Determining the impact of an interprofessional learning in practice model on learners and patients

A scoping review of interprofessional education in healthcare: evaluating competency development, educational outcomes and challenges

BACKGROUND

Interprofessional education (IPE) is essential in healthcare to enhance collaboration, communication and teamwork among health professions education students. This review aimed to map out the core competencies health professions education students develop during IPE and identify the positive and negative educational outcomes.

METHODS

A comprehensive search strategy was developed and reported in accordance with the PRISMA ScR guidelines. The search was conducted across five electronic databases (Medline, Scopus, Web of Science, PsycINFO and EBSCO) for peer-reviewed articles published in English within the last 20 years. Data was extracted and core competencies were categorised into four defined areas-roles and responsibilities; interprofessional communication; values for interprofessional practice; teams and teamwork. The frequency of occurrence of each core competency, along with the positive and negative outcomes of IPE were analysed. Mixed methods analysis was used to integrate both qualitative and quantitative data.

RESULTS

Team and teamwork emerged as the most frequently attained core competency in IPE. The positive impacts of IPE include significant improvements in role clarity, communication skills, and teamwork dynamics. However, negative impacts were also noted, such as logistical challenges and interpersonal issues like power dynamics and communication barriers, which impeded the personal professional growth and professional interactional skill-related benefits of IPE. Additionally, some participants reported feeling overwhelmed by the extra workload required for IPE activities.

CONCLUSION

IPE is a valuable component of health professions education, significantly contributing to the development of core competencies necessary for interprofessional collaborative practice. Addressing the challenges and implementing best practices can further enhance the effectiveness of IPE programs, ultimately improving healthcare outcomes. The implications for practice, training of healthcare students and future research are discussed.

Nursing students' perceived ability to practice interprofessional collaboration after the inclusion of virtual and immersion interprofessional education activities: A quantitative exploration

BACKGROUND

Little is known about the influence of interprofessional education (IPE) on interprofessional collaboration (IPC), particularly following the COVID 19 pandemic.

AIM

To examine nursing students' perceived ability to practice IPC after exposure to virtual lectures and immersive clinical IPE activities founded on the competencies from the National Interprofessional Competency Framework.

DESIGN

A cross-sectional design was used.

METHODS

Third year nursing students (n=105) enrolled in a pediatric theory and clinical completed surveys including: Demographic items, the revised Interprofessional Collaborative Competency Attainment Survey (ICCAS) and the Interprofessional Education Collaborative Competency Self-Assessment (IPEC) (Version 3). Students completed reflective questions about their IPE experiences. Descriptive statistics, paired t-tests, confidence intervals, and point estimates were used to measure the differences from pre- to post-participation for all items of the ICCAS and IPEC.

RESULTS

Participants reported improved IPC competence on every item and overall, after the IPE activities. Participants from urban campuses had lower ICCAS scores (PE 0.38, 95 % CI, 0.12-0.65) than those from rural campuses (PE 0.45 95 % CI, 0.18-0.72). Students who identified as men had higher team functioning scores before participating in the IPE activities than women (PE 0.50; 95 % CI,: 0.05-0.95). The IPEC Interaction items mean score was 4.03 ±.50 and IPE values items were higher with a mean of 4.62 ± 0.46.

CONCLUSIONS

The findings can guide development and implementation of IPE experiences for nursing and allied healthcare students.

The Effect of Interprofessional Education on Student Readiness for Collaborative Practice

BACKGROUND

Health care reform promotes interprofessional patient-centric health care models associated with improved population health outcomes. Interprofessional education (IPE) programs are necessary to cultivate collaborative care, yet little evidence exists to support IPE pedagogy within nursing and other health science academia.

METHOD

This quasiexperimental study examined differences in pre- and posttest Readiness for Interprofessional Learning Scale (RIPLS) scores following an IPE intervention. The IPE intervention consisted of a video presentation and a debriefing session after a simulated interprofessional collaborative patient care conference that introduced baccalaureate nursing and health science students to the roles and responsibilities of clinicians in team-based primary care. Pre- and postintervention RIPLS scores were analyzed.

RESULTS

Pre- and postintervention RIPLS scores increased across all subscales, with distinct variation between nursing and health science student subscales.

CONCLUSION

This IPE intervention had positive effects on students' readiness for interprofessional learning. Additional research is warranted to support health science pedagogy. [J Nurs Educ. 2024;63(5):304-311.].

