Changing dominance in mixed profession groups: putting theory into practice

Clinician experience of being interprofessional: an interpretive phenomenological analysis

Clinicians are increasingly required to work and learn interprofessionally, yet few studies explore the nature of being interprofessional. The purpose of this study was to explore the lived experience of clinicians who identify as interprofessional or have an interprofessional identity. Interpretive phenomenological analysis (IPA) was applied as a qualitative research approach and analytical method. Fifteen key informants from a range of professions, settings, and roles were recruited via purposive sampling. Data was collected via semi-structured interviews, observation of participants' day-to-day practice, and review of organizational documents, and analyzed using IPA. Six interdependent Group Experiential Themes were developed: (i) The power of person-centered holistic care, (ii) Learning and growth through curiosity, reflection, and willingness to be vulnerable, (iii) Welcomes, values, and empowers all others, (iv) Trust and mutual respect through belonging and connection, (v) The contribution of background and previous experiences, and (vi) The influence of workplace context. Each Group Experiential Theme had between two and nine sub-themes. Results support the value of understanding and making explicit the concepts that comprise clinician interprofessional identity. The findings can be used to support clinicians, educators, leaders, and policy makers to develop and sustain interprofessional identity, and subsequently cultivate a culture of interprofessional collaborative practice. Future research is needed to further explore the themes, investigate their inter-relationships, and present the concepts that comprise clinician interprofessional identity in a way that is accessible to healthcare professionals and facilitates their integration into practice.

EPIS-RI: Indonesian translation, cultural adaptation and construct validation of an interprofessional identity measure

Interprofessional Education (IPE) as a preparatory stage for Interprofessional collaboration (IPC) is overlooked in some low-and middle-income countries, including Indonesia. One of the driving forces behind IPC is the development of Interprofessional Identity (IPI), which has yet to be assessed in the Indonesian context. Our study aims were translating and culturally adapting the Extended Professional Identity Scale (EPIS) and confirming its construct validity. We invited third-year students from three programs (medicine, nursing, and dietetics) without previous IPE experience to participate in the study. Using Confirmatory Factor Analysis (CFA), we examined the construct validity, analyzed internal consistency, and conducted a Kruskal-Wallis test to identify variations across professions. Of 513 students approached, 335 participated (response rate 65.3%). The CFA showed factor loadings ranging between .59 and .86, while correlations among subscales varied from .55 to .86. All five goodness-of-fit indices were sufficient. The internal consistency of subscales interprofessional belonging, commitment, and beliefs was .82, .84 and .87, respectively, and .90 for the overall scale. Interprofessional belonging and commitment were different among various students (p-value = .009 and .004) and the dietetics students had lower scores than other students. The Indonesian EPIS (EPIS-RI) demonstrated reliability and construct validity.

Interprofessional socialization of first-year medical and midwifery students: effects of an ultra-brief anatomy training

BACKGROUND

Interprofessionalism is considered a key component in modern health profession education. Nevertheless, there remains ongoing debate about when and where to introduce interprofessional trainings in the curriculum. We identified anatomy, a subject commonly shared among health professionals, as a practical choice for initiating early intergroup-contact between first-year medical and midwifery students. Our study examined the effects of a four-hour block course in anatomy on interprofessional socialization and valuing, as well as long-term effects on intergroup contact.

METHODS

Based on different concepts and theories of learning, we implemented 12 interprofessional learning stations. Several measures were taken to foster group cohesion: (1) self-directed working in interprofessional tandems on authentic obstetric tasks, (2) competing with other tandems, (3) creating positive interdependencies during task completion, and (4) allowing room for networking. In a pre-post design with a three-month follow-up, we assessed the outcomes of this ultra-brief training with qualitative essays and quantitative scales.

RESULTS

After training, both groups improved in interprofessionalism scores with strong effect sizes, mean difference in ISVS-21 = 0.303 [95% CI: 0.120, 0.487], P < .001, η² = 0.171, while the scales measuring uniprofessional identity were unaffected, mean difference in MCPIS = 0.033 [95% CI: -0.236, 0.249], P = .789. A follow-up indicated that these positive short-term effects on the ISVS-21 scale diminished after 12 weeks to baseline levels, yet, positive intergroup contact was still reported. The qualitative findings revealed that, at this initial stage of their professional identity development, both medical and midwifery students considered interprofessionalism, teamwork and social competencies to be of importance for their future careers.

