A comparison of performance by medical and midwifery students in multiprofessional teaching

Development of an interdisciplinary training program about chronic pain management with a cognitive behavioural approach for healthcare professionals: part of a hybrid effectiveness-implementation study

BACKGROUND

Many applied postgraduate pain training programs are monodisciplinary, whereas interdisciplinary training programs potentially improve interdisciplinary collaboration, which is favourable for managing patients with chronic pain. However, limited research exists on the development and impact of interdisciplinary training programs, particularly in the context of chronic pain.

METHODS

This study aimed to describe the development and implementation of an interdisciplinary training program regarding the management of patients with chronic pain, which is part of a type 1 hybrid effectiveness-implementation study. The targeted groups included medical doctors, nurses, psychologists, physiotherapists, occupational therapists, dentists and pharmacists. An interdisciplinary expert panel was organised to provide its perception of the importance of formulated competencies for integrating biopsychosocial pain management with a cognitive behavioural approach into clinical practice. They were also asked to provide their perception of the extent to which healthcare professionals already possess the competencies in their clinical practice. Additionally, the expert panel was asked to formulate the barriers and needs relating to training content and the implementation of biopsychosocial chronic pain management with a cognitive behavioural approach in clinical practice, which was complemented with a literature search. This was used to develop and adapt the training program to the barriers and needs of stakeholders.

RESULTS

The interdisciplinary expert panel considered the competencies as very important. Additionally, they perceived a relatively low level of healthcare professionals' possession of the competencies in their clinical practice. A wide variety of barriers and needs for stakeholders were formulated and organized within the Theoretical Domain Framework linked to the COM-B domains; 'capability', 'opportunity', and 'motivation'. The developed interdisciplinary training program, including two workshops of seven hours each and two e-learning modules, aimed to improve HCP's competencies for integrating biopsychosocial chronic pain management with a cognitive behavioural approach into clinical practice.

CONCLUSION

We designed an interdisciplinary training program, based on formulated barriers regarding the management of patients with chronic pain that can be used as a foundation for developing and enhancing the quality of future training programs.

Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta‐analysis

Background

Sub‐optimal classification, interpretation and response to intrapartum electronic fetal monitoring using cardiotocography are known problems. Training is often recommended as a solution, but there is lack of clarity about the effects of training and which type of training works best.

Objectives

Systematic review of the effects of training healthcare professionals in intrapartum cardiotocography (PROSPERO protocol: CRD42017064525).

Search strategy

CENTRAL, Cochrane Library, MEDLINE, EMBASE, PsycINFO, British Nursing Database, CINAHL, ERIC, Scopus, Web of Science, ProQuest, grey literature and ongoing clinical trials were searched.

Selection criteria

Primary studies that reported impact of training healthcare professionals in intrapartum cardiotocography. Title/abstract, full‐text screening and quality assessment were conducted in duplicate.

Data collection and analysis

Data were synthesised both narratively and using meta‐analysis. Risk of bias and overall quality were assessed with the Mixed Methods Appraisal Tool and GRADE.

Main results

Sixty‐four studies were included. Overall, training and reporting were heterogeneous, the outcomes evaluated varied widely and study quality was low. Five randomised controlled trials reported that training improved knowledge of maternity professionals compared with no training, but evidence was of low quality. Evidence for the impact of cardiotocography training on neonatal and maternal outcomes was limited, showed inconsistent effects, and was of low overall quality. Evidence for the optimal content and method of delivery of training was very limited.

Conclusions

Given the scale of harm and litigation claims associated with electronic fetal monitoring, the evidence‐base for training requires improvement. It should address intervention design, evaluation of clinical outcomes and system‐wide contexts of sub‐optimal practice.

Tweetable abstract

Training in fetal monitoring: systematic review finds little evidence of impact on neonatal outcomes.

Training in fetal monitoring: systematic review finds little evidence of impact on neonatal outcomes.

The Development and Psychometric Evaluation of the Electronic Fetal Monitoring Knowledge Scale

BACKGROUND

The aim of this study was to develop and assess the psychometric properties of the Electronic Fetal Monitoring Knowledge Scale (EFMKS), a self-report and short instrument measuring knowledge concerning Electronic Fetal Monitoring (EFM). Methods. The EFMKS was developed in a three-phase process by using an integrated mixed-methods approach that included literature reviews, professional focus groups, expert consultations and a psychometric survey evaluation. The psychometric evaluation was conducted by recruiting a sample of 128 professionals (midwives and doctors). Content validity, exploratory factor analysis, discriminant and construct validity, test-retest reliability and internal consistency were explored.