Describing the evidence linking interprofessional education interventions to improving the delivery of safe and effective patient care: a scoping review

Empirical evidence indicates that collaborative interprofessional practice leads to positive health outcomes. Further, there is an abundance of evidence examining student and/or faculty perceptions of learning or satisfaction about the interprofessional education (IPE) learning experience. However, there is a dearth of research linking IPE interventions to patient outcomes. The objective of this scoping review was to describe and summarize the evidence linking IPE interventions to the delivery of effective patient care. A three-step search strategy was utilized for this review with articles that met the following criteria: publications dated 2015-2020 using qualitative, quantitative or mixed methods; the inclusion of healthcare professionals, students, or practitioners who had experienced IPE or training that included at least two collaborators within coursework or other professional education; and at least one of ten Centers for Medicare & Medicaid Services quality measures (length of stay, medication errors, medical errors, patient satisfaction scores, medication adherence, patient and caregiver education, hospice usage, mortality, infection rates, and readmission rates). Overall, n=94 articles were identified, providing overwhelming evidence supporting a positive relationship between IPE interventions and several key quality health measures including length of stay, medical errors, patient satisfaction, patient or caregiver education, and mortality. Findings from this scoping review suggest a critical need for the development, implementation, and evaluation of IPE interventions to improve patient outcomes.

From the Nexus vision to the NexusIPE™ learning model

The Nexus vision of simultaneously transforming health professions education and healthcare delivery to achieve Triple (now Quadruple) Aim outcomes was first articulated in the 2012 proposal and funding of the National Center for Interprofessional Practice and Education (National Center). Over the past decade, the National Center has worked with over 70 sites implementing large scale and practice-based interprofessional practice and education (IPE) programs. Because what is needed to implement the Nexus to achieve Quadruple Aim outcomes was not well understood in 2012, the National Center took a social innovations and developmental evaluation approach. This iterative method led to the development of the National Center NexusIPE™ Learning Model that adapts the 3-P high-level stages (Presage, Process, and Product), proposed as a framework for IPE by Barr and colleagues. National Center collaborators' lessons learned about the Nexus vision are highlighted in this issue and provide real-world examples of elements of the NexusIPETM Learning Model. Reflecting on ten years of experience, the National Center leaders recognize the need for Nexus transformation and the relevance of the NexusIPETM Learning Model today as education and health systems grapple with mounting workforce challenges. The model provides opportunities to address growing workforce shortages, provide equitable care that leads to health, and support the well-being of practice teams in the face of challenges such as the COVID-19 pandemic.

Introspective Learning From Interprofessional Virtual Grand Rounds

BACKGROUND

Interprofessional collaboration in health care settings improves patient safety and outcomes, yet collaboration among health professionals requires specific competencies and skills. Providing nursing students with interprofessional learning experiences with multiple health professions is possible yet challenging.

PROBLEM

Opportunities for effective online interprofessional learning are lacking.

APPROACH

This article explores nursing students' reflections on how an interprofessional learning experience, Virtual Grand Rounds (VGRs), influenced their personal development and provided meaningful learning that they can use in their practices as professional nurses. Thematic analysis was done on the open-ended questions in students' final reflection assignment.

OUTCOMES

Analysis of student reflections identified 5 learning themes including the value of teamwork and collaboration, the importance of communication skills, professional identity, plans to engage diverse health professions, and the desire for future learning.

CONCLUSIONS

Student reflections indicate the VGR was an effective method for nursing students to experience collaboration with multiple health professions without disrupting curriculums.

Measuring Interprofessional Collaboration's Impact on Healthcare Services Using the Quadruple Aim Framework: A Protocol Paper

Despite decades of research on the impact of interprofessional collaboration (IPC), we still lack definitive proof that team-based care can lead to a tangible effect on healthcare outcomes. Without return on investment (ROI) evidence, healthcare leaders cannot justifiably throw their weight behind IPC, and the institutional push for healthcare manpower reforms crucial for facilitating IPC will remain variable and fragmentary. The lack of proof for the ROI of IPC is likely due to a lack of a unifying conceptual framework and the over-reliance on the single-method study design. To address the gaps, this paper describes a protocol which uses as a framework the Quadruple Aim which examines the ROI of IPC using four dimensions: patient outcomes, patient experience, provider well-being, and cost of care. A multimethod approach is proposed whereby patient outcomes are measured using quantitative methods, and patient experience and provider well-being are assessed using qualitative methods. Healthcare costs will be calculated using the time-driven activity-based costing methodology. The study is set in a Singapore-based national and regional center that takes care of patients with neurological issues.

