprofessional Global Immersion to Foster Role Formation in Nursing Students

BACKGROUND

Nursing programs are instrumental in developing the knowledge, skills, and attitudes necessary for nursing practice. Opportunities are lacking for role formation for successful transition into practice.

METHOD

An intraprofessional global clinical immersion program was utilized as the setting for students to develop their role identity. Students from each level of nursing traveled to Jamaica to participate in a clinical immersion experience. Students participated in structured collaboration among students in different programs and acted as the instrument other students utilized to develop their role. Students had the opportunity to work with each other every day, and they provided authentic feedback for each other on their role-formation process.

RESULTS

Program evaluation revealed that the immersion helped students gain confidence in their roles as they transition into practice.

CONCLUSION

Results of this evaluation support the sustainability of the structured global immersion experiences for professional role formation. [J Nurs Educ. 2019;58(5):294-297.].

A review of interprofessional training wards: Enhancing student learning and patient outcomes

Background: In an interprofessional training ward (ITW), students from different health professions collaboratively perform patient care with the goal of improving patient care. In the past two decades, ITWs have been established world-wide and studies have investigated their benefits. We aimed to compare ITWs with respect to their logistics, interprofessional learning outcomes and patient outcomes. Methods: We explored PubMed, CINAHL, Web of Science and EMBASE (1990-June 2017) and included articles focusing on interprofessional, in-patient training wards with student teams of medical and other health professions students. Two independent reviewers screened studies for eligibility and extracted data. Results: Thirty-seven articles from twelve different institutions with ITWs were included. ITWs world-wide are organized similarly with groups of 2-12 students (i.e. medical, nursing, physiotherapy, occupational therapy, and pharmacy) being involved in patient care, usually for a period of two weeks. However, the type of clinical ward and the way supervisors are trained differ. Conclusions: ITWs show promising results in short-term student learning outcomes and patient satisfaction rates. Future ITW studies should measure students' long-term interprofessional competencies using standardized tools. Furthermore, a research focus on the impact of ITWs on patient satisfaction and relevant patient care outcomes is important.

Piloting a practice model in a Norwegian nursing home- A student-managed ward: A way to empower students for the nursing role

This paper focuses on the experiences of nursing students on a student-managed ward, the purpose of which was to empower students for the nursing role. Five nursing students operated and managed a nursing home ward for eight weeks during their final year of nursing education. The students claimed that a group of five students was beneficial. However, a group of five was too large for one nurse to follow up. The students reported that they needed visible supervisors in order to develop professional nursing skills, both in terms of knowledge and practical implementation. The students argued that they became more independent through this form of organisation, since the supervisor was not constantly watching everything they did. The students felt more responsible for the daily running and follow-up of the patients because they were in charge. Peer-assistant learning was highly recommended in relation to self-esteem, and improved results and skills in the students' practice. Collaboration with some of the assistant nurses was challenging. The results indicate that this kind of clinical training can contribute to more empowerment and better preparation for the nursing role than the traditional way.

Heidelberger Interprofessionelle Ausbildungsstation (HIPSTA): a practice- and theory-guided approach to development and implementation of Germany's first interprofessional training ward

Background: Deficits in care and impaired patient-safety have been linked to inefficient interprofessional collaborative practice. Interprofessional training wards (IPTW) are an interprofessional educational intervention which aim to enable students and trainees from different health professions to work self-responsibly in order to manage the medical treatment and rehabilitation of real-life patients together as an interprofessional team. We aimed to develop and implement Germany´s first IPTW at the department of Surgery at Heidelberg University Hospital. Methods: The Kern cycle was used to develop an ITPW curriculum. Practical as well as theoretical considerations guided the design of the IPTW. Common project management tools including blueprinting and RASCI (Responsibility, Approval, Support, Consultation, Information) matrix were applied. Results: Since April 2017, 7 cohorts of students and trainees have had four-week long placements on HIPSTA. They run the IPTW in early and late shifts. Nursing and medical facilitators are supporting the IP team as needed. Learning objectives are operationalized as EPAs (entrustable professional activities) and interprofessional learning goals. Since initiation only minor modifications to the curriculum have been necessary and satisfaction of students/trainees, facilitators and patients is high. Conclusion: IPTWs can be established and run in the German health care system even in a complex clinical setting. The early involvement of all professions in a steering group seems to be key to success. Nursing and medical facilitators are of utmost importance for daily routine. The experiences outlined here could help others aiming to implement IPTWs at their sites. IPTWs might address a number of hitherto unaddressed educational needs. Trial registration: Not applicable.

