Interprofessional Education and Collaborative Practice-If Not Now, When?

Conceptualizing interprofessional working - when a lawyer joins the healthcare mix

Research, policy and practice in the field of interprofessional collaboration have focused on how medical, nursing, allied health and social care practitioners work together to positively impact patient care. This paper extends conceptual thinking about interprofessional practice by focusing on lawyers as part of the interprofessional mix. This attention is prompted by medical-legal partnerships (MLPs), a service model by which lawyers join health care settings to assist patients with unmet, and often health-harming, legal needs. MLPs are present in around 450 hospitals and other health care sites across the United States and the model has spread to other countries, including Australia, the United Kingdom and Canada. However, enthusiasm for the MLP model is not yet matched by good evidence on how, when and for whom the model works. Interprofessional scholars contend that imprecise terminology and poor conceptualization of interprofessional arrangements hinder high-quality research and evaluation. In response to their critiques, this paper formulates a stepwise conceptual framework to guide the design, implementation and study of interprofessional arrangements that connect health, social care and legal practitioners. This framework draws on findings from national surveys of MLP initiatives in several countries and adapts several key conceptual frameworks that have been developed from systematic reviews of interprofessional working in primary health care. These conceptual frameworks are valuable because they promote clarity about different modes of interprofessional working and characterize the factors at macro (policy, funding), meso (organizational) and micro (practitioner, patient) levels that help or hinder professionals from different disciplines in working together. The paper considers factors at these three levels that require particular attention when lawyers join health care settings and proposes questions for future research in this emerging area.

Interprofessional Substance Use Disorder Education in Health Professions Education Programs: A Scoping Review

PURPOSE

The authors conducted this scoping review to (1) provide a comprehensive evaluation and summation of published literature reporting on interprofessional substance use disorder (SUD) education for students in health professions education programs and (2) appraise the research quality and outcomes of interprofessional SUD education studies. Their goals were to inform health professions educators of interventions that may be useful to consider as they create their own interprofessional SUD courses and to identify areas of improvement for education and research.

METHOD

The authors searched 3 Ovid MEDLINE databases (MEDLINE, In-Process & Other Non-Indexed Citations, and Epub Ahead of Print), Embase.com, ERIC via FirstSearch, and Clarivate Analytics Web of Science from inception through December 7, 2018. The authors used the Medical Education Research Study Quality Instrument (MERSQI) to assess included studies' quality.

RESULTS

The authors screened 1,402 unique articles, and 14 met inclusion criteria. Publications dated from 2014 to 2018. Ten (71%) included students from at least 3 health professions education programs. The mean MERSQI score was 10.64 (SD = 1.73) (range, 7.5-15). Interventions varied by study, and topics included general substance use (n = 4, 29%), tobacco (n = 4, 29%), alcohol (n = 3, 21%), and opioids (n = 3, 21%). Two studies (14%) used a nonrandomized 2-group design. Four (29%) included patients in a clinical setting or panel discussion. Ten (72%) used an assessment tool with validity evidence. Studies reported interventions improved students' educational outcomes related to SUDs and/or interprofessionalism.

CONCLUSIONS

Interprofessional SUD educational interventions improved health professions students' knowledge, skills, and attitudes toward SUDs and interprofessional collaboration. Future SUD curriculum design should emphasize assessment and measure changes in students' behaviors and patient or health care outcomes. Interprofessional SUD education can be instrumental in preparing the future workforce to manage this pressing and complex public health threat.

An Interprofessional Substance Use Disorder Course to Improve Students' Educational Outcomes and Patients' Treatment Decisions

PURPOSE

Substance use is a public health concern. Health professions organizations recommend improvements in substance use disorder (SUD) education. Mezirow's transformative learning theory was used as the educational framework to develop a course that would provide students with opportunities to improve their understanding of SUDs; to assess, challenge, and reflect on their attitudes toward patients with SUDs; to receive direct observation, assessment, and feedback on behavior change counseling; and to engage in interprofessional education. The study's purpose was to evaluate the impact of an interprofessional SUD course on students' educational outcomes and their attitudes toward interprofessionalism.

METHOD

Students from several health professions-medicine, pharmacy, physician assistant, nursing, and social work-attended a monthly interprofessional education SUD course starting in spring 2018. The course, taught by an interprofessional faculty, consisted of 4 interactive classes focused on empathy and recognizing personal bias; behavioral change counseling; and recognition, screening, and treatment of SUDs. Students attended a 12-step recovery meeting and had an optional opportunity to counsel a patient using behavioral change counseling.

RESULTS

Seventy-eight students completed the course. Students demonstrated significant improvements in their attitudes toward patients with SUDs and toward interprofessionalism, as measured by the Substance Abuse Attitude Survey and the Student Perceptions of Interprofessional Clinical Education survey. Nearly 70% of students counseled a patient with an SUD, and 93% of counseled patients agreed to follow-up care.

CONCLUSIONS

The course (1) enriched students' understanding, attitudes, and behaviors toward patients with SUDs and toward interprofessional collaboration and (2) positively influenced patients' treatment decisions.

Now is the Time for Psychology to Support the Transformation of Academic Health Centers

Psychologists have made important contributions in academic health centers (AHC), but the reputation of psychology as a discipline has been mixed, by turns viewed as a superfluous soft science, or seen as an important contributor to the AHC mission. AHCs currently face exceptional challenges to the viability of AHCs, including: planned alterations from fee-for-service to value-based funding that requires high quality at lower cost; and rising demands to demonstrate competence in trainees. Now more than ever, psychologists can and must help AHCs to meet these challenges.