Existing models of interprofessional collaborative practice in primary healthcare: a scoping review

Educating students to provide interprofessional collaborative practice (IPCP) in primary healthcare (PHC) requires a robust rigorous model relevant to future practice. A scoping review was undertaken to identify existing models of IPCP in PHC, the interprofessional or collaborative theories on which the models were based, reported outcomes, and enablers of and barriers to IPCP in PHC. The 35 eligible studies included 27 models, most of which were designed for a specific PHC site or program. Although almost half of the studies cited established interprofessional competencies in support of the models, only 13 included theoretical support, and only two cited interprofessional theory. Outcomes for clients, practitioners, practices, and students were primarily experiential and positive. A few researchers reported negative experiences or no difference between comparison groups. Key enablers of IPCP in PHC were strong supportive, inclusive relationships and practices. The most common barriers were time and resource constraints and poor understanding of IPCP. The review suggests a need for a stronger theoretical basis for IPCP in PHC that can accommodate different settings, and for more observational research that links relationship factors to outcomes at the practice, population, and wider health system levels.

An Experimental Education Project for Consultations of Older Adults during the Pandemic and Healthcare Lockdown

Objective: To develop a mentor-supervised, interprofessional, geriatric telemedicine experiential education project in response to the COVID-19 pandemic. Method: Medical and pharmacy students collaborated via remote consultations to address the coexistence of multimorbidity and polypharmacy in geriatric patients. In-depth interviews of students and patients as well as Likert scale-based telephonic survey were performed for a comprehensive evaluation of the project’s significance. Results: To date, 49 consultations have been conducted. Remote consultations performed by medical and pharmacy students working collaboratively were beneficial for both students, participants. Conclusions and Practice Implications: This experimental education project provided students with authentic challenges while simultaneously delivering care to the older adults who are susceptible to disruption of care associated with the pandemic. Further development and expanded implementation of such approaches may be a post-pandemic practice to provide more accessible care for senior patients while incorporating interprofessional education.

Using community pharmacies and team observed structured clinical encounters (TOSCEs) for interprofessional education and training

INTRODUCTION

Collaborative practice improves patient outcomes and is a needed student skill. An interprofessional education and collaborative practice (IPECP) program was developed using community pharmacies, clinics, and emergency departments. This study's purpose was to assess student pharmacists' team attitudes and skill development after the IPECP using team observed structured clinical encounters (TOSCEs).

METHODS

Nineteen pairs of fourth-year pharmacy and second-year physician assistant students practiced together in a community pharmacy (two days) and clinic or emergency department (two days). They completed TeamSTEPPS training and two team modules. Assessments included TOSCEs and pre/post attitude surveys.

RESULTS

Students significantly increased all TOSCE domain skills with pre- to post-mean score (SD) of: team communications 3.0 (0.5) to 4.1 (0.5), collaboration 2.8 (0.6) to 4.0 (0.5), roles and responsibilities 2.4 (0.4) to 3.8 (0.5), patient-centered care 2.8 (0.5) to 4.1 (0.6), conflict management 2.8 (0.5) to 4.1 (0.6), team functioning 2.7 (0.6) to 3.9 (0.6), and global performance 2.8 (0.6) to 4.0 (0.5). Afterwards, students reported positive attitudes about team-based patient care. All students stated the experience increased patient and healthcare professional communication skills and understanding of patient problems, and decreased errors. Most students (84%) agreed team care increased interventions compared to individually provided care. Most students (84%) thought the experience was worthwhile, and 68% agreed the IPECP program should be continued.

CONCLUSIONS

This study supports that IPECP can be conducted in a community pharmacy and clinic or emergency department to improve student team skills as evidenced by documented team skills development during TOSCEs.

Feasibility of Interprofessional Education in a Community Pharmacy

OBJECTIVE

To evaluate student learning, preceptor opinions, and feasibility of conducting interprofessional education in a community pharmacy.

METHODS

Six pharmacy and 6 physician assistant students from 2 universities were paired to practice together in a community pharmacy for 1 day and clinic or emergency department for 1 day. Investigator-developed surveys were completed anonymously by students and preceptors. Students self-assessed learning and team attitudes. Preceptors evaluated team functioning and provided feedback. Students and preceptors attended separate focus groups to discuss their experiences.