Interprofessional education and collaborative practice: Psychometric analysis of the Readiness for Interprofessional Learning Scale in undergraduate Serbian healthcare student context

BACKGROUND

There is an implicit expectation for medical sciences students to work together effectively as members of health-care team, and interprofessional education is therefore widely accepted. Students' attitudes, which are affected by various factors, have been recognized as the most important predictors of successful implementation of interprofessional education with the aim of developing collaborative practice. The Readiness for Interprofessional Learning Scale has often been used in studies to measure these perspectives.

OBJECTIVES

To describe the psychometric properties of the Serbian cross-culturally adapted version of the original Readiness for Interprofessional Learning Scale, to assess the attitudes of undergraduate health science students towards interprofessional education and to evaluate whether a professional group and student characteristics have influence on attitudes towards collaborative practice and shared learning.

DESIGN

A descriptive/analytical and comparative cross-sectional study.

SETTINGS

Faculty of Medicine in Serbia.

PARTICIPANTS

Nursing and medical students after completed first clinical rotations (n = 257).

METHODS

The Readiness for Interprofessional Learning Scale for assessing attitudes among students towards interprofessional learning, Professional Identity Questionnaire for Nursing Students for assessing professional identity in nursing students, Professional Nursing Image Survey for assessing attitudes of medical students towards the nursing profession, as well as a socio-demographic questionnaire were the instruments used in this research study. The data were analysed using descriptive and inferential statistics.

RESULTS

Exploratory factor analysis on 19 items revealed two-factors accounting for 51.1% of the total variance with the internal reliability α = 0.90. The mean total score of the Readiness for Interprofessional Learning Scale was 73.5 (SD = 11.5) indicating that students are ready for interprofessional learning. Nursing students, female students; students in their first years of studies, and those with previously completed education in the field of health care, have been more ready for interprofessional learning and collaborative practice. In the multiple linear regression analysis, gender and assessing professional nursing skills and abilities were significant predictors of medical students' readiness for interprofessional learning, whereas professional identity was for nursing students.

CONCLUSION

The Serbian version of the Readiness for Interprofessional Learning Scale has proven to be reliable and valid for the "teamwork, collaboration and shared learning" subscale, while the "role and responsibilities" subscale showed lower stability. The results of this study revealed positive students' attitudes towards interprofessional learning, which is important for Serbia, as a candidate country for European Union membership, and thus making our educational system more inclusive for joining the European Higher Education Area.

An interprofessional patient assessment involving medical and nursing students: a qualitative study

Interprofessional collaboration is fundamental to providing optimal patient care. The readiness of the team entering a framework of interprofessional collaborative practice is critical to its success. In this study, we conducted an interprofessional education (IPE) activity for medical and nursing students in an acute care setting. Over nine occasions, 21 student pairs (one nursing and one medical student per pair) jointly assessed a patient and created a list of problems and interventions to achieve the patient's goals. Immediately after the activity, students were debriefed to gain insight into their experiences. Debriefing sessions were audiotaped and analysed using a phenomenological approach and four major themes were identified. Overall, students felt responsible for representing their profession and were initially apprehensive about the interprofessional task. Nevertheless, they identified their own shortcomings and recognized the value in their partner's approach. These realizations promoted convergence on a shared vision to provide optimal care for patients as a team. Acknowledging and understanding these perceptions may help design better ways to improve patient care. This educational model may be utilized by others who are seeking IPE activities in acute care.

The Progress and Promise of Interprofessional Education in Athletic Training Programs

Context:

Interprofessional education (IPE), an emerging theme in health professional education programs, intends to prepare students for collaborative practice in order to improve patient outcomes. In 2012, the profession of athletic training strategically began to increase program participation in IPE.

Objective:

This article compares 2 studies that examined the presence of IPE in athletic training.

Design:

Cross-sectional design utilizing similar surveys regarding athletic training program participation in, and readiness for, IPE initiatives were administered via Qualtrics in 2012 and 2015.

Patients and Other Participants:

Program directors of Commission on Accreditation of Athletic Training Education–accredited athletic training programs were surveyed in 2012 and 2015 using the “Interprofessional Education Assessment and Planning Instrument for Academic Institutions” in addition to program demographic information and IPE participation.