RESULTS

The expert panel determined that the content validity was satisfactory. The final 10-item scale consisted of three factors explaining 73% of the total variance in the data. Discriminant validity was satisfactory. Internal consistency reliability (α = 0.89) and test-retest reliability (0.85) were satisfactory. The majority of the midwives and the obstetricians had a good level of knowledge while approximately one third of them had a low level of knowledge in EFM.

CONCLUSION

The EFMK demonstrated good content validity, an easily interpretable three-factor structure, high internal consistency, high test-retest reliability, and satisfactory discriminant and construct validity with sample characteristics. The EFMKS may be used for evaluating the EFM knowledge of health professionals and for identifying the areas of their knowledge gap. Based on study findings, an annual multi-professional CTG training is necessary for all intrapartum staff and in particular for the midwives and doctors with shorter clinical experience in the labor ward.

Nursing and medical students near-peer activity in the anatomy laboratory: format for success

BACKGROUND/AIMS

An anatomy interprofessional near-peer learning activity (AIP-NPLA) between nursing and medical students was piloted to assess its implementability. This study aimed to: (1) identify key factors of feasibility and (2) describe student-group perceptions of their experience of the interprofessional education (IPE) activity.

METHODS

A total of 59 medical and 179 nursing students participated in the AIP-NPLA whereby medical students were asked to facilitate and lead group discussions with their nursing students colleagues on an anatomical topic using a donor cadaver. Each AIP-NPLA session lasted a total of two hours. A mixed methods approach was employed using both quantitative and qualitative means of assessment. Variables such as Readiness for Interprofessional Learning, Professional Self-Identity, Clinical Teaching Preference, and Near-Peer Teaching and Learning Experience were assessed quantitatively using validated surveys. Qualitative measures included thematic content analysis of focus group interviews conducted following the AIP-NPLA to capture the perceptions of the student groups' experience in the IPE activity.

RESULTS

The results of this investigation demonstrated that there are key factors to consider when designing successful and sustainable IPE activities; the level of clinical exposure and therefore student-group pairing based on professional self-identify scores, optimal tutor-to-tutee group ratios and an activity format that maintained an informal, flexible and free forum for discussion on a topic of common knowledge. Focus group interviews also revealed reflections on professional stereotypes.

CONCLUSION

These findings suggest that early implementation of IPE activities outside of a clinical setting are beneficial and can foster both learning from one another and positive perceptions of interprofessional roles when carefully designed.

[Fetal heart rate analysis: Evaluation of an in situ training program on cardiotocography interpretation during labor in the Auvergne-Rhône-Alpes region (France)]

OBJECTIVES

To evaluate an in situ training program on caradiotocography interpretation during labor in the Auvergne-Rhône-Alpes region (France).

METHODS

Fifteen hospital maternity unit took part to an "outreach visit" training on fetal cardiotocography interpretation between November 2011 and 2015. Professionals were asked to answer to a 10 questions test based on the French classification of fetal heart rate, at inclusion (Test 0: T0), immediately after (Test 1: T1), and long time after the training (Test 2: T2). The mean score for each maternity (T0, T1, T2) was compared individually. Subgroup analysis considered the level of perinatal care of each maternity (level 1 or 2) and the type of practice (public or private).

RESULTS

The study included 332 healthcare professionals belonging to 8 level 1 (53.5%) and 7 level 2 (47.7%) maternity units. The T0 mean score was 4.79 (IC 95% [4.54; 5.02]) instead of 6.71(IC 95% [6.49; 6.93]) at T1 (P<0.05). Seventeen professionals (22.9%) answered T2 with a mean time of 35.2 months (Median value: 40 months) and a mean score of 5.32. The mean score was significantly higher at T2 than at T0 (5.32-IC 95%[4.94-5.70] (P<0.001) but lower than the score at T1 (P<0.05).

CONCLUSION

An "outreach visit" training on fetal cardiotocography interpretation improves theknowledge of healthcare professionals at short and long term.

