Exploring physiotherapy students' experiences of interprofessional collaboration in the clinical setting: a critical incident study

Perceived competences, attitudes, and training needs in conflict management among a cohort of Italian physiotherapists: A cross-sectional survey study

Conflict management is rarely explored among physiotherapists though they often work in teams. Hence, this study explored attitudes, perceived competencies, beliefs, training experiences, and needs in conflict management among Italian physiotherapists. We conducted a cross-sectional online survey study between June and September 2023 among Italian physiotherapists. The survey instrument comprised four sections. Section 1: Socio-Demographic and Professional Data: Explored participant profiles and conflict frequency. Section 2: Attitudes and Competences: assess conflict-related behaviours and management styles (Likert Scale). Section 3: Training Experiences and Needs: Evaluated training importance and conflict-related issues with other professionals (Likert Scale). Section 4: Beliefs About Factors: Participants rated (0-10) factors influencing conflict management and its impact on care and well-being. Descriptive analyses were performed, presenting continuous data as mean (SD) and categorical data as frequencies/percentages. Likert scale responses were dichotomised (agreement/disagreement), and consensus was defined as ≥70% agreement. Median, quartiles, and box-and-whisker plots depicted responses were used for 0-to-10 scales. Physiotherapists (n = 203; mean age: 39±10.40) generally leaned towards a constructive communication style, characterised by compromise and collaboration, viewing conflict management as an opportunity to grow. There was a disparity between their exhibited behaviours and self-assessment of appropriateness in conflict resolution. Only 27.6% considered their conflict resolution skills as satisfactory. However, 85.7% acknowledged the significance of being trained in conflict management. Challenges were evident in conflicts within interprofessional relationships and communication with superiors. Both personal and organisational factors were identified as influencing conflict management, with participants recognising the detrimental impact of conflicts on their well-being and patient care. This study highlighted educational gaps in conflict management among Italian physiotherapists, showing areas of improvement in their training. Our results suggested that physiotherapists might need additional training in conflict management to enhance workplace well-being and the quality of care provided.

Pharmacist trainees narrow scope of interprofessional collaboration and communication in hospital practice

Early curricular exposure to interprofessional education (IPE) is intended to acclimatize health professional trainees to shared-care in the practice settings they will ultimately join. However, IPE activities typically reside outside actual organizational and social systems in which interprofessional care is delivered. We aimed to explore how pharmacist trainees experience collaborator and communicator competency roles during team-based workplace-based learning. Participants maintained written diaries reflecting on interprofessional collaboration and communication during an eight-week hospital clerkship. Diary entries and transcripts from semi-structured follow-up interviews were analyzed from the social constructivist perspective using reflective thematic analysis. Participant accounts of on-ward activities represented most collaborator and communicator roles outlined in pharmacy and interprofessional competency frameworks, but were predominantly between the pharmacist trainee and physicians. Pharmacist trainees did not routinely engage with other health professions on a daily basis. Additionally, reported encounters with other team members were typically information exchanges and not episodes of authentic interdependent or shared care. Interactions were almost completely devoid of perceived interpersonal or role conflict. These findings offer insight into how pharmacist trainees perceive and develop competencies for team-based care. Further work is required to understand how such limited scope of interprofessional communication and collaboration might ultimately impair quality patient care.

Critical Incident Techniques and Reflection in Nursing and Health Professions Education: Systematic Narrative Review

BACKGROUND

The terms critical incident technique and reflection are widely used but often not fully explained, resulting in ambiguity.

PURPOSE

The aims of this review were to map and describe existing approaches to recording or using critical incidents and reflection in nursing and health professions literature over the last decade; identify challenges, facilitating factors, strengths, and weaknesses; and discuss relevance for nursing education.

METHODS

A systematic narrative review was undertaken. MEDLINE and the Cumulative Index to Nursing and Allied Health Literature were searched using MeSH terms, returning 223 articles (2006-2017). After exclusions, 41 were reviewed.

RESULTS

Articles were categorized into 3 areas: descriptions of the development of an original tool or model, critical incidents or reflection on events used as a learning tool, and personal reflections on critical incidents.

CONCLUSIONS

Benefits have been identified in all areas. More attention is needed to the pedagogy of reflection and the role of educators in reflection.

