Interprofessional teamwork: still haven't decided what we are educating for?

The VOTIS, part 2: Using a video-reflexive assessment activity to foster dispositional learning in interprofessional education

Effective interprofessional collaborative practice (IPCP) requires a new way of working characterized by distributed leadership skills, shared decision-making, and the adoption of uniprofessional and interprofessional identities. Health professional educators are tasked with preparing clinicians for IPCP through interprofessional education (IPE). Numerous IPE teaching interventions have been developed, ranging in length from hours to semesters, designed to introduce students to interprofessional ways of working - usually evaluated in terms of student satisfaction, perceptions of other disciplines and conceptual knowledge. However, working interprofessionally also requires integrating dispositional knowledge into one's emerging interprofessional habits and values. In this paper, we describe a learning activity, inspired by a new video-reflexive methodology, designed to foster dispositional learning of interprofessional skills using a video-based assessment tool: the Video Observation Tool for Interprofessional Skills (VOTIS). Based on focus group and interview data, we suggest the activity's usefulness in fostering conceptual, procedural and dispositional knowledge, as well as reflexive feedback literacy. Overall, our qualitative evaluation of the VOTIS suggests the merits of drawing on video-reflexive methodology and pedagogical theory to re-imagine IPE as a dynamic process, requiring the development of interprofessional skills that must be appropriated into students' emerging (inter)professional identities.

The VOTIS, part 1: development and pilot trial of a tool to assess students' interprofessional skill development using video-reflexive ethnography

This paper explores the development and evaluation of the video Observation Tool for Interprofessional Skills (VOTIS). We describe the development of an authentic interprofessional assessment tool that incorporates video reflection and allows formative and summative assessment of individual learners' interprofessional skills within an authentic interprofessional context. We then investigate its validity and reliability. The VOTIS was developed using a modified Delphi technique. The tool was piloted with 61 students and 11 clinical educators who completed the VOTIS following team meetings where students interacted about their interprofessional clinical work. The following were calculated: internal consistency; students' proficiency levels; inter-rater reliability between students and clinical educators; and inter-rater reliability between clinical educators and an independent rater. Results indicate that the VOTIS has acceptable internal consistency and moderate reliability and has value in evaluating students' interprofessional skills. Study outcomes highlight the need for more explicit wording of tool content and instructions and further clinical educator training to increase the utility and reliability of the VOTIS as a learning and assessment tool.

Using Q-methodology to determine students' perceptions of interprofessional anatomy education

Interprofessional education (IPE) prepares healthcare students for collaboration in their future careers. The purpose of this study was to determine which aspects of the IPE Program in Anatomy at McMaster University contributed to the development of healthcare student's interprofessional skills. Q-methodology was used to identify the students' common viewpoints of the IPE experience. A total of 26/28 (93%) of students in the course from the medical, nursing, midwifery, physician assistant, occupational therapy, and physiotherapy programs participated in this study. Students were asked to sort a Q-sample of 43 statements about the IPE dissection course derived from previous qualitative studies of the program. Using the centroid factor extraction and varimax rotation, three salient factors (groups) emerged, namely: (1) Anatomy IPE Enthusiasts, (2) Practical IPE Advocates, and (3) Skeptical IPE Anatomists. The Anatomy IPE Enthusiasts believed that students from different disciplines brought unique anatomical knowledge and each group member guided others through difficult material. The Practical IPE Advocates expressed that they would be stronger advocates for interprofessional teams in the future because of the course. The Skeptical IPE Anatomists strongly disagreed that learning with students from different disciplines helped them gain an understanding of their roles in the context of other healthcare professionals and felt that there was little benefit from the IPE program compared to other non-interprofessional programs. These findings about student attitudes are critical to drive an evidence-based evolution of the IPE dissection course, since students' perceptions can have a profound influence on interprofessional collaboration in the workplace.