An interprofessional education pilot program in maternity care: findings from an exploratory case study of undergraduate students

An interprofessional team of maternity care providers and academics developed a pilot interprofessional education (IPE) program in maternity care for undergraduate students in nursing, midwifery and medicine. There are few published studies examining IPE programs in maternity care, particularly at the undergraduate level, that examine long-term outcomes. This paper outlines findings from a case study that explored how participation in an IPE program in maternity care may enhance student knowledge, skills/attitudes, and may promote their collaborative behavior in the practice setting. The program was launched at a Canadian urban teaching hospital and consisted of six workshops and two clinical shadowing experiences. Twenty-five semi-structured, in-depth interviews were completed with nine participants at various time points up to 20 months post-program. Qualitative analysis of transcripts revealed the emergence of four themes: relationship-building, confident communication, willingness to collaborate and woman/family-centered care. Participant statements about their intentions to continue practicing interprofessional collaboration more than a year post-program lend support to its sustained effectiveness. The provision of a safe learning environment, the use of small group learning techniques with mixed teaching strategies, augmented by exposure to an interprofessional faculty, contributed to the program's perceived success.

A mixed-methods study of interprofessional learning of resuscitation skills

OBJECTIVES

This study aimed to identify the effects of interprofessional resuscitation skills teaching on medical and nursing students' attitudes, leadership, team-working and performance skills.

METHODS

Year 2 medical and nursing students learned resuscitation skills in uniprofessional or interprofessional settings, prior to undergoing observational ratings of video-recorded leadership, teamwork and skills performance and subsequent focus group interviews. The Readiness for Interprofessional Learning Scale (RIPLS) was administered pre- and post-intervention and again 3-4 months later.

RESULTS

There was no significant difference between interprofessional and uniprofessional teams for leadership, team dynamics or resuscitation tasks performance. Gender, previous interprofessional learning experience, professional background and previous leadership experience had no significant effect. Interview analysis showed broad support for interprofessional education (IPE) matched to clinical reality with perceived benefits for teamwork, communication and improved understanding of roles and perspectives. Concerns included inappropriate role adoption, hierarchy issues, professional identity and the timing of IPE episodes. The RIPLS subscales for professional identity and team-working increased significantly post-intervention for interprofessional groups but returned to pre-test levels by 3-4 months. However, interviews showed interprofessional groups retained a 'residual positivity' towards IPE, more so than uniprofessional groups.

CONCLUSIONS

An intervention based on common, relevant, shared learning outcomes set in a realistic educational context can work with students who have differing levels of previous IPE and skills training experience. Qualitatively, positive attitudes outlast quantitative changes measured using the RIPLS. Further quantitative and qualitative work is required to examine other domains of learning, the timing of interventions and impact on attitudes towards IPE.

Clinical risk management and patient safety education for nurses: a critique

Nurses have a pivotal role to play in clinical risk management (CRM) and promoting patient safety in health care domains. Accordingly, nurses need to be prepared educationally to manage clinical risk effectively when delivering patient care. Just what form the CRM and safety education of nurses should take, however, remains an open question. A recent search of the literature has revealed a surprising lack of evidence substantiating models of effective CRM and safety education for nurses. In this paper, a critical discussion is advanced on the question of CRM and safety education for nurses and the need for nurse education in this area to be reviewed and systematically researched as a strategic priority, nationally and internationally. It is a key contention of this paper that without 'good' safety education research it will not be possible to ensure that the educational programs that are being offered to nurses in this area are evidence-based and designed in a manner that will enable nurses to develop the capabilities they need to respond effectively to the multifaceted and complex demands that are inherent in their ethical and professional responsibilities to promote and protect patient safety and quality care in health care domains.

Interprofessional education of medical students and paramedics in emergency medicine

BACKGROUND

Emergency medicine is team work from the field to the hospital and therefore it is also important for physicians to understand the work of paramedics, and vice versa. Interprofessional emergency medicine education for medical and paramedic students in Helsinki was started in 2001. It consisted of a 15 European credit transfer system (ECTS) credits programme combining 22 students in 2001. In 2005, the number of students had increased to 25. The programme consisted of three parts: acute illness in childhood and adults (AI), advanced life support (ALS) and trauma life support (TLS). In this paper, we describe the concept of interprofessional education of medical students and paramedics in emergency medicine.

