The M-C-M' cycle and social capital

Capital sharing and socialization in an interprofessional student-led clinic: a Bourdieuan analysis

BACKGROUND

Interprofessional student-led clinics offer authentic clinical experiences of collaborative patient care. However, theoretical research on the sustainability of these clinics, considering forms of capital beyond the economic, remains limited. This study addresses this gap by employing Bourdieu's theoretical framework to explore how alternative conceptions of capital; both social and cultural might sustain conditions for interprofessional working in a student-led clinic serving patients living with a chronic neurological impairment.

METHODS

The teaching and learning focussed clinic was established in 2018 to mirror a clinical service. Semi-structured focus groups with participants involving 20 students from 5 professions and 11 patients gathered in-depth insights into their experiences within the clinic. A thematic analysis was guided by Bourdieu's concepts of field, habitus, and capital.

RESULTS

In the complex landscape of the student-led clinic, at the intersection of a patient support group, a hospital-based aged care facility, and university-based healthcare professions, three pivotal mechanisms emerged underpinning its sustainability: Fostering students' disposition to interprofessional care, Capitalizing on collaboration and patient empowerment, and a Culture of mutual exchange of capital. These themes illustrate how students and patients specific dispositions towards interprofessional healthcare enriched their habitus by focusing on shared patient well-being goals. Diverse forms of capital exchanged by students and patients fostered trust, respect, and mutual empowerment, enhancing the clinic experience.

CONCLUSION

This study bridges an important gap in theoretically informed explorations of the conditions for sustaining student-led clinics, drawing on Bourdieu's theory. It accentuates the significance of investment of diverse forms of capital in such clinics beyond the economic, whilst emphasizing a primary commitment to advancing interprofessional healthcare expertise. Recognizing patients as equal partners shapes clinic dynamics. In order for student clinics to thrive in a sustainable fashion, educators must shift their focus beyond solely maximizing financial resources. Instead, they should champion investments in a wider range of capital forms. This requires active participation from all stakeholders; faculties, patient partners, service providers, and students. These findings underscore the importance of investing in interprofessional learning by optimizing various forms of capital, and embracing patients as dynamic contributors to the clinic's sustainability.

Student Interprofessional Facilitator Training (SIFT) program: building capacity in clinical education leadership

BACKGROUND

While there are many teacher training programs for health professional students, few are interprofessional, and few integrate assessment and feedback prior to participation as peer teachers. In 2021, The Student Interprofessional Facilitator Training (SIFT) program was developed to allow senior students, already trained in peer teaching, to revise, build on, and practice their newly acquired skills in an interprofessional context. The aim of this study was to explore participant perception and performance, and the contextual factors that influence student aspirations as clinical teachers.

METHODS

Alumni of the 2021 Peer Teacher Training program (n = 74) were invited to participate in the SIFT program. Those who participated were invited to attend individual semi-structured interviews. Thematic analysis was used to code and categorise data into themes, using Communities of Practice as a conceptual framework. Skills in interprofessional facilitation were observed, assessed and students were provided with individual feedback. Assessment data were analysed using descriptive statistics.

RESULTS

Sixteen students from six disciplines joined the SIFT program, and 13/16 (81%) completed. Students were from medicine, nursing, diagnostic radiography, medical imaging, dentistry and speech pathology. Students reported an increased recognition of teaching as a learned skill, development of clinician identity formation as educators, development of interprofessional communication skills, increased awareness of the roles of other health professions, and an increased understanding of leadership. Participants expressed a desire for additional opportunities for interprofessional networking and peer teaching. A good level of competence in facilitation skills was reached by participants.

CONCLUSION

The SIFT program provided a sustainable framework for health professional students to develop and evidence their teaching and leadership skills in an interprofessional context. This study highlighted the important role of observation, assessment and feedback in student teacher training programs. The process of clear assessment guidelines, direct observation with feedback from supervisors provided a way to ensure quality improvement in peer teaching. The SIFT program will help to build capacity of interprofessional programs where large numbers of teachers are required for small group teaching. The next step will be to ensure a variety of opportunities within interprofessional contexts, and with face-to-face engagement.

Use of Established Guidelines When Reporting on Interprofessional Team-Based Learning in Health Professions Student Education: A Systematic Review

PURPOSE

Team-based learning (TBL) has gained popularity across the health professions, including in interprofessional contexts. The authors conducted this systematic review to summarize the published evidence regarding the extent, design, and practice of interprofessional TBL within health professions (including medical) degree programs to inform interprofessional education (IPE) educators and curricula designers.

METHOD

In June 2020, the authors searched PubMed Central, CINAHL, Web of Science, and ERIC for original research articles describing TBL programs with student representation from multiple health professions degree programs that were published between January 2010 and June 2020. Included articles underwent data extraction for study characteristics (e.g., country of origin, topics covered, class descriptors) and the 7 core design elements of TBL: team formation, readiness assurance, immediate feedback, sequencing of in-class problem solving, the 4 Ss (significant problem, same problem, specific choice, and simultaneous reporting), incentive structure, and peer review.