How we implemented Continuous Interprofessional Education at a newly established public hospital in Singapore

Introduction

To promote interprofessional collaboration (IPC), our newly established hospital implemented the Continuing Interprofessional Education (CIPE) initiatives, which included a half-day workshop and 15 sessions of Grand Rounds, with the content focusing on establishing interprofessional patient-centered care pathways, policies, and ultimately to build a community of IPC.

Methods

To evaluate the impact of the CIPE initiatives, 120 staff who attended at least 50% of the CIPE sessions were invited to complete the Interprofessional Attitudes Scale (IPAS).

Results

67.5% of the invited participants completed the survey. The majority of the participants answered “agree” or “strongly agree” for the domains of Teamwork/Roles/Responsibilities, Patient-centeredness, Diversity and Ethics, and Community Centeredness after going through the CIPE initiatives. The Interprofessional Bias domain revealed mixed responses.

Discussions and Implications of practice

The significant contributing factors towards the success of the CIPE Grand Rounds included: (1) the topics were proposed by our staff and centered on clinical practice; (2) the delivery format was interactive, guided by adult learning principles. The mixed responses regarding the presence of biases among the participants suggested that interprofessional biases are deep-rooted in the healthcare setting, and attendance of these CIPE Grand Rounds made participants more acutely aware of these biases. However, more actions are needed to eradicate these biases.

Development of interprofessional healthcare teamwork skills: mapping students' process of learning

Higher education institutions commonly prepare future healthcare workers to engage in increasingly complex, interprofessional healthcare environments through interprofessional education. Development of appropriate teamwork skills is complex and takes time. However, much of the research on student engagement with teamwork in higher education has been focused on the end goal of teamwork. This obscures the process of how students learn to work in interprofessional healthcare teams and in what ways, over time. The current study used an exploratory interpretive approach to obtaining students' experiences, perceptions and developing understanding of teamwork from the start of their undergraduate studies, through to completion of five semesters of group or teamwork projects. Through qualitative methodology, educators explored student experiences of teamwork, their focus at designated points of their undergraduate teamwork, and the meaning they attributed to being a member of a team. Student perceptions of successful teamwork developed over time to a positive and purposeful orientation toward teamwork, learner attributes that enhanced team function, and a growing awareness of how the assessment context affected team function. By mapping these processes of learning over time, educators can gain a clearer understanding of influences and experiences that impact on student learning in teamwork.

The relationship between post-resuscitation debriefings and perceptions of teamwork in emergency department nurses

BACKGROUND

Emergency department nurses are faced with traumatic patient events while functioning as members of multidisciplinary teams. Postresuscitation debriefings have been shown to benefit health care professionals and patient clinical outcomes. The purpose of this study was to examine the relationship between the use of post resuscitation debriefings and perceptions of teamwork in emergency department nurses. The study also addressed the type and timing of debriefing to determine whether these factors are associated with perceptions of teamwork.

METHODS

A nationwide survey was disseminated to emergency department nurses throughout the United States. The design aimed to compare the results from the Nursing Teamwork Survey with the data regarding frequency, type, and timing of debriefings. An ANOVA and Scheffe post hoc was done as well.

RESULTS

The 68 responses which were included in the data were from 27 different states. Results showed that when debriefings were done more frequently (η = .41, p = .02), were conducted using a formal debriefing method (η = .36, p = .01), and were held immediately after a situation (η = .36, p = .03), there was a significant positive relationship (eta coefficient) with higher levels of trust, team orientation, backup, shared mental model, and leadership.

CONCLUSION

Findings may be used to increase utilization of debriefings and improve perceptions of teamwork among emergency department nurses.