METHODS

After finishing the programmes in 2001 and in 2005, the students' opinions regarding the education were collected using a standardized questionnaire.

RESULTS

There were good ratings for the courses in AI (2001 vs. 2005, whole group; 4.3 +/- 0.7 vs. 4.2 +/- 0.4, P = 0.44) ALS (4.7 +/- 0.5 vs. 4.4 +/- 0.5, P = 0.06) and TLS (3.9 +/- 0.7 vs. 4.4 +/- 0.5, P = 0.01) in both years. Most of the medical students considered that this kind of co-education should be arranged for all medical students (2001 vs. 2005; 4.8 +/- 0.6 vs. 4.4 +/- 0.5, P = 0.02) and should be obligatory (3.5 +/- 1.5 vs. 3.1 +/- 1.3, P = 0.35).

CONCLUSIONS

Co-education was well received and determined by the students as an effective way of improving their knowledge of emergency medicine and medical skills. The programme was rated as very useful and it should be included in the educational curriculum of both student groups.

Contemporary UK paramedical training and education. How do we train? How should we educate?

OBJECTIVE

To develop an understanding of the current system and future development of training and education within a large UK ambulance trust, based upon the experiences, beliefs, and opinions of stakeholders.

METHODS

This was a qualitative naturalistic inquiry using an interpretative constructivist approach for 44 interviews with a range of ambulance staff. Stakeholder views on training and education were analysed and compared using the constant comparison method.

RESULTS

Key emergent themes included: issues around prescribed programme entry levels and methods; the desire for a higher education curriculum with a balance between theory and practice; valid and reliable assessment methods; development of a supportive mentorship framework; an emphasis on self directed professional development with a focus on deskilling issues; and development of interprofessional collaborative links.

CONCLUSION

This thematic review suggests that this UK ambulance service is in a transition stage, with significant organisational, professional, and cultural challenges. The dichotomies, boundaries, and development issues are part of the development of an emerging profession for which it is essential that the educational agenda is addressed.

Student attitudes towards anatomy teaching and learning in a multiprofessional context

CONTEXT

We carried out a survey of attitudes to learning anatomy amongst students from a range of health care disciplines in a multiprofessional context.

SETTING

A joint course called the Common Foundation Programme (CFP) presented by a hospital medical school and a joint university faculty of health and social care sciences in the UK in the first term of the students' courses.

PARTICIPANTS

Students following degree courses in biomedical science, medicine, nursing, physiotherapy, diagnostic radiography and therapeutic radiography.

OBJECTIVES

To assess student attitudes to cadaveric work, learning anatomy and multiprofessional learning, and to compare student performance between degree courses in an anatomy assessment.

DESIGN

A questionnaire was designed that requested demographic information and the students' attitudes to cadaveric work, anatomy learning and multiprofessional learning on a Likert scale. All students sat the same anatomy assessment at the end of the first term.

RESULTS

The biomedical science and medical students were the most apprehensive about entering the dissecting room. The biomedical science students enjoyed working in a multidisciplinary group the most. Assessment results varied widely and the physiotherapy and medical students scored more highly than students in other disciplines, although all students had participated in the same course.

CONCLUSIONS

It was possible to teach anatomy in the context of the shared learning experience of the CFP, although performance varied widely. Reasons for the differences are discussed and suggestions for the design of multiprofessional courses involving anatomy are made.

Learning for real life: patient-focused interprofessional workshops offer added value

OBJECTIVES

This paper reports relevant findings of a pilot interprofessional education (IPE) project in the Schools of Medicine and Healthcare Studies at the University of Leeds. The purpose of the paper is to make a contribution towards answering 2 questions of fundamental importance to the development of IPE. Is there a demonstrable value to learning together? What types of IPE, under what circumstances, produce what type of outcomes?

DESIGN

Pre-registration house officers (PRHOs), student nurses and pre-registration pharmacists attended a series of 3 workshops intended to develop participants' understanding about each other's professional roles, to enhance teamworking and to develop communication skills. Evaluation covered the process of development of the workshops, the delivery of the workshops and their effects on both facilitators and participants.