The influence of culture, structure, and human agency on interprofessional learning in a neurosurgical practice learning setting: a case study

The World Health Organization supports the notion that interprofessional learning (IPL) improves healthcare outcomes and contributes to safe, effective, and high-quality care. Consequently, IPL is an integral component within most UK undergraduate healthcare programs. Although much is written about IPL, research to date has mainly focused on the classroom or simulation lab as a setting for IPL. Less is known about how the practice learning environment influences the experiences and outcomes for those involved. A case study research design, situated within a critical realist framework, was undertaken which aimed to better understand how IPL was facilitated for undergraduate healthcare students within a neurosurgical practice learning setting. Interviews, non-participatory observations, and secondary documentary data were used as the methods of data collection to inform the case. Thematic analysis was undertaken, and the findings clustered into overarching themes of culture, structure, and human agency, facilitating a more in-depth exploration of the complex interplay between the factors influencing IPL in the study setting. IPL was supported within the setting which operated as an 'interprofessional community of practice,' facilitating student engagement and investing in its staff for the benefit of the patients who had complex neurological needs. A practice-based IPL Multi-Dimensional Assessment Tool was also created to enable colleagues in practice learning environments worldwide to better understand their capability and capacity for the facilitation of practice-based IPL.

"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.

Defining and understanding the relationship between professional identity and interprofessional responsibility: implications for educating health and social care students

This paper is concerned with exploring the relationship between perceptions of professional identities, interprofessional education (IPE) and collaborative practice. It seeks to introduce the concept of interprofessional responsibility as both a shift in the way in which to conceptualise the professional identity of Health and Social Care (H&SC) staff and as a new set of practices that help to inform the way in which students are prepared for collaborative working. The presented research, undertaken as part of a Ph.D. study, is based upon semi-structured interviews (n = 33) with H&SC staff who were recruited from both the United Kingdom (UK) Health Service and UK universities. Drawing upon thematic analysis of the data, the results of the research identified that previous conceptualisations of professional identity aligned to a whole profession do not relate to the way in which professionals perceive their identities. Senior professionals claimed to be more comfortable with their own professional identity, and with working across professional boundaries, than junior colleagues. Academic staff also identified that much IPE currently taught in universities serves the purpose of box-ticking rather than being delivered in meaningful way. It is proposed that the findings have implications for the way in which IPE is currently taught, and that adoption of the proposed concept of 'interprofessional responsibility' may help address some of the concerns these findings raise.

The Impact of Structured Inter-professional Education on Health Care Professional Students' Perceptions of Collaboration in a Clinical Setting

PURPOSE

To examine how a structured inter-professional education (IPE) clinical placement influences health care professional (HCP) students' perceptions of inter-professional collaboration (IPC) relative to that of students in a traditional clinical placement.

METHODS

This study used a mixed-methods design. The Interdisciplinary Education Perception Scale (IEPS) was administered to HCP students (n=36) in two Toronto hospitals before and after a structured 5-week IPE clinical placement to examine changes in their perceptions of IPC. Students in a traditional clinical placement (n=28) were used as a control group. Focus groups were then conducted with seven students who took part in the structured IPE clinical placement. A coding framework was devised a priori, and the qualitative results were used to explain the quantitative findings.

RESULTS

There were no statistically significant differences between groups after the structured IPE clinical placement, but the intervention group showed a greater positive trend in total IEPS scores from baseline to follow-up. Qualitative data suggest that students valued the knowledge and skills gained through the structured IPE clinical placement.

CONCLUSIONS

Findings suggest that structured IPE clinical placements may provide students with valuable collaborative learning opportunities, enhanced respect for other professionals, and insight into the value of IPC in healthcare delivery. More research is needed to explore other factors that influence specific perceptions among physical therapy students.

Purpose: To examine how a structured inter-professional education (IPE) clinical placement influences health care professional (HCP) students' perceptions of inter-professional collaboration (IPC) relative to that of students in a traditional clinical placement. Methods: This study used a mixed-methods design. The Interdisciplinary Education Perception Scale (IEPS) was administered to HCP students (n=36) in two Toronto hospitals before and after a structured 5-week IPE clinical placement to examine changes in their perceptions of IPC. Students in a traditional clinical placement (n=28) were used as a control group. Focus groups were then conducted with seven students who took part in the structured IPE clinical placement. A coding framework was devised a priori, and the qualitative results were used to explain the quantitative findings. Results: There were no statistically significant differences between groups after the structured IPE clinical placement, but the intervention group showed a greater positive trend in total IEPS scores from baseline to follow-up. Qualitative data suggest that students valued the knowledge and skills gained through the structured IPE clinical placement. Conclusions: Findings suggest that structured IPE clinical placements may provide students with valuable collaborative learning opportunities, enhanced respect for other professionals, and insight into the value of IPC in healthcare delivery. More research is needed to explore other factors that influence specific perceptions among physical therapy students.

Inter-professional Education in the Acute-Care Setting: The Clinical Instructor's Point of View

PURPOSE

The purpose of this study was to gain an understanding of the opportunities and challenges involved in providing clinical inter-professional education (IPE) to physical therapy (PT) students in the acute-care setting from the perspective of PT clinical instructors (CIs).

METHODS

Focus groups were conducted in four acute-care hospitals in Toronto. Participants were recruited using a purposive and convenience sampling approach in order to enhance our understanding of the perceptions of acute-care PT CIs. Eighteen full-time PT CIs with an average of 11 years in practice participated. A constant comparative process was employed to identify recurrent issues and themes within and between groups.