RESULTS

Twelve articles were included. Significant variability was noted in the application and reporting of the 7 core design elements of TBL, which highlighted challenges to the implementation of interprofessional TBL.

CONCLUSIONS

Although the structured format of TBL provides a suitable pedagogy for IPE, this review identified challenges associated with the effective integration of IPE into TBL, including: the unequal distribution of students to teams as a result of there being multiple disciplines from different programs; varied levels of student experience with the pedagogy of TBL; a lack of resources required for large groups of students; timetabling requirements for multiple disciplines from different programs; inability to provide more than 1 TBL session; design of patient cases that suit multiple disciplines; alignment of topics within the curricula of multiple disciplines, programs, and universities; inequities in grading for different students within the same TBL program; and limited opportunity for peer review.

Interregional Diversity of Social Capital in the Context of Sustainable Development—A Case Study of Polish Voivodeships

The relationship between social capital and sustainable development challenges is of special importance. However, social capital is a complex phenomenon that is analyzed in different contexts and cannot be investigated with the use of a single variable. Social capital is difficult to define, which is why the selection of variables for measuring social capital can be problematic. The aim of this study was to analyze variations in social capital at the regional level. The study was conducted in Poland, and it covered all 16 Polish voivodeships (regions) where social capital was evaluated based on five measures: civic engagement in political and social life, degree of selfless behavior, sense of security and social confidence, formation of social structures, and the observance of social norms (external factors), and attitudes (internal factors) that foster desirable social interactions. The correlations between the above measures were also determined. Composite indicators of the analyzed measures were developed with the use of the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method. The results were used to rank Polish voivodeships and group them into three classes based on the corresponding values of the adopted measures. Pearson’s correlation coefficient was used in the correlation analysis. The analysis involved a total of 26 indicators based on the data provided by Statistics Poland, the National Election Committee, Social Diagnosis project, and Moja Polis website. Polish voivodeships not only differ considerably in terms of the evaluated measures of social capital, but are also characterized by significant internal variation within each measure. The majority of Polish voivodeships were grouped in class II denoting average values of the evaluated measures, which could suggest that Poland is deficient in social capital. The Pomeranian voivodeship scored highest and the Łódź voivodeship scored lowest in the analyzed measures of social capital. A significant correlation was observed only between civic engagement in political and social life versus the formation of social structures and the observance of norms and attitudes that foster desirable social interactions.

Interprofessional Team-based Learning: Building Social Capital

Often the first-time health professionals work together is as new graduates, with a paucity of shared learning among the various health disciplines within university curricula. This is largely due to the complexities of delivering interprofessional education (IPE) and the preference of individuals to work within their established silos. With its ability to nurture collaboration among students, there is a developing trend to use team-based learning (TBL) as a teaching method to engage health care students in IPE. Using the conceptual lens of social capital theory, the purpose of this article is to provide readers with an overview and evidence for the use of TBL within the interprofessional health care education setting, highlighting the benefits and challenges.

Interprofessional Education of Allied Health Professionals – Perspectives of Experts / Interprofessionelles Lehren und Lernen in den Gesundheitsprofessionen aus Sicht von Experten/-innen

Given increasing requirements for health care services, interprofessional cooperation between healthcare professions has been recently gaining momentum. To ensure that cooperation with other healthcare professionals does not occur for the first time in clinical settings, several projects have been developed over the past years in Germany, aiming to prepare future clinicians for interprofessional cooperation during their study or vocational training programs. The conceptual diversity underlying these projects is reflected for instance in their target groups, as well as in their different structures, contents and aims. The prevailing heterogeneity in this field partly results of structural decisions made by project designers. The present study aims to explore the perspectives of experts involved in the development of those interprofessional education programs. Accordingly, this paper aims to provide information on the perspectives of a population which has until now received little consideration in this context, and to identify and describe opportunities and challenges for the implementation of interprofessional teaching and learning processes.

Relevant categories providing a systematic representation of the study results could be extracted based on the content analysis of qualitative, semi-structured expert interviews.

The study results show that interprofessional cooperation between health professions is inextricably linked with interprofessional education. At the same time, current projects and publications still rank low on the general and relevant policy-making agenda. This points to the need for the provision of more support and necessary structural and organizational conditions for interprofessional teaching, as well as to significantly intensify discussions on the topic on various levels.

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.

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.

Development of the Social Capital Questionnaire in Greece

The Greek version of the social capital questionnaire (SCQ-G) was evaluated in a sample of 521 adults drawn from three different urban areas in Greece. Exploratory factor analysis followed by multi-trait scaling yielded six factors: Participation in the Community, Feelings of Safety, Family/Friends Connections, Value of Life and Social Agency, Tolerance of Diversity, and Work Connections. The factor solution is similar to the patterns identified originally in Australia and the US. Variations suggest that social capital does not share the same structure in different countries. The SCQ-G is a useful scale to measure individual-level social capital in Greece. Social capital measurement tools should be validated in each cultural or national setting in which they are used.