CONCLUSION

This study advocates for an early implementation of interprofessional learning objectives in anatomical curricula. Young health profession students are receptive to interprofessional collaboration at this initial stage of their professional identity and derive strong advantages from a concise training approach. Yet, maintaining these gains over time may require ongoing support and reinforcement, such as through longitudinal curricula. We believe that an interprofessional socialization at an early stage can help break down barriers, and help to avoid conflicts that may arise during traditional monoprofessional curricula.

Evaluation of a newly developed flipped-classroom course on interprofessional practice in health care for medical students

Interprofessional education is expected to promote collaborative practice and should therefore be included in health professionals' curricula. Reports on interprofessional curricular development and its evaluation are rare. We therefore undertook a comprehensive quantitative and qualitative evaluation of a new, mandatory course on interprofessional collaboration for medical students during their third year of the Bachelor of Medicine study programme. The newly developed and implemented course spans over six weeks and was designed in a hybrid, flipped-classroom format. It incorporates experience- and case-based learning as well as interactions with other health professionals. Each student completes an eLearning and a clinical workshadowing individually before attending the - due to the pandemic - virtual live lectures. To assess quality and usefulness of teaching-learning formats and course structure to learn about interprofessional collaboration and to develop interprofessional competencies and identity, a quantitative and qualitative evaluation was performed with more than 280 medical students and 26 nurse educators from teaching hospitals using online surveys (open & closed-ended format). Data were analyzed descriptively and using content analysis processes. Students appreciated the flipped-classroom concept, the real-world case-based learning scenarios with interprofessional lecturer teams, and the possibility of an experience-based learning opportunity in the clinical setting including interaction with students and professionals from other health professions. Interprofessional identity did not change during the course. Evaluation data showed that the course is a promising approach for teaching-learning interprofessional competencies to medical students. The evaluation revealed three factors that determined the success of this course, namely, a flipped-classroom concept, the individual workshadowing of medical students with another health professional, mainly nurses, and live sessions with interprofessional teaching-learning teams. The course structure and teaching-learning methods showed potential and could serve as a template for interprofessional course development in other institutions and on other course topics.

Interprofessional identity and motivation towards interprofessional collaboration

INTRODUCTION

It is unknown whether interprofessional identity is able to explain interprofessional behaviours. Extended professional identity theory provides clues by combining two psychological identity approaches. The aim of this study is to investigate whether interprofessional identity is a source for intrinsic motivation towards interprofessional collaboration related to wider group membership.

METHODS

Participants of this double-blinded study were 47 dentistry and 41 dental hygiene students (86.3% response) without interprofessional education (IPE) experience. Group productivity was used as indicator of group effort and equal communication as indication for interprofessional direction. The extended professional identity scale (EPIS) was used to measure interprofessional identity eight weeks prior to a mandatory IPE course. Based on EPIS levels, students were assigned to a low or high interprofessional identity group condition. Subsequently, 12 interprofessional teams (four to five members) were randomly composed per condition. Each group received eight problems (regarding roles, responsibilities and collaborative practice) for which they were expected to provide up to 10 solutions. Six trained psychologists rated the validity of solutions after which the percentage of solutions per group was calculated. Additionally, the psychologists rated interprofessional direction by observing team communication (asking questions, topic control, prosocial formulations, and speech frequency) during the second group meeting.

RESULTS

No interprofessional identity differences were found with regard to gender and profession. The mean difference between groups with low versus high interprofessional identity was 0.5 (M = 3.4; SD = 0.5 and M = 3.9, SD = 0.4, respectively), t = -5.880, p < 0.001. Groups with high identity generated more solutions compared to low identity groups (91.5% vs. 86.4%), t = -2938, p = 0.004. The correlation between individual interprofessional identity and group effort was significant, r = 0.22, p = 0.036. Groups with high identity showed more interprofessional direction, t = -2.160, p = 0.034.

DISCUSSION

Interprofessional identity has a positive effect on congruent interprofessional behaviours after 10 weeks. More research is required to understand interprofessional identity in relation to performance in education and work.

