Launching first-year health sciences students into collaborative practice: Highlighting institutional enablers and barriers to success

The interprofessional practice experiences of final-semester prelicensure BSN students completing clinical immersion: A descriptive qualitative study

BACKGROUND

The goal of interprofessional practice experiences in health professions programs is to develop interprofessional collaborative practice skills.

PURPOSE

The purpose of the study was to explore the meaning final-semester Bachelor of Science in Nursing students attributed to interprofessional practice experiences during clinical immersion.

METHODS

The theoretical framework for this descriptive qualitative study was experiential learning theory. A sample of 12 participants was drawn from final-semester prelicensure Bachelor of Science in Nursing students at a college of nursing at a public research university. Data were collected through one-on-one semi-structured interviews and analyzed through inductive thematic analysis.

RESULTS

The analysis yielded four themes: professional and interprofessional identity, working with team members, communication practices, and trusting relationships. Patterns across themes were clinical environment culture, nursing school preparation, nurse preceptor role, fear/concern/worry, and night shift.

CONCLUSION

Consistency in preceptors, welcoming clinical environments, and opportunities to practice communicating with team members contributed to interprofessional collaborative practice skill development and improved perceptions of readiness for practice. Academic and clinical educators may use findings to (a) identify immersion placements for interprofessional practice experiences, (b) design curricula reflective of interprofessional practice, (c) advance teaching strategies to promote interprofessional practice, and (d) create learning environments that aid in professional and interprofessional identity formation.

Enablers and barriers of first-year common semesters and semester-long courses aimed at interprofessional collaborative practice capability development: A scoping review

Designing a first-year undergraduate common semester aimed at developing interprofessional collaborative practice (IPCP) capabilities is challenging. A scoping review was conducted to identify enablers and barriers for common semesters. Due to limited numbers of eligible studies, the review was expanded to include studies of semester-long first-year courses aimed at IPCP development. Key enablers of common semesters or courses in 35 included studies were: real-world, problem-solving, hands-on, interprofessional teamwork aligned with graduate practice capabilities relevant across disciplines; continuous feedback and critical evaluation; relationship building amongst students and staff; cohesive, well-trained interprofessional teams of staff and leaders; secure, supportive institutional policies and structures. Key barriers included: students' lack of preparation, perceptions of irrelevance, and misaligned expectations; variable student capability and response amongst professions; miscommunicated or misaligned course outcomes; course, faculty or institutional non-integration; and cost, logistic, and evaluation issues. Outcomes were mainly positive improvements in self-evaluated student IPCP skills and understanding, variability between professions, and persistent misconceptions. Scales measuring capabilities lacked uniformity, and few studies were comparative or observational. Overall, the review suggests noncompetitive undergraduate first-year common semesters or courses positively impact IPCP capability development when robustly assessed, clearly evaluated, and supported by an integrated IPE culture.

Honors students in the health professions: An academic-practice partnership for developing interprofessional competencies through simulation

Abundant literature supports the value of interprofessional education (IPE) in health profession programs, but few studies focus on undergraduate honors students. The goals of this academic-practice partnership quality improvement project were to increase awareness of IPE, provide experiential opportunities to learn the principles of interprofessional practice, assess perceptions of readiness for practice, and to explore motivations and learning expectations of undergraduate nursing and pre-medical honors students. Average scores on the Readiness for Interprofessional Learning Scale (RIPLS) increased in several areas after the IPE simulation experiences, with small to medium effect sizes (Cohen's d) on individual items and two subscales (Teamwork & Collaboration and Positive Professional Identity). Themes identified in the narrative data were opportunity, fun, self-awareness, situational awareness, and the value of teamwork. These findings add to literature on honor students' expectations and motivations for learning and can be used in designing interprofessional collaborative learning activities for undergraduate health profession students.

Standardized Patient Simulation Using SBIRT (Screening, Brief Intervention, and Referral for Treatment) as a Tool for Interprofessional Learning

Introduction

Substance misuse is a critical social and health care issue, and learning how to effectively screen for misuse and perform a brief intervention is useful for all health care professions. As an intercollegiate, interprofessional group, we developed a mechanism for delivering interprofessional education (IPE) using SBIRT (screening, brief intervention, and referral for treatment) as a tool to identify potential substance misuse.

Methods

A total of 1,255 students from nursing, pharmacy, medicine, physician assistant, social work, dietetics, and occupational therapy programs participated in the training and evaluation of this IPE experience over 2 academic years. The training incorporated asynchronous SBIRT training, in-person student role-plays, and a standardized patient (SP) interaction.

