The interprofessional learning experience: Findings from a qualitative study based in an outpatient setting

Healthcare professionals' experiences of required competencies in mentoring of interprofessional students in clinical practice: A systematic review of qualitative studies

AIM

To synthesize evidence on healthcare professionals' experiences of competencies in mentoring undergraduate healthcare, social care and medical students during their interprofessional clinical practice.

DESIGN

This review was conducted by the JBI methodology for systematic reviews of qualitative evidence.

METHODS

Studies were included if they were based on the phenomenon of interest and used qualitative or mixed methods (qualitative share). The included studies were critically appraised using the standardized JBI Critical Appraisal Checklist. Qualitative research findings were extracted and synthesized using the meta-aggregation approach.

DATA SOURCES

Five databases (CINAHL, PubMed, Scopus, Medic and ProQuest) were systematically searched from each database's inception on 28 June 2023.

RESULTS

A total of 5164 studies were initially screened, and 25 were identified for inclusion in this review. Three synthesized findings were identified: competencies related to (1) preparing for and developing interprofessional clinical practice, (2) supporting the learning process in interprofessional clinical practice and (3) creating an interprofessional mentor identity.

CONCLUSION

Although competent mentors are essential to implementing and developing interprofessional clinical practice, some mentors find interprofessional mentoring challenging. High-quality interprofessional mentoring requires specific competence that differs from profession-specific and individual mentoring.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

To ensure that interprofessional clinical practice is of high quality and strengthens students' professional and interprofessional growth, special attention should be given to mentors' interprofessional mentoring competence, and a range of opportunities and organizational structures should be provided for competence development.

IMPACT

This systematic review provides insights into the specific competencies required for interprofessional mentoring. These findings can support healthcare professionals, educators and policymakers in developing interprofessional clinical practice and mentoring competence.

REPORTING METHOD

This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and ENTREQ reporting guidelines. No patient or public contribution.

Exploring experiential learning within interprofessional practice education initiatives for pre-licensure healthcare students: a scoping review

BACKGROUND

Interprofessional collaborative team-based approaches to care in health service delivery has been identified as important to health care reform around the world. Many academic institutions have integrated interprofessional education (IPE) into curricula for pre-licensure students in healthcare disciplines, but few provide formal initiatives for interprofessional practice (IPP). It is recognized that experiential learning (EL) can play a significant role supporting IPP education initiatives; however, little is known of how EL is used within education for IPP in healthcare settings.

METHODS

We conducted a scoping review to map peer-reviewed literature describing IPP education initiatives involving EL for pre-licensure students in healthcare disciplines. A literature search was executed in MEDLINE, CINAHL, EMBASE, ERIC, PsycINFO, Scopus, and Social Services Abstracts. After deduplication, two independent reviewers screened titles and abstracts of 5664 records and then 252 full-text articles that yielded 100 articles for data extraction. Data was extracted using an Excel template, and results synthesized for presentation in narrative and tabular formats.

RESULTS

The 100 included articles represented 12 countries and IPP education initiatives were described in three main typologies of literature - primary research, program descriptions, and program evaluations. Forty-three articles used a theory, framework, or model for design of their initiatives with only eight specific to EL. A variety of teaching and learning strategies were employed, such as small interprofessional groups of students, team huddles, direct provision of care, and reflective activities, but few initiatives utilized a full EL cycle. A range of perspectives and outcomes were evaluated such as student learning outcomes, including competencies associated with IPP, impacts and perceptions of the IPP initiatives, and others such as client satisfaction.

CONCLUSION

Few educational frameworks specific to EL have been used to inform EL teaching and learning strategies to consolidate IPE learning and prepare students for IPP in healthcare settings. Further development and evaluation of existing EL frameworks and models would be beneficial in supporting robust IPP educational initiatives for students in healthcare disciplines. Intentional, thoughtful, and comprehensive use of EL informed by theory can contribute important advances in IPP educational approaches and the preparation of a future health care workforce.