Interprofessional learning in a student-run dental clinic: The effect on attitudes of students in oral healthcare

The purpose of this study was to gain insight into change in attitudes held by students in oral healthcare about interprofessional learning and collaboration after one year of work in a student-run dental clinic (SRDC). Third- and fourth-year bachelor of dental hygiene students (n = 221) and first- and second-year master of dentistry students (n = 203) participated in baseline and follow-up measurements and completed 570 questionnaires. The Readiness for Interprofessional Learning Scale (RIPLS) was used to measure changes in attitudes toward Interprofessional Education (IPE) during participation in the SRDC. To validate the questionnaire for the setting, professional groups, and wording of RIPLS, we performed exploratory and confirmatory factor analyses. Two modified subscales remained: "Teamwork & Collaboration" and "Negative Professional Identity." Mixed linear models were used to assess relationships between students' attitudes toward IPE and participation in the SRDC. Overall, the students had positive attitudes toward IPE. At baseline, the attitudes of the dental hygiene and dentistry students were almost equally positive. After one year, dental hygiene students demonstrated a significantly more positive attitude toward collaborative learning and teamwork than the dentistry students. Further research should investigate whether the positive attitudes impact behavior in professional practice.

Interprofessional Identity in Health and Social Care: Analysis and Synthesis of the Assumptions and Conceptions in the Literature

Interprofessional identity (IPI) development is considered essential in reducing incongruency and improving interprofessional collaboration. However, noticeable differences in conceptualizations are being put forward in the literature, hindering interpretation of research findings and translation into practice. Therefore, a Concept Analysis and Critical Interpretative Synthesis of empirical research articles were conducted to explore the assumptions and conceptions of IPI. Independent literature screening by two researchers led to the inclusion and extraction of 39 out of 1334 articles. Through critical analysis, higher order themes were constructed and translated to a synthesizing argument and a conceptual framework depicting what constitutes IPI (attributes), the boundary conditions (antecedents) and the outcomes (consequences) of its development. The attributes refer to both IPI's structural properties and the core beliefs indicative of an interprofessional orientation. The antecedents inform us on the importance of IPI-fitting constructivist learning environments and intergroup leadership in enabling its development. This development may lead to several consequences with regard to professional wellbeing, team effectiveness and the quintuple aim. Given the educational orientation of this study, ways for facilitating and assessing the development of IPI among learners across the professional continuum have been proposed, although empirical research is needed to further validate links and mediating and moderating variables.

Interprofessional identity in clinicians: A scoping review

Interprofessional collaborative practice (IPCP) has been recognized as invaluable in delivering safe, high-quality patient care with finite resources. However, despite a decade of advances in interprofessional (IP) research, policy, and competency frameworks, IPCP does not always occur in practice. One reason may be the influence of a clinician's identity in an IP context. The purpose of this scoping review was to understand the nature of IP identity in healthcare clinicians. The PRISMA framework was used to support a comprehensive search strategy and screening of 1746 articles. Inclusion criteria included original research, theses, and reviews, a primary focus on IP identity or professional identity (PI) in an IP team, and a focus on health professionals, including students transitioning to practice. Ninety-five papers met the eligibility criteria, though once charted, just four of the 95 papers focused on IP identity in clinicians. Three further papers examined shared team identity, 25 papers referred to, but did not focus on IP identity, and the remaining 63 papers explored PI in an IP team. While limited studies on clinician IP identity restrict conclusive findings, patterns were identified to direct further research on the nature of IP identity in clinicians. These include values and beliefs, individual and personal factors, profession and professional experience, education, socialization, context, leadership, and the process of IP identity development. While identity is undeniably central to being a clinician, the values, beliefs, attributes, and experiences that contribute to clinician IP identity, how clinician IP identity develops, and factors that influence IP identity remain unclear. The results of this review highlight the value of further investigation of the nature of IP identity, the interplay between PI and IP identity, and identity in an IP context.

Interprofessional Treatment of Malnutrition and Sarcopenia by Dietitians and Physiotherapists: Exploring Attitudes, Interprofessional Identity, Facilitators, Barriers, and Occurrence

Purpose

Malnutrition and sarcopenia require dietetic and physiotherapy interventions. In this study, we aimed to compare interprofessional identity of dietitians and physiotherapists, as well as attitudes towards, facilitators and barriers for, and occurrence of interprofessional treatment of malnutrition and sarcopenia by both professions.