RESULTS

Three main themes emerged from the focus groups: (1) Clinical IPE happens when inter-professional collaboration (IPC) occurs; however, IPC differs according to setting, access to other professions, time, support, and structure. (2) IPE is a lifelong learning process that applies to both CIs and students. (3) Student preparedness is a prerequisite for clinical IPE.

CONCLUSIONS

IPC is an integral part of clinical IPE that requires ongoing commitment and reflection by CIs to ensure that they are ready to instruct students who have some preparation in formal IPE. More knowledge about providing clinical IPE in a structured manner, through academic and health institutions, will allow CIs to become role models for future generations of PT students.

Theoretical insights into interprofessional education: AMEE Guide No. 62

In this Guide, we support the need for theory in the practice of interprofessional education and highlight a range of theories that can be applied to interprofessional education. We specifically discuss the application of theories that support the social dimensions of interprofessional learning and teaching, choosing by way of illustration the theory of social capital, adult learning theory and a sociological perspective of interprofessional education. We introduce some of the key ideas behind each theory and then apply these to a case study about the development and delivery of interprofessional education for pre-registration healthcare sciences students. We suggest a model that assists with the management of the numerous theories potentially available to the interprofessional educator. In this model, context is central and a range of dimensions are presented for the reader to decide which, when, why and how to use a theory. We also present some practical guidelines of how theories may be translated into tangible curriculum opportunities. Using social capital theory, we show how theory can be used to defend and present the benefits of learning in an interprofessional group. We also show how this theory can guide thinking as to how interprofessional learning networks can best be constructed to achieve these benefits. Using adult learning theories, we explore the rationale and importance of problem solving, facilitation and scaffolding in the design of interprofessional curricula. Finally, from a sociological perspective, using Bernstein's concepts of regions and terrains, we explore the concepts of socialisation as a means of understanding the resistance to interprofessional education sometimes experienced by curriculum developers. We advocate for new, parallel ways of viewing professional knowledge and the development of an interprofessional knowledge terrain that is understood and is contributed to by all practitioners and, importantly, is centred on the needs of the patient or client. Through practical application of theory, we anticipate that our readers will be able to reflect and inform their current habitual practices and develop new and innovative ways of perceiving and developing their interprofessional education practice.

Examining international clinical internships for canadian physical therapy students from 1997 to 2007

PURPOSE

To describe international clinical internships (ICIs) for Canadian physical therapy (PT) students, explore the experiences of individuals involved in ICIs, and develop recommendations for future ICIs based on these findings.

METHODS

This study employed a mixed-methods approach. An online questionnaire surveyed academic coordinators of clinical education (ACCEs, n=14) on the availability, destinations, and number of ICIs from 1997 to 2007. Semi-structured telephone interviews were then conducted with eight PT students, seven ACCEs, and three supervising clinicians to investigate their ICI experiences. Interview transcripts were coded descriptively and thematically using NVivo.

RESULTS

ICIs are currently available at 12 of 14 Canadian PT schools. A total of 313 students participated in ICIs in 51 different destination countries from 1997 to 2007. Over this period, increasing numbers of students participated in ICIs and developing countries represented an increasing proportion of ICI destinations. Key themes identified in the interviews were opportunities, challenges, and facilitating factors.

CONCLUSIONS

ICIs present unique opportunities for Canadian PT students. Recommendations to enhance the quality of future ICIs are (1) clearly defined objectives for ICIs, (2) additional follow-up post-ICI, and (3) improved record keeping and sharing of information on ICI destination countries and host sites.

The Leicester Model of Interprofessional education: developing, delivering and learning from student voices for 10 years

There are few sustained interprofessional learning opportunities in practice which engage the whole cohort of health and social care students across a region, the Leicester Model of Interprofessional Education is such an example. Since 1995 the Leicester Model has evolved to enable health and social care students to learn about the complexities of delivering multi-agency care in a range of health and social care settings. The learning environment is situated at the front line of service delivery. The education model takes students through a cycle of learning and applies a problem-solving, experiential learning approach which promotes deep learning. Follow-up data indicates that deep learning is achieved. This paper describes the original setting and presents the evaluation outcomes of the Leicester Model's "Health in the Community" course, which is delivered in city-centre communities, where inequalities in health are greatest. It traces a ten-year trajectory of interprofessional student group evaluations which helped shape this learning experience. Year-on-year positive student outcomes indicate the potential of the model to motivate and prepare future professionals for team working. Its sustainability has been achieved through ensuring the integration of education research in the development process, engagement of practitioners who value the student contributions to team working, placing patients central to the learning experience and establishing working partnerships between Higher Education Institutions, local health and social care organizations and the voluntary sector.