“Refreshed…reinforced…reflective”: A qualitative exploration of interprofessional education facilitators’ own interprofessional learning and collaborative practice

An exploration of perceptions of online asynchronous and synchronous interprofessional education facilitation strategies

Interprofessional education (IPE) has increasingly been delivered online using synchronous and asynchronous mediums; however, little research focuses on facilitation strategies in the synchronous environment. We explored whether the perceived strategies used by facilitators in online synchronous IPE facilitation are similar to those used in face-to-face and online asynchronous IPE facilitation, and if the strategies are used to a similar degree online in both synchronous and asynchronous environments. Following completion of an online IPE course, students and facilitators were invited to complete an anonymous questionnaire exploring their perceptions of the facilitation strategies used in their synchronous and asynchronous IPE experiences. Responses were received from 118 students and 21 facilitators. Descriptive statistics indicate that students and facilitators perceived facilitation strategies are being used in online synchronous settings that have previously been recognized in asynchronous and face-to-face IPE settings. This included strategies linked to communicating about the design/organization of the experience, providing direct instruction, facilitating and encouraging interprofessional interaction, and contextualizing IPE. Wilcoxon Signed-Rank tests demonstrated a perception that these strategies were being used to a greater extent in the synchronous than asynchronous environment. This knowledge is useful to further refine the training of online IPE facilitators in both synchronous and asynchronous settings.

Sustainable interprofessional education programmes: What influences teachers to stay involved?

Delivery of interprofessional education (IPE) initiatives for pre-licensure students is increasingly the norm in health and social care training programmes. This collaborative form of education relies on teachers from various disciplines joining together to facilitate IPE. When IPE programmes first start, goodwill often prevails and facilitators are keen to take part. But as time goes on, retaining the IPE facilitator workforce is challenging. Research was undertaken to explore the experience of IPE facilitators who were part of a New Zealand university-based ten year old IPE programme. The research used a qualitative survey approach. Responses were received from 29% of all those invited to participate. Closed questions were collated and free-text survey responses analyzed using Template Analysis. Three themes and one integrative theme were identified. Themes include facilitators who are recognized, facilitators who are confident, and facilitators who are inspired. Themes were mediated by macro, meso and micro level forces. The cross-cutting integrative theme showed IPE facilitators experienced individual tipping points, with the potential to influence their continued involvement. These tipping points need to be recognized and addressed by those in senior level positions (macro-governance and meso-management), to ensure IPE facilitators continue and IPE programmes remain sustainable.

Seeing the patient as a person in interprofessional health professions education

Increasing prevalence of chronic disease leads to an increased need for person-centered care. To prepare future health professionals for this need, educational institutions provide interprofessional education in which they actively involve patients (hereafter called experts by experience). The organization of inter-institutional, interprofessional education with the active involvement of experts by experience poses challenges. To overcome these challenges, a joint student- and expert by experience-led organization was established, named Patient as a Person Foundation. This organization functions as the linking pin between three educational institutions. Jointly, they enabled the involvement of 181 experts by experience in interprofessional education and 1313 students from nine study programs over the course of two curriculum years. To facilitate joint education involving patients, Patient as a Person Foundation realizes three main activities: (a) recruitment and instruction of experts by experience, (b) enabling the inter-institutional organization of education and facilitating its logistics and financing, and (c) universal training of teaching staff. This interprofessional Education and Practice Guide aims to provide lessons on how to sustainably organize interprofessional education involving experts by experience across multiple educational institutions. The key lessons provided in this guide, underpinned by research and key literature, aim to inspire and enable similar initiatives elsewhere.

Effectiveness of electronic learning for continuing interprofessional education on behavior change of healthcare professionals: A scoping review

Electronic learning (e-learning) for continuing professional education (CPE) in healthcare has been shown to improve learners' satisfaction, attitudes, and performance. E-learning outcomes for continuing interprofessional education (CIPE) are less known, and the features of electronic CIPE programs that promote behavior change are unclear. In this scoping review, we sought to identify the program features and areas of behavior change in healthcare professionals using e-learning for CIPE. PubMed, CINAHL, ERIC, PsycINFO, Cochrane Library databases, and Google/Google Scholar were searched for all English articles published in the last 10 years. From the 32 studies included in our review, eight types of e-learning methods were identified. More than 35,542 healthcare professionals of different professions had participated in the programs. Thirty studies demonstrated positive behavior changes, with four areas of behavior changes identified. The most common area of change was in patient care practices. Five common program features facilitating behavior change were also identified. Most successful programs provided interactive and authentic learning experiences, which promoted direct clinical application. Future researche should include monitoring of sustained behavior changes at work, linked to patient outcomes.