Data Collection and Analysis:

The participants involved included 160 of 367 surveyed (43.6%) in 2012 and 162 of 380 surveyed (42.6%) in 2015.

Results:

Data were analyzed, and χ2 analysis revealed a significant relationship between level of accreditation and academic unit housing the program in both studies. Significant change was also shown in program participation in IPE from 2012 to 2015. However, institutional readiness and infrastructure for IPE was low in nearly all categories.

Conclusions:

Interprofessional education has a greater presence in Commission on Accreditation of Athletic Training Education professional programs that reside in health science–related academic units and are accredited at the master's level. However, less than 50% of the programs participate in IPE. There is also a need for greater institutional infrastructure and readiness for IPE.

The effect of an interprofessional simulation-based education program on perceptions and stereotypes of nursing and medical students: A quasi-experimental study

BACKGROUND

Interprofessional education is intended to train practitioners to collaboratively address challenges in healthcare delivery, and interprofessional simulation-based education (IPSE) provides realistic, contextual learning experiences in which roles, responsibilities, and professional identity can be learned, developed, and assessed. Reducing negative stereotypes within interprofessional relationships is a prime target for IPSE.

OBJECTIVES

We sought to understand whether perceptions of interprofessional education and provider stereotypes change among nursing and medical students after participating in IPSE. We also sought to determine whether changes differed based on the student's discipline.

DESIGN

This was a quasi-experimental pretest-posttest study.

SETTING

The study took place at a large mid-Atlantic public university with a comprehensive health science campus.

PARTICIPANTS

147 senior Bachelors of Science in Nursing students and 163 fourth-year medical students participated.

METHODS

Students were grouped into interprofessional teams for a two-week period and participated in three two-hour simulations focused on collaboration around acutely ill patients. At the beginning of the first session, they completed a pretest survey with demographic items and measures of their perceptions of interprofessional clinical education, stereotypes about doctors, and stereotypes about nurses. They completed a posttest with the same measures after the third session.

RESULTS

251 students completed both the pretest and posttest surveys. On all three measures, students showed an overall increase in scores after the IPSE experience. In comparing the change by student discipline, medical students showed little change from pretest to posttest on stereotypes of doctors, while nursing students had a significant increase in positive perceptions about doctors. No differences were noted between disciplines on changes in stereotypes of nurses.

CONCLUSIONS

This study demonstrated that a short series of IPSE experiences resulted in improved perceptions of interprofessional practice and changes in stereotypical views of each profession even when the experience was not directly designed to address these issues. Differences observed between nursing and medical students should be explored further.

Perceptions of residents, medical and nursing students about Interprofessional education: a systematic review of the quantitative and qualitative literature

BACKGROUND

To identify facilitators and barriers that residents, medical and nursing students perceive in their Interprofessional Education (IPE) in a clinical setting with other healthcare students.

METHODS

A systematic review was carried out to identify the perceptions of medical students, residents and nursing students regarding IPE in a clinical setting. PubMed, CINAHL, ERIC and PsycInfo were searched, using keywords and MeSH terms from each database's inception published prior to June 2014. Interprofessional education involving nursing and medical students and/or residents in IPE were selected by the first author. Two authors independently assessed studies for inclusion or exclusion and extracted the data.

RESULTS

Sixty-five eligible papers (27 quantitative, 16 qualitative and 22 mixed methods) were identified and synthesized using narrative synthesis. Perceptions and attitudes of residents and students could be categorized into 'Readiness for IPE', 'Barriers to IPE' and 'Facilitators of IPE'. Within each category they work at three levels: individual, process/curricular and cultural/organizational. Readiness for IPE at individual level is higher in females, irrespective of prior healthcare experience. At process level readiness for IPE fluctuates during medical school, at cultural level collaboration is jeopardized when groups interact poorly. Examples of IPE-barriers are at individual level feeling intimidated by doctors, at process level lack of formal assessment and at cultural level exclusion of medical students from interaction by nurses. Examples of IPE-facilitators are at individual level affective crises and patient care crises situations that create feelings of urgency, at process level small group learning activities in an authentic context and at cultural level getting acquainted informally. These results are related to a model for learning and teaching, to illustrate the implications for the design of IPE.

CONCLUSIONS

Most of the uncovered barriers are at the cultural level and most of the facilitators are at the process level. Factors at the individual level need more research.