Results

A significant majority of participants indicated that this IPE experience enhanced their interprofessional skills (91%), was useful for interprofessional development (79%), was relevant to their career (92%), and would benefit their clients (93%). Faculty debrief sessions supported the efficacy of SBIRT as a platform for IPE.

Discussion

Students believed that utilizing SBIRT as an interprofessional learning experience enhanced their overall educational experience and assisted with developing interprofessional relationships and that team-based care would lead to improved patient outcomes. Faculty found this learning activity to be effective in developing student insight regarding future professional peers and patient interview skill development through role-plays with peers and SPs.

Moving IPE from being 'worthy' to 'required' in health professional curriculum: Is good governance the missing part?

Introduction: There is an accelerating trend towards interdisciplinary learning and teaching activities in higher education. However, traditional discipline-based approaches to making and implementing decisions (academic governance) can be out of step. Within health professional education, there is a particular need to embrace interdisciplinary approaches to learning in the form of interprofessional education (IPE). The aim of this study was to identify academic governance models that successfully, or otherwise, supported the maintenance of quality standards of IPE programs and learning activities.Method: A 10-year literature search yielded 11 articles that addressed the IPE governance of academic standards.Results: Three models were identified: centralized, decentralized, and stand-alone. Key features of each are described with discussion on strengths and weaknesses for curriculum development, academic leadership and student learning, and the challenges of enabling interprofessional governance within traditional university academic governance structures.Conclusion: As with interdisciplinary education more broadly, there is emerging literature regarding effective governance systems to enable quality IPE within individual institutions. Educators should give careful consideration to the optimal governance model for their particular institution and context.

Longitudinal evaluation of attitudes to interprofessional collaboration: time for a change?

Longitudinal evaluation of interprofessional programming is necessary to understand the impact of interprofessional education (IPE) for collaborative practice. Attitude is one measure of intended behavior. The Interprofessional Attitude Scale (IPAS) was developed as an improved measure to examine the readiness for interprofessional education and collaborative practice. As a means to pilot a protocol for a longitudinal comprehensive evaluation of an interprofessional program with 13 health professional programs in 6 health science faculties, the IPAS was administered over a 3-year period to three cohorts of students. The results of the IPAS indicated no significant differences detected across the 3 years. Although there was a significant difference on the Patient Centredness subscale for Cohorts 2 and 3 the effect size was small. Previous experience in an interprofessional course was a predictor of more positive patient centeredness attitudes, but other IPE experience and years of education were not predictors of any interprofessional attitudes. Students from the Medicine & Dentistry (M&D) faculty ranked significantly lower on the teamwork roles and responsibilities subscale compared to the other faculties, except Rehabilitation Medicine (RM). However, once the outliers in RM were removed, there was a significant difference on this subscale between RM and M&D. This paper outlines the challenges with using the IPAS as part of a comprehensive program evaluation and identifies issues with longitudinal data collection for evaluation with large student cohorts.

"Getting Out of That Siloed Mentality Early": Interprofessional Learning in a Longitudinal Placement for Early Medical Students

PURPOSE

Although descriptions of interprofessional education often focus on interactions among students from multiple professions, embedding students from 1 profession in clinical settings may also provide rich opportunities for interprofessional learning (IPL). This study examines affordances and barriers to medical students' interactions with and opportunities to learn from health care professionals while learning health systems science in clinical workplaces.

METHOD

In May 2017, 14 first-year medical students at the University of California, San Francisco participated in a semistructured interview about IPL experiences during a 17-month, weekly half-day clinical microsystem placement focused on systems improvement (SI) projects and clinical skills. Communities of practice and workplace learning frameworks informed the interview guide. The authors analyzed interview transcripts using conventional qualitative content analysis.

RESULTS

The authors found much variation among the 14 students' interprofessional interactions and experiences in 12 placement sites (7 outpatient, 4 inpatient, 1 emergency department). Factors influencing the depth of interprofessional interactions included the nature of the SI project, clinical workflow, student and staff schedules, workplace culture, and faculty coach facilitation of interprofessional interactions. Although all students endorsed the value of learning about and from diverse health care professionals, they were reluctant to engage with, or "burden," them.

CONCLUSIONS

There are significant IPL opportunities for early medical students in longitudinal placements focused on SI and clinical skills. Formal curricular activities, SI projects conducive to interprofessional interactions, and faculty development can enhance the quality of workplace-based IPL.