Teaching staff in interprofessional education: A proposed terminology

Different terms (e.g., interprofessional, multiprofessional, interdisciplinary) are used in interprofessional education and collaboration without sufficient differentiation or precision in regard to meaning. In recent years academic publications in English and German have contributed to clarifying this issue. However, there are no definitions internationally or in the German-speaking countries (Germany, Austria, Switzerland) specifically referring to the people engaged in teaching interprofessional education. Teaching in interprofessional education has evolved from the traditional role of expert to one of mentor or facilitator. It is also evident that those who teach play a central role in the success of interprofessional courses. While many different designations are used to refer to interprofessional teachers in the relevant literature and in the language of daily use, a uniform and adequate terminology should be used to refer to such teaching staff. Based on literature reviews, this commentary seeks to propose terms for teaching staff active in the area of interprofessional education and thus provide a basis for discussion in the German-speaking countries. Taking the results of the literature analysis and the roles of teachers in interprofessional settings into consideration, we propose that the English term "IP facilitator" (IP for interprofessional) should also be used in the German-speaking world and "facilitateur IP" in the French-speaking world. A French translation is included in attachment 1 to enable broader discussion in Switzerland.

Education for integrated working: A qualitative research study exploring and contextualizing how practitioners learn in practice

Integrated working can be a means of providing efficient and cost-effective care, which benefits both service users and health professionals. However, it does require readiness of practitioners to work in new and innovative ways to achieve integration. This paper describes the findings of a qualitative study exploring the nature of practice-based education and training underpinning successful integrated care teams using an ecological systems theory lens. Nine teams in the West Midlands region of the United Kingdom (UK) participated in this study. A total of 27 participants were involved in semi-structured interviews during which they shared their views and experiences of learning in practice. Thematic analysis of interview transcripts highlighted the shifting context of working in integrated teams impacting on learning, the influence of leadership on education and training, the nature of in-service training, and the knowledge-sharing culture. The findings highlight that the learning climate is highly dependent on the leadership ethos in the practice context, which influences the allocation of time and resources for training and clinical supervision. Whilst formal education and training has an important role to play in fostering integrated working, informal learning is pivotal to successful integration and potentially has greater impact making it worthy of further study.

Mental performance and mental health services in sport: a call for interprofessional competence and collaboration

The provision of holistic care for athletes often involves interprofessional teams with specialists to support athletic performance and overall wellness. Yet, regarding psychological support, some have advocated for a single professional to attain both a certified mental performance consultant (CMPC) credential and any type of mental health license (e.g., Licensed Psychologist [LP], Licensed Social Worker [LSW], or Licensed Professional Counselor [LPC]) to address the mental performance and mental health needs of athletes. Unfortunately, this approach may hinder interprofessional collaboration and ignore distinctions between CMPCS and other types of mental health professionals. Alternatively, CMPCs and various types of mental health professionals may work together on interprofessional psychological support teams. The purpose of this paper is to clarify the distinct historical and theoretical foundations of mental performance consulting, clinical psychology, social work, and professional counseling in sport contexts to serve as a resource for enhancing interprofessional competence within such teams. The distinct training pathways of CMPCs, LPs, LSWs, and LPCs are outlined with attention to how each can serve a valuable role on an interprofessional support team for athletes. Applications of the World Health Organization's framework for interprofessional education and collaborative practice (IPECP) to psychological support teams in sport contexts is discussed.

Insights from healthcare academics on facilitating interprofessional education activities

Facilitators are of paramount importance to the success of interprofessional education (IPE) activities; hence, it is crucial to explore their perspectives and experiences in delivering IPE in Qatar. Using an exploratory case study approach, semi-structured interviews were conducted, in 2018, among faculty members, who had facilitated at least one IPE activity in Qatar, from healthcare professional education programs at Qatar University Colleges of Pharmacy, Medicine, and Health Sciences, Weill Cornell Medicine in Qatar, the University of Calgary in Qatar, and the College of North Atlantic. Interviews were recorded and transcribed verbatim. Inductive thematic content analysis was implemented. Twenty-one interviews were conducted with the following professions represented: medicine (n = 6), pharmacy (n = 5), nursing (n = 4), biomedical science (n = 3), respiratory theory (n = 2) and public health (n = 1). Four main themes emerged from the interviews: drivers to facilitator involvement that included interest and commitment to IPE and awareness of collaborative practice benefits; facilitator participation which was based on facilitator attributes and preparedness and readiness for IPE facilitation; the organizational support in terms of dedicated structure for IPE and IPE design and delivery and; student participation in terms of group dynamics and student engagement. Some key recommendations include having a dedicated unit for IPE, scheduling protected time for IPE, and organizing facilitators' training and debriefing workshops. The facilitators valued and appreciated IPE in preparing students for future collaborative practice. These findings can inform the development of quality and sustainable IPE activities in the future.