An evaluation of the opportunities for collaborative practice occurring in and the impact of interprofessional education on advanced pharmacy practice experiences

BACKGROUND

To evaluate the impact of interprofessional (IP) education (IPE) programs during the first three years of a four-year doctor of pharmacy program on student preparedness and ability to function as a collaborative team member and to garner student feedback on collaboration experienced during the Advanced Pharmacy Practice Experiences (APPEs).

INTERPROFESSIONAL EDUCATION ACTIVITY

Likert scale based statements and open-ended questions were added to the student course evaluations for the APPEs for two graduating classes of students. Quantitative data were analyzed using SPSS (repeated measures ANOVA and MANOVA). Thematic analysis by three reviewers reaching consensus was used to evaluate the qualitative data. Students reported being well prepared for IP collaboration (average ratings ranged from a mean of 3.37-3.46 on a scale of 1-4; 1=not at all prepared and 4=very well prepared). On average, students spent 26-50% of their time working with colleagues from other healthcare professions. In describing their preparedness for IP collaboration, the IP core competency of teams/teamwork was addressed in 50% of the submitted responses. The competencies of values/ethics, roles/responsibilities and IP communication were addressed by 2%, 20% and 28% of the written responses, respectively.

DISCUSSION

Required longitudinal IP programs in the first three years of the pharmacy curriculum contribute to the students' perceived preparedness for collaborative practice during their APPEs. Developing practice sites to increase the opportunities for students to practice collaboratively is key. Further education of and emphasis by preceptors relative to the IPE competencies is desired.

Using complexity theory to develop a student-directed interprofessional learning activity for 1220 healthcare students

BACKGROUND

More and better interprofessional practice is predicated to be necessary to deliver good care to the patients of the future. However, universities struggle to create authentic learning activities that enable students to experience the dynamic interprofessional interactions common in healthcare and that can accommodate large interprofessional student cohorts. We investigated a large-scale mandatory interprofessional learning (IPL) activity for health professional students designed to promote social learning.

METHODS

A mixed methods research approach determined feasibility, acceptability and the extent to which student IPL outcomes were met. We developed an IPL activity founded in complexity theory to prepare students for future practice by engaging them in a self-directed (self-organised) learning activity with a diverse team, whose assessable products would be emergent creations. Complicated but authentic clinical cases (n = 12) were developed to challenge student teams (n = 5 or 6). Assessment consisted of a written management plan (academically marked) and a five-minute video (peer marked) designed to assess creative collaboration as well as provide evidence of integrated collective knowledge; the cohesive patient-centred management plan.

RESULTS

All students (including the disciplines of diagnostic radiology, exercise physiology, medicine, nursing, occupational therapy, pharmacy, physiotherapy and speech pathology), completed all tasks successfully. Of the 26 % of students who completed the evaluation survey, 70 % agreed or strongly agreed that the IPL activity was worthwhile, and 87 % agreed or strongly agreed that their case study was relevant. Thematic analysis found overarching themes of engagement and collaboration-in-action suggesting that the IPL activity enabled students to achieve the intended learning objectives. Students recognised the contribution of others and described negotiation, collaboration and creation of new collective knowledge after working together on the complicated patient case studies. The novel video assessment was challenging to many students and contextual issues limited engagement for some disciplines.

CONCLUSIONS

We demonstrated the feasibility and acceptability of a large scale IPL activity where design of cases, format and assessment tasks was founded in complexity theory. This theoretically based design enabled students to achieve complex IPL outcomes relevant to future practice. Future research could establish the psychometric properties of assessments of student performance in large-scale IPL events.

Community of practice and student interaction at an acute medical ward: An ethnographic study

BACKGROUND

A deeper understanding is needed of the acute medical care setting as a learning environment for students.

AIM

To explore workplace culture of an acute medical ward and students' interactions within this community.

METHOD

An ethnographic design was applied. Medical and nurse students' interactions were observed and informal questioning performed. Field notes were transcribed and analysed qualitatively, inspired by Wengers' "Community of practice" theory.

RESULTS

We identified four characteristics that regulated how students adapt and interact in the community of practice. Complex and stressful situations were stabilized by routines and carriers of culture. Variable composition and roles of community members were a part of the daily routine but did not seam obvious to students. Transitions through community boundaries were confusing especially for new students. Levels of importance and priority: Hierarchies and orders of priority were present as regulators of roles, routines and interactions, and of how staff approach different patient groups.