Methods

A cross-sectional online survey was distributed from December 4, 2021 until January 31, 2022 through an international online network platform for professionals (LinkedIn). Practitioners working as dietitian or physiotherapist in a healthcare setting were eligible for participation. Outcome measures concerned perceptions regarding shared problem domains, interprofessional treatment, attitudes towards interprofessional treatment, interprofessional identity, facilitators, and barriers. A Chi²-test, Mann–Whitney U-test, and Spearman’s Rho correlation were calculated.

Results

Data from 53 physiotherapists and 48 dietitians were included. Malnutrition is considered a shared problem domain by both professions (U = 1248.000; p = 0.858). While sarcopenia is treated by both professions (U = 1260.000; p = 0.927), physiotherapists consider sarcopenia more often a shared problem domain compared to dietitians (U = 1003.000; p = 0.044). Attitudes towards interprofessional treatment were mostly positive (73%, n = 35 and 87%, n = 46 respectively). Interprofessional identity of dietitians was lower compared to physiotherapists (median = 4.0 versus median = 4.3 respectively; U = 875.000, p = 0.007). This was explained by lower interprofessional belonging (median = 4.0 versus median = 4.8 respectively; U = 771.000, p < 0.001) and lower interprofessional commitment (median = 4.0 versus median = 4.3 respectively; U = 942.500, p = 0.023). Interprofessional identity was correlated with efficient means of communication (r = 0.30, p = 0.003) and bureaucracy (r = −0.21, p = 0.034). Other barriers reported included available time, financial compensation, interprofessional knowledge, and obtaining extra care. Most reported facilitators concerned role clarity, clarity of expertise, and willingness of others to collaborate.

Conclusion

Dietitians and physiotherapists have different interprofessional identities, but both are advocates of interprofessional treatment. Both professions mostly treat malnutrition and sarcopenia individually and have different perceptions regarding sarcopenia as shared problem domain. Facilitators were mainly related to clarity and commitment while barriers were mainly related to resources.

Facilitating interprofessional identity development in healthcare students through dedicated interprofessional placements

There is a growing body of research evidencing the benefits of dedicated interprofessional placements in preparing healthcare students for interprofessional practice. However, little is known about if and how students develop their interprofessional identity during interprofessional placements. This study addresses this knowledge gap by exploring final-year students' interprofessional identity development during dedicated interprofessional placement(s). Thirty-eight students from five health professions were interviewed and data analyzed inductively to identify themes. Participants also drew images representing their perceptions of interprofessional identity and its relationship to professional identity as part of the data collection. The themes showed participants progressed from conceptualizing interprofessional identity as a requirement of the placement at the start of the placement, toward internalizing an interprofessional identity by the end of their placement. Context influences interprofessional identity salience. A commitment from healthcare professionals to model interprofessional practice, combined with explicitly facilitating interprofessional identity development, is recommended to facilitate continued interprofessional identity development in different contexts post placement.

The development and psychometric evaluation of an interprofessional identity measure: Extended Professional Identity Scale (EPIS)

The purpose of this study was to develop and evaluate an interprofessional identity measurement instrument based on Extended Professional Identity Theory (EPIT). The latter states that interprofessional identity is a social identity superordinate to a professional identity consisting of three interrelated interprofessional identity characteristics: belonging, commitment and beliefs. Scale development was based on five stages: 1) construct clarification, 2) item pool generation, 3) review of initial item pool, 4) shortening scale length (EFA to determine top four highest factor loadings per subscale; 97 dental and dental hygiene students), and 5) cross-validation and construct validity confirmation (CFA; 152 students and 48 teachers from six curricula). Explained variance of the EPIS was 65%. Internal consistency of the subscales was 0.79, 0.81 and 0.80 respectively and 0.89 of the overall scale. CFA confirmed three-dimensionality as theorized by EPIT. Several goodness-of-fit indexes showed positive results: CFI = 0.968 > 0.90, RMSEA = 0.039 < 0.05, and SRMR = 0.056 ≤ 0.08. The factor loadings of the CFA ranged from 0.58 to 0.80 and factors were interrelated. The Extended Professional Identity Scale (EPIS) is a 12-item measurement instrument with high explained variance, high internal consistency and high construct validity with strong evidence for three-dimensionality.