Reflexivity and expansive learning theory in interprofessional workplace learning

Our aim in this article was to combine the theories of reflexivity and expansive learning theory to elucidate how they may interact in interprofessional health student teams' learning activities in the workplace. According to Margaret Archer reflexivity is "the regular exercise of the mental ability, shared by all normal people, to consider themselves in relation to their (social) context and vice versa." It stems from the individual's inner dialogue. In interprofessional student teams, the participants' inner dialogs may interplay, forming team reflexivity. We have elucidated how individual reflexivity and team reflexivity are related in the workplace. Expansive learning theory focuses on the learning possibilities in the zone of proximal development. Working through contradictions, the team may develop the object, which may be something drastically new. We regard team reflexivity as a driving force for elucidating and differentiating complex contradictions, stimulating the development of the object. Our study may inspire educators to further develop the pedagogical design of their interprofessional courses. We describe how team reflexivity may be facilitated in the student team activity, among the health-care staff, and in the administrative collaboration between educational institutions and governmental health services.

Beyond competencies - describing work ready plus graduates for the New Zealand medical imaging workforce

INTRODUCTION

Medical imaging is a profession where technology and practice is moving forward at a fast pace, while also being situated within rapidly evolving models of healthcare delivery. This requires capabilities in our graduates beyond the competencies to undertake the role. This study used an existing Professional Capability Framework as the foundation for the development of a survey tool to identify those capabilities most valued by the health services that provide placement opportunities for students.

METHODS

A prospective survey, conducted online, was used to gather the data from senior medical imaging staff who work regularly with students and new graduates.

RESULTS

The results identified the top capabilities within each of three domains of personal, interpersonal, and cognitive capabilities. The results from the personal domain show that remaining calm under pressure or when things take an unexpected turn; understanding personal strengths and limitations; being willing to face and learn from errors; wanting to do as good a job as possible and having energy, passion and enthusiasm for the profession and role are most valued by the profession. We have identified links between the most desired interpersonal capabilities and attributes of well-functioning interprofessional teams and the cognitive capabilities align to those required for critical thinking and clinical reasoning.

CONCLUSIONS

These results have allowed the curriculum development team to review the graduate profile of medical imaging technology graduates. The curriculum development team has begun a process to incorporate learning strategies that will encourage the development of these capabilities in our graduates.

Student Perceptions of Collaboration Skills in an Interprofessional Context: Development and Initial Validation of the Self-Assessed Collaboration Skills Instrument

An integral component of interprofessional education (IPE) is the development of a collaboration-ready health-care workforce. While collaboration is a fundamental element of IPE, there is no existing measure of collaboration skills that is not context specific. This article describes the development and initial validation of the Self-Assessed Collaboration Skills (SACS) measure. Items were initially drawn from the Collaboration Skills Assessment Tool rubric, an educational assessment tool. The SACS measure was piloted in a sample of students in an introductory IPE course. Following scale revision, the SACS was piloted a second time in a sample of students in an IPE health systems course and then validated in a sample of students in an introductory IPE course. Exploratory factor analysis was used to assess scale factor structure in Pilots 1 and 2 and confirmatory factor analysis to confirm factor structure in the validation sample. Convergent and discriminant validity were also assessed. The final SACS measure is an 11-item scale consisting of three dimensions of collaboration: information sharing, learning, and team support. The SACS measure demonstrates high internal consistency and both convergent and discriminant validity as a measure of collaboration. The SACS can be implemented in any setting for assessing collaboration in clinical and nonclinical contexts.

Articulating the ideal: 50 years of interprofessional collaboration in Medical Education

CONTEXT

Health care delivery and the education of clinicians have changed immensely since the creation of the journal Medical Education. In this project, we seek to answer the following three questions: How has the concept of collaboration changed over the past 50 years in Medical Education? Have the participants involved in collaboration shifted over time? Has the idea of collaboration itself been transformed over the past 50 years?

METHODS

Starting from a constructionist view of scientific discourse, we used directed content analysis to sample, code and analyse 144 collaboration-related articles over the 50-year life span of Medical Education. We developed an analytical framework to identify the key components of varying articulations of 'collaboration', with a focus on shifts in language and terminology over time. Our sample was drawn from an archive of 1221 articles developed to celebrate the 50th anniversary of Medical Education.