RESULTS

The course was well received by the participants. The learning reported by the participants reflected 2 project objectives. Participants emphasised communication skills--both with other professionals and patients--and the development of increased awareness of others' roles. These 2 aspects were interlinked.

CONCLUSIONS

The project aims and 2 of the learning outcomes were achieved. There was a demonstrable value to learning together, particularly with regard to interprofessional communications. This project was effective and can make a contribution towards answering the question 'What types of IPE, under what circumstances, produce what type of outcomes?'

Skill mix, doctors and nurses: substitution or diversification?

This commentary surveys the current arguments for and against modifying the work of doctors and nurses by placing the main viewpoints - substitution and diversification - within the policy background, particularly that of the UK. We discuss the forces for modification: cost effectiveness, professional development, quality improvement and pragmatic management and how each provides a stand-point for evaluation of the issues. Policy makers and managers in the health sector should be aware of the rather fragmented evidence base for doctor-nurse substitution and should consider skill mix changes only when they are clear about: purpose, evidence base, acceptable risks, accountability and quality assurance. Doctor-nurse substitution is not necessarily cost effective, nor is it unfailingly a gain in nurse professionalism or in quality of care. Of the management perspectives available - advocacy, skepticism or pragmatism - the current evidence and policy base favours pragmatism over evaluations of the rightness or wrongness of a general policy.

Medical and midwifery students: how do they view their respective roles on the labour ward?

BACKGROUND

It has been suggested that much of the medical and midwifery student curricula on normal pregnancy and birth could be taught as a co-operative effort between obstetric and midwifery staff. One important element of a successful combined teaching strategy would involve a determination of the extent to which the students themselves identify common learning objectives.

AIM

The aim of the present study was to survey medical and midwifery students about how they perceived their respective learning roles on the delivery suite.

METHODS

A descriptive cross-sectional survey study was undertaken. The study venue was an Australian teaching and tertiary referral hospital in obstetrics and gynaecology Survey participants were medical students who had just completed a 10 week clinical attachment in obstetrics and gynaecology during the 5th year of a six year undergraduate medical curriculum and midwifery students undertaking a one year full-time (or two year part-time) postgraduate diploma in midwifery.

RESULTS

Of 130 and 52 questionnaires distributed to medical and midwifery students, response rates of 72% and 52% were achieved respectively The key finding was that students reported a lesser role for their professional colleagues than they identified for themselves. Some medical students lacked an understanding of the role of midwives as 8%, 10%, and 23% did not feel that student midwives should observe or perform a normal birth or neonatal assessment respectively. Of equal concern, 7%, 22%, 26% and 85% of student midwives did not identify a role for medical students to observe or perform a normal birth, neonatal assessment or provide advice on breastfeeding respectively.

SUMMARY

Medical and midwifery students are placed in a competitive framework and some students may not understand the complementary role of their future colleagues. Interdisciplinary teaching may facilitate co-operation between the professions and improve working relationships.

Is multidisciplinary learning effective among those caring for people with diabetes?

The role of multi-professional learning for those providing clinical services to people with diabetes has yet to be defined. Several assumptions are generally made about education in the context of multi-professional settings. It is argued that different professions learning together could potentially improve professional relationships, collaborative working practices and ultimately standards of care. Greater respect and honesty may emerge from a team approach to learning with a commensurate reduction in professional antagonism. Personal and professional confidence is reportedly enhanced through close contact with other professionals during team-based learning exercises. We have examined current evidence to support multidisciplinary learning in the context of medical education generally as well as in diabetes education. Previous investigation of available literature by Cochrane reviewers, aimed at identifying studies of interprofessional education interventions, yielded a total of 1042 articles, none of which met the stated inclusion criteria. Searches involving more recent publications failed to reveal more robust evidence. Despite a large body of literature on the evaluation of interprofessional education, studies generally lacked the methodological rigour needed to understand the impact of interprofessional education on professional practice and/or health care outcomes. Nevertheless, planners continue to advocate, and endorse, joint training between different groups of workers (including nurses, doctors and those in professions allied to medicine) with the objective of producing an integrated workforce of multidisciplinary teams. Whilst the concept of multi-professional learning has strong appeal, it is necessary for those responsible for educating health care professionals to demonstrate its superiority over separate learning experiences.