Social capital and rates of gonorrhea and syphilis in the United States: Spatial regression analyses of state-level associations

We conducted spatial regression analysis to account for spatial clustering of sexually transmitted diseases (STDs) and to examine the state-level association between social capital (using Putnam's public use data set) and rates of gonorrhea and syphilis. We conducted the analysis for the 48 contiguous states of the United States for 1990, 1995, and 2000 and controlled for the effects of regional variation in STD rates, and for state variation in poverty, income inequality, racial composition, and percentage aged 15-34 years. We compared the results of the spatial regression analysis with those of ordinary least squares (OLS) regression. Controlling for all population-level variables, the percentage of variation explained by the OLS regression and by the spatial regression were similar (mid-90s for gonorrhea and low-70s for syphilis), the standardized parameter estimates were similar, and the spatial lag parameter was not statistically significant. Social capital was not associated with STD rates when state variation in racial composition was included in the regression analysis. In this analysis, states with a higher proportion of residents who were African-American had higher STD rates. When we did not control for racial composition, regression analysis showed that states with higher social capital had lower STD rates. We conjecture that sexual networks and sexual mixing drive the association between social capital and STD rates and highlight important measurement and research questions that need elucidation to understand fully the relationship between social capital and STDs.

Health implications of access to social capital: findings from an Australian study

This paper considers the health implications of access to social capital (SC) using data from a survey of households in two suburbs in Adelaide, Australia. SC was conceptualised as comprising 'infrastructure'--the networks and values that facilitate access to resources; and 'resources'--the resources available through this infrastructure. Questionnaires were delivered to all households in the area, asking the adult with the next birthday to complete it. In all, 530 (50%) were returned. A partial least-squares path analysis was undertaken using demographic, SC and health latent variables, and a measure of perceived relative advantage. Three infrastructure (values, formal networks and informal networks) and four resource (help, acceptance by neighbours, civic activities and feelings of control) variables were considered. Mental and physical health were measured using the SF-12. The values variable was associated with all the resource variables, the informal networks variable was related to help, and the formal networks variable was associated with civic actions. There were significant sociodemographic differences in a number of the infrastructure and resource variables, as well as mental and physical health. Those who were better off materially also had greater access to elements of SC, and reported better health. Values, informal networks, help, and control were all directly or indirectly positively associated with better mental health. No SC variables were associated with physical health. Perceived relative advantage was positively associated with a number of SC variables and also mental and physical health. The implications for health promotion are discussed.

The limits of social capital: Durkheim, suicide, and social cohesion

Recent applications of social capital theories to population health often draw on classic sociological theories for validation of the protective features of social cohesion and social integration. Durkheim's work on suicide has been cited as evidence that modern life disrupts social cohesion and results in a greater risk of morbidity and mortality-including self-destructive behaviors and suicide. We argue that a close reading of Durkheim's evidence supports the opposite conclusion and that the incidence of self-destructive behaviors such as suicide is often greatest among those with high levels of social integration. A reexamination of Durkheim's data on female suicide and suicide in the military suggests that we should be skeptical about recent studies connecting improved population health to social capital.

Local services and amenities, neighborhood social capital, and health

Recent work on health and place has examined the impact of the environment on health. At the local level, research has followed several strands, such as contextual effects of neighborhoods, the impact of differential access to services and amenities, effects of a neighborhood's collective efficacy, and the relationship between social capital and health. Of these four approaches, social capital has generated the most debate; some scholars discuss social capital as a key epidemiological variable, while others discount or dismiss its utility. We undertook this research to assess whether the concept of social capital could increase our understanding of the impact of neighborhoods on residents' health. We utilized key informant interviews and focus groups to understand ways in which residents of diverse neighborhoods in one large California city perceived that their local communities were affecting health. We argue in this paper that using the term "social capital" to discuss social resources and their mobilization in a particular neighborhood highlights the ways in which social resources can vary in relation to economic resources, and that residents of neighborhoods with differing levels of services and amenities face different issues when mobilizing to improve their neighborhoods. Additionally, the projects that people invest in vary by neighborhood socioeconomic status. We draw on the paired concepts of "bridging" and "bonding" social capital, and discuss that while stores of bonding social capital may be more uniform across neighborhoods of varying SES, bridging social capital tends to be found in greater amounts in neighborhoods of higher SES which allows them greater success when mobilizing to improve their neighborhoods.

What is social capital and how does it relate to health?

During the last 25 years, a new term has cropped up in social sciences, social capital. In the last 10 years, this term acquired a new dimension which relates it to health. Following an analysis of theoretical issues surrounding social capital and social support, recent research is used to illustrate how these are affecting health. It is argued that more theoretical development is needed before social capital can be used to form a new community nursing practice. Until then, the ideas of social capital (social contact, companionship, etc.) may guide our mode of operation during nursing interventions.