Development of a person-centered caregiver singing model for formal caregivers of people living with dementia in South Africa

This action research study explored the co-design of a person-centered caregiver singing (PCCS) protocol and caregivers' experiences of applying the PCCS intervention with people living with dementia. Eight caregivers across two care homes participated in four iterative cycles aimed at refining the training. Qualitative data collected from semi-structed group interviews, individual interactions and researcher reflections were analysed via thematic analysis which informed the refinements to the training protocol. A Person-Centered Caregiver Singing Model was developed from the thematic findings relating to caregivers' experiences of applying the PCCS intervention: enhanced caregiver capabilities, resident's wellbeing, improved relationship, the positive ecological shift, and ease of caregiving. PCCS fostered caregivers' empathy and self-efficacy, helping them better attune to and meet the needs of people with dementia. Findings suggest music therapists could share music therapy-informed skills with caregivers for use in daily care. Further research would be beneficial to understand the relationship between live music interventions and caregivers' self-efficacy and empathy, and to explore the training barriers in South Africa.

Facilitators and Barriers to Student Learning and Impact of an Undergraduate Clinical Posting in Psychiatry: A Thematic Analysis

BACKGROUND

There is an absence of information on empirical evaluation of undergraduate psychiatry training programs in India. We aimed to evaluate a clinical posting in psychiatry for undergraduate medical students.

METHODS

We employed levels one and two of Kirkpatrick's four-level program evaluation model. The qualitative study used written feedback that was collected using a semistructured questionnaire. For quantitative metrics, we used end-of-posting assessment scores and frequencies of standard comments provided by examiners on case-based discussions with students to evaluate their clinical skills.

RESULTS

We obtained written feedback from 40 female and 19 male fifth-semester students. We identified facilitators (patient interaction, outpatient department observation and teaching, demonstration of signs, case presentation and discussion, evening posting, observation of clinical work, use of anecdotes while teaching, and lectures by senior faculty) and barriers (organizational issues related to evening posting and disinterest in didactic teaching) to the students learning psychiatry, and the perceived impact of the posting for the students (changed attitudes, knowledge, self-efficacy, and skills acquired). The mean total score on case-based discussion, assigned to 22 groups of students, was 3.86 out of 5.

CONCLUSION

We described the impact of the posting and identified unique facilitators and barriers to students' learning in psychiatry. These findings will inform the choice of teaching-learning methods in the context of the new Competency-Based undergraduate Medical Education (CBME) curriculum.

Exploring patient experiences in the student outpatient clinic - A contribution to learning

OBJECTIVE

To understand how patients experience participation in student encounters.

METHODS

Qualitative semi-structured telephone interviews with ten cardiac surgery patients who had attended voluntary postoperative consultations in a student outpatient clinic. The interview guide included questions about reasons for and experiences of being part of a teaching situation. Interviews were analysed through inductive thematic analysis where pieces of text in each interview were assigned different codes and condensed into themes.

RESULTS

The patients expressed a duality in their reasons for participating in student consultations: (1) a personal need for assurance (safety) and (2) a wish to help students (altruism). Students were perceived as professional and sometimes insecure. Being part of an educational situation was meaningful to the patients because they did not feel objectified. Knowing that there was a backup supervisor made the patients feel safe even though the supervisor was not present during all parts of the consultation.

CONCLUSIONS

Patients experienced safety, understood their role in all parts of the consultation, and shared a wish to help students learn.

PRACTICE IMPLICATIONS

A sequential consultation model alternating between student- and supervisor-driven supervision can balance student autonomy and patient safety. This knowledge could guide future patient-centred medical education in student clinics.

Interprofessional versus uniprofessional dyad learning for medical students in a clinical setting

OBJECTIVES

The aim of the present study was to explore and compare medical students' perceived learning outcomes when treating patients under supervision in two different learning settings: a uniprofessional or an interprofessional dyad.

METHODS

The design of the study is a qualitative interview study. Data were collected from October 2016 to June 2017 via semi-structured group interviews performed at the end of the clinical placement in an orthopaedic outpatient clinic for medical students in the last semester of the curriculum. In the placement, the students worked by turns in either a uniprofessional dyad with two medical students or an interprofessional dyad with a nursing student. The data from the interviews were analysed using Systematic Text Analysis.

RESULTS

Overall, 21 students were interviewed. The students appreciated the authenticity of dealing with real patient problems. Both dyads provided the possibility of working as a professional, but the interprofessional dyad had a more authentic setting. In both dyads, the students' interdependence and mutual support promoted the acquisition of knowledge and skills. Working in the interprofessional dyad facilitated relationships between the professions, and the medical students became aware of some of their own profession's strengths and weaknesses. The interprofessional collaboration contributed to different perspectives on the patients' course of treatment and led to a more holistic understanding of the treatment.