CONCLUSION

The culture shaped a pattern for, and created prerequisites that challenged students' adaptation and created a space for learning. Students' task on arrival was to enter the semipermeable membrane of the community of practice and to understand and adapt to its culture, and try to become accepted.

Every team needs a coach: Training for interprofessional clinical placements

Despite growing awareness of the benefits of interprofessional education and interprofessional collaboration (IPC), understanding how teams successfully transition to IPC is limited. Student exposure to interprofessional teams fosters the learners' integration and application of classroom-based interprofessional theory to practice. A further benefit might be reinforcing the value of IPC to members of the mentoring team and strengthening their IPC. The research question for this study was: Does training in IPC and clinical team facilitation and mentorship of pre-licensure learners during interprofessional clinical placements improve the mentoring teams' collaborative working relationships compared to control teams? Statistical analyses included repeated time analysis multivariate analysis of variance (MANOVA). Teams on four clinical units participated in the project. Impact on intervention teams pre- versus post-interprofessional clinical placement was modest with only the Cost of Team score of the Attitudes Towards Healthcare Team Scale improving relative to controls (p = 0.059) although reflective evaluations by intervention team members noted many perceived benefits of interprofessional clinical placements. The significantly higher group scores for control teams (geriatric and palliative care) on three of four subscales of the Assessment of Interprofessional Team Collaboration Scale underscore our need to better understand the unique features within geriatric and palliative care settings that foster superior IPC and to recognise that the transition to IPC likely requires a more diverse intervention than the interprofessional clinical placement experience implemented in this study. More recently, it is encouraging to see the development of innovative tools that use an evidence-based, multi-dimensional approach to support teams in their transition to IPC.

Students' Perceptions on an Interprofessional Ward Round Training - A Qualitative Pilot Study

INTRODUCTION

Ward rounds are an essential activity for interprofessional teams in hospital settings and represent complex tasks requiring not only medical knowledge but also communication skills, clinical technical skills, patient management skills and team-work skills. The present study aimed to analyse final year students', nurses' as well as physiotherapists' views on a simulation-based interprofessional ward round training.

METHODS

In two successive passes a total number of 29 final year students, nursing students and physiotherapy students (16 in the first run, 13 in the second) volunteered to participate in two standardized patient ward round scenarios: (1) patient with myocardial infarction, and (2) patient with poorly controlled diabetes. Views on the interprofessional ward round training were assessed using focus groups.

RESULTS

Focus group based feedback contained two main categories (A) ward round training benefits and (B) difficulties. Positive aspects enfolded course preparation, setting of the training, the involvement of the participants during training and the positive learning atmosphere. Difficulties were seen in the flawed atmosphere and realization of ward rounds in the daily clinical setting with respect to inter-professional aspects, and course benefit for the different professional groups.

CONCLUSION

The presented inter-professional ward round training represents a well received and valuable model of interprofessional learning. Further research should assess its effectiveness, processes of interprofessional interplay and transfer into clinical practice.

Student learning in interprofessional practice-based environments: what does theory say?

Student learning in interprofessional practice-based environments has garnered significant attention in the last decade, and is reflected in a corresponding increase in published literature on the topic. We review the current empirical literature with specific attention to the theoretical frameworks that have been used to illustrate how and why student learning occurs in interprofessional practice-based environments. Our findings show there are relatively few theoretical-based studies available to guide educators and researchers alike. We recommend a more considered and consistent use of theory and suggest that professional identity and socio-cultural frameworks offer promising avenues for advancing understandings of student learning and professional identity development within interprofessional practice-based environments.

An Interprofessional Education Panel on Development, Implementation, and Assessment Strategies

This report provides a primer for implementing interprofessional education (IPE) within pharmacy and health sciences curricula. In 2013, a panel of administrators and faculty members, whose institutions offered IPE, funded by the Josiah Macy Jr. Foundation, shared best collaborative practice models at the American Association of Colleges of Pharmacy (AACP) Annual Meeting. These presenters subsequently collaborated to write a primer as guidance for other institutions interested in successfully implementing and continuously enhancing the quality of IPE programs. In this article, these IPE faculty members provide a rationale for creating IPE reforms, discuss successful strategies for innovative IPE programs, and share lessons learned for implementing effective assessment tools. A structure and process for determining outcomes of IPE models are presented and strategies for exploring shared education opportunities across health professions and for integrating top-down and bottom-up methods for IPE programs are given.