RESULTS

Interprofessional collaboration is conceptualised in three primary ways throughout our sample: as a psychometric property; as tasks or activities, and, more recently, as 'togetherness'. The first conceptualisation articulates collaboration as involving knowledge or skills that are teachable to individuals, the second as involving the education of teams to engage in structured meetings or task distribution, and the third as the building of networks of individuals who learn to form team identities. The 'leader' of collaboration is typically conceptualised as the doctor, who is consistently articulated by authors as the active agent of collaborative care. Other clinicians and students of other professions are, as the wording in this sentence suggests, usually positioned as 'others', and thus as more passive participants in, or even observers of, 'collaboration'.

CONCLUSIONS

In order to meet goals of meaningful collaboration leading to higher-quality care, it behoves us as a community of educators and researchers to heed the ways in which we teach, think and write about interprofessional collaboration, interrogating our own language and assumptions that may be betraying and reproducing harmful care hierarchies.

Tackling wicked problems: how theories of agency can provide new insights

OBJECTIVES

This paper reviews why and how theories of agency can be used as analytical lenses to help health professions education (HPE) scholars address our community's wicked problems. Wicked problems are those that resist clear problem statements, defy traditional analysis approaches, and refuse definitive resolution (e.g. student remediation, assessments of professionalism, etc.). We illustrate how theories of agency can provide new insights into such challenges by examining the application of these theories to one particular wicked problem in HPE: interprofessional education (IPE).

METHODS

After searching the HPE literature and finding that theories of agency had received little attention, we borrowed techniques from narrative literature reviews to search databases indexing a broad scope of disciplines (i.e. ERIC, Web of Science, Scopus, MEDLINE and PubMed) for publications (1994-2014) that: (i) examined agency, or (ii) incorporated an agency-informed analytical perspective. The lead author identified the theories of agency used in these articles, and reviewed the texts on agency cited therein and the original sources of each theory. We identified 10 theories of agency that we considered to be applicable to HPE's wicked problems. To select a subset of theories for presentation in this paper, we discussed each theory in relation to some of HPE's wicked problems. Through debate and reflection, we unanimously agreed on the applicability of a subset of theories for illuminating HPE's wicked problems. This subset is described in this paper.

RESULTS

We present four theories of agency: Butler's post-structural formulation; Giddens' sociological formulation; cultural historical activity theory's formulation, and Bandura's social cognitive psychology formulation. We introduce each theory and apply each to the challenges of engaging in IPE.

CONCLUSIONS

Theories of agency can inform HPE scholarship in novel and generative ways. Each theory offers new insights into the roots of wicked problems and means for contending with them.

Using a real-life case scenario to integrate additional health professions students into an existing interprofessional team seminar

The World Health Organization stated that the goal of interprofessional education (IPE) is to prepare students as collaboration-ready members of interprofessional care teams. Educators try to create meaningful and relevant learning experiences for multiple health professions students. A longitudinal Interprofessional Team Seminar (IPTS) course includes over 650 students from seven health professions at the professional training level. Recommendations from the National Athletic Trainers' Association (NATA) promote the inclusion of athletic training (AT) students in IPE initiatives. A new IPTS module included AT students focusing on the attributes of rapidly forming and different care teams as the patient transitions from an on-field injury, to acute care, inpatient care, and rehabilitative care, and back to activities of daily living. Qualitative review of reflections from the students assessed the impact of these IPTS modules. The intentional design of this course, focusing on behaviours of collaborative practice and supporting students to be collaboration ready, effectively introduced and highlighted profession-specific strengths and unique contributions to team-based care.

Interprofessional anatomy education in the United Kingdom and Ireland: Perspectives from students and teachers

There is increasing recognition of multiprofessional learning in anatomy and its role in medical and healthcare professions. This study utilized two components to investigate anatomy interprofessional education (AIPE) in the United Kingdom and Ireland. First, a survey involving qualitative and quantitative components asked Heads of Anatomy to report on their institutions' uptake of AIPE. Second, a series of case studies explored the experiences of students by using evaluation forms and an in-depth