CONCLUSIONS

Interprofessional dyads have the potential to improve learning outcomes in the clinical training of medical students. Further studies are needed to explore the benefits across medical specialities and settings.

Patients' experiences of being treated by an interprofessional student team compared with uniprofessional treatment by residents supported by nurses: a case study

Clinical experience, preferably interprofessional, is an important part of health professionals' undergraduate training. In recent years, more and more patient treatment has been moving to outpatient clinics with research suggesting hat this shift is not compromising students' learning outcomes. The purpose of this study was to explore orthopedic outpatients' perceived experiences of being treated by an interprofessional student team consisting of one medical and one nursing student versus being treated by a resident doctor supported by nurses in a uniprofessional setup. We performed an exploratory single case study with two embedded units: 1) a quantitative part with a survey (n = 89) including seven questions and 2) a qualitative part with interviews (n = 46). In the questionnaire, three of the seven questions revealed a significant difference in favor of the student teams. However, the qualitative part of the study did not indicate any differences between the groups. In this study, patients' experiences in an orthopedic outpatient clinic were not influenced by being treated by interprofessional student teams compared to normal patient pathway with registrars and nurses working uniprofessionally. This information is important in designing and implementing student curriculums with clinical training in outpatient clinics. Furthermore, the interprofessional student team can undertake unassisted consultations with selected patients with indirect supervision from the supervisors, making the clinical setting realistic for the students. However, in this teaching model, feedback to the students relies only on the students' written patient records; even if patient satisfaction is high, structured observation of student performance may be necessary as a supplementary teaching tool. This may be incorporated in future studies of patient-student relations in clinical training in an outpatient setting.

Interprofessional pharmacotherapy workshop: intervention to improve health professionals' and students' attitudes towards collaboration between physicians and pharmacists

Collaboration between physicians and pharmacists is recognized as an important factor for reducing medication errors and improving patient outcomes. Therefore, two pharmacotherapy workshops were delivered in Croatia - one for pre-registration medical (n=42, 4th-6th year) and pharmacy (n=38, 4th-5th year) students, and the other one for physicians (n=18) and pharmacists (n=23). The purpose of this study was to determine whether participation in common pharmacotherapy workshop could improve attitudes among participants towards interprofessional collaboration between pharmacists and physicians. Attitudes were measured by validated questionnaire "Scale of Attitudes Towards Collaboration Between Pharmacists and Physicians" at the beginning and at the end of the workshops. Three complex clinical scenarios were presented during the workshops. Participants were given general information about cases (all participants) and 2 groups of specific information (only for medical students/physicians and only for pharmacy students/pharmacists). For the first scenario, medical and pharmacy students/professionals were not allowed to exchange their specific information. However, participants collaborated for the 2nd and 3rd scenarios in order to achieve the hypothesized therapeutic goals. Before the workshops, pharmacists and pharmacy students showed more positive attitudes than physicians and medical students. However, the workshop contributed in closing the gap by equating health care professionals' attitudes. Additionally, students' attitudes were more positive after the workshop with an increase of 10% for medical and 2.2% for pharmacy students. This study indicates that interprofessional pharmacotherapy workshops could significantly improve attitudes toward collaboration between physicians and pharmacists for both students and practicing professionals.

Emotions and clinical learning in an interprofessional outpatient clinic: a focused ethnographic study

During the last decade, there has been a growing recognition that emotions can be of critical importance for students' learning and cognitive development. The aim of this study was to investigate the self-reported and the observed relationship of: activity-, outcome-, epistemic-, and social emotions' role in students' learning in a clinical interprofessional context. We conducted a focused ethnography study of medical and nursing students' clinical placement in an interprofessional orthopaedic outpatient clinic where the students performed consultations with patients, together. We used content analysis to analyse observational notes and interviews. Two themes were identified. First self-regulated learning with two sub-themes: unexpected incident and reflection. The second theme was cooperative learning with three sub-themes: equality, communication, and role distribution. Participants only reported activating emotions. Negative emotions often occurred when the students together experienced an incongruity between their cognitive capability and the type of task. However, because of the possibility for students to call for a supervisor, the negative activating emotions often, in connection with reflection on the incident, resulted in a positive emotion due to the students' awareness of having acquired new knowledge and capability, and thereby, learning. It is important to be aware of the close interplay between emotions and clinical learning in an interprofessional context. The learning environment must include easy access for supervision.