The good enough facilitator: exploring online interprofessional therapeutic facilitation in times of COVID-19

In the time of COVID-19, universities have been forced to engage with online learning more than ever before. The facilitator is a key player in the orchestration of online learning and as such, this paper seeks to present a radical reworking of the Garrison and Archer Community of Inquiry model that emphasizes the importance of a therapeutic presence in online interprofessional facilitation. Drawn from a strand of inductive empirical qualitative research based on 15 years' experience of online interprofessional education, this paper employs a therapeutic lens to propose the good enough facilitator as a theoretical construct that emphasizes the importance of the facilitator understanding when to intervene and when to retreat within the online space. Online interprofessional asynchronous discussion groups are explored to illustrate the value of the good enough facilitator in online learning.

Students' perceptions of interprofessional education and collaborative practice: analysis of freehand drawings

There is a global shortage of healthcare professionals, but in the social economic environment of Africa workforce numbers are lower than the global average per head of population. It is argued that interprofessional and collaborative care may offer a solution to this problem, and therefore interprofessional education has become a requirement for accreditation. This paper reports on an innovative initiative of a South African university, which implemented four two-hour education sessions of which the two middle sessions were simulated with standardised patients. The 28 interprofessional student groups each created a freehand drawing of their perception of collaborative practice during the fourth and final session. Four out of the 28 images were randomly selected and analysed according to specified steps by three researchers using qualitative methods. Seven themes emerged, which identify the characteristics and principles of collaborative practice and suggest that culture plays an important role. The findings also reveal the tensions arising from the difficult and uphill battle to attain collaborative practice due to silo based training models, multidisciplinary care, and fragmented healthcare services. Educational planners may need to consider the challenges of implementation of the theory of IPE into the real world of practice as well as how to overcome the hidden cultural issues that may impede success.

Online interprofessional education facilitation: A scoping review

INTRODUCTION

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

AIM

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

METHODS

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

RESULTS

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

DISCUSSION

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

Strategies for interprofessional facilitators and clinical supervisors that may enhance the emotional intelligence of therapy students

Emotional intelligence (EI) is a critical skill for occupational therapy, physiotherapy, and speech pathology students (therapy students). This article reports the findings from an analysis of interviews with therapy students (n = 24) to determine the aspects of clinical placements that therapy students perceived as influencing the changes in EI scores. This article reports the findings of the qualitative phase of a longitudinal, retrospective mixed methods design. Interviewees were selected using purposive sampling. Of those interviewed, 95% agreed that clinical placements had a significant impact on a range of EI skills with changes being both positive and negative. Content analysis showed that students perceived their EI skills had changed because of the following aspects of clinical placements: student-supervisor interactions, student interactions with patients in emotional distress and being encouraged to reflect and hear feedback on their EI skills. To support and enhance student's EI skills, interprofessional facilitators and profession-specific supervisors are recommended to utilise the following strategies with interprofessional cohorts. Supervisors and facilitators should be emotionally in-tune with students and trust students to work autonomously with patients experiencing emotional distress, pain and loss, especially those with complex needs. Importantly, interprofessional facilitators and direct supervisors should encourage students to reflect on their EI skills both individually and as a group. Supervisors should frequently evaluate and provide feedback to students on their EI skills, at the same time as providing feedback on their practical and clinical reasoning skills.

An exploration of teaching presence in online interprofessional education facilitation

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Blurred lines: Emerging practice for registered dietitian-nutritionists in integrative and functional nutrition

BACKGROUND

This study explored the health philosophy and practice orientation of RDNs in the United States.

METHODS

A randomly selected group of RDNs were recruited to take an online survey using a reduced version of Integrative Medicine practice (IM-30). Confirmatory factor analysis, analyses of variance, and non-parametric tests were used to investigate the relationships between dietetic professionals' personal health philosophy, lifestyle, and orientation to Integrative Medicine.

RESULTS

Overall construct validity of the IM-26 scale was demonstrated by Cronbach's α with reliabilities ranging from 0.766 to 0.89. Results from chi-square test of goodness-of-fit test (N = 477, χ2 = 228.72, p = 0.123) and RMSEA of 0.016 showed good model fit. IM orientation varied significantly by work setting and certification in one or more CAM therapies.

CONCLUSIONS

The orientation towards Integrative Medicine for a majority of US dietitians is in the awareness and learning phases of adoption.