RESULTS

Students reported improved understanding of discipline-specific roles. Students stated shared learning would improve future ability to work on a team (n = 9), helped with understanding patients' clinical problems (n = 8), and improved professional communications (n = 8). Students thought teams avoided healthcare delivery errors (n = 12), improved patient care (n = 11), increased efficiency (n = 8), and increased interventions (n = 7) compared to solo practice. Some students (n = 6) felt preceptors did not provide enough feedback. Students and preceptors stated the project should be continued. Students suggested improving orientation by including team functioning expectations and insuring patient availability for medication therapy management reviews. Preceptors wanted more training on providing team feedback and thought the experience should be longer to accommodate physician assistant student orientation to pharmacy operations.

CONCLUSIONS

Interprofessional education in a community pharmacy was feasible and resulted in students learning about discipline roles, team functioning, and team care. Additional training and orientation for both students and preceptors are needed. More than 1 day at each practice site is needed to enhance interprofessional learning and skills.

Evaluation Tools for Interdisciplinary Palliative Care Learning Experiences: A Literature Review

Background: An interdisciplinary palliative care team began exploring evaluation tools used to assess changes in the knowledge, skills, and attitudes of learners participating in clinical learning experiences on an interdisciplinary palliative care consult service. This article will review existing evaluation tools, examine the themes that emerge, discuss their strengths and limitations, and make recommendations for continued development in the field. Methods and Findings: A literature search was performed using the MEDLINE database. Search terms included combinations of the following: interdisciplinary education, assessment/evaluation, and palliative care or palliative care assessment/test. Four hundred eighty-seven articles were captured during the initial search. Articles that focused on student readiness for interdisciplinary education and team self-assessments of current interdisciplinary collaboration practices were excluded. Nine articles were included in the review. Evaluation tools varied in terms of learner type, assessment type, and frequency. No tool was comprehensive in the assessment of knowledge, skills, and attitudes or truly interdisciplinary. Conclusions: There is a lack of comprehensive and interdisciplinary evaluation tools in the published literature. Further research should be conducted to develop a tool that meets the needs of learners in clinical experiences within an interdisciplinary service.

The state of the science of interprofessional collaborative practice: A scoping review of the patient health-related outcomes based literature published between 2010 and 2018

INTRODUCTION

If interprofessional collaborative practice is to be an important component of healthcare reform, then an evidentiary base connecting interprofessional education to interprofessional practice with significantly improved health and healthcare outcomes is an unconditional necessity. This study is a scoping review of the current peer reviewed literature linking interprofessional collaborative care and interprofessional collaborative practice to clearly identified healthcare and/or patient health-related outcomes. The research question for this review was: What does the evidence from the past decade reveal about the impact of Interprofessional collaborative practice on patient-related outcomes in the US healthcare system?

MATERIALS AND METHODS

A modified preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach was followed.

RESULTS

Of an initial 375 articles retrieved 20 met review criteria. The most common professions represented in the studies reviewed were physicians, pharmacists and nurses. Primary care was the most common care delivery setting and measures related to chronic disease the most commonly measured outcomes. No study identified negative impacts of interprofessional collaborative practice. Eight outcome categories emerged from a content analysis of the findings of the reviewed studies.

CONCLUSIONS

The results suggest a need for more research on the measurable impact of interprofessional collaborative practice and/or care on patient health-related outcomes to further document its benefits and to explore the models, systems and nature of collaborations that best improve population health, increase patient satisfaction, and reduce cost of care.

Scoping Pharmacy Students' Learning Outcomes: Where Do We Stand?

Background: The professional abilities of graduate pharmacists have been associated with pharmacy undergraduates’ educational settings and features. This study aimed to perform a scoping review on how students’ learning outcomes are achieved, including learning assessment strategies, focusing on current pharmacy practice education. Methods: Relevant keywords, e.g., “pharmacy practice”, “(students or undergraduates)” and “outcomes” were browsed in Public/Publisher MEDLINE, Scientific Electronic Library Online, Directory of Open Access Journals, and other relevant databases for recently published sources (2018 and 2017). Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria were followed to assure the scoping quality. All types of students’ learning outcomes were addressed for indexed publications in English, Portuguese or Spanish. Reviews, descriptive studies and commentaries were excluded. Study data are presented in tables comprising objectives, methods, number of participants and main research findings. Results: Overall, 100 studies were identified and 22 were selected. The selected studies were distributed into seven main topics: real practices (n = 9); active-learning strategies (n = 5); comparisons between different teaching pedagogies (n = 3); pharmacy curriculum (n = 2); and other evaluations (n = 3). Conclusions: Studies on pharmacy students’ learning outcomes are limited. Pharmacy undergraduates’ performance was dependent on the learning strategies and extension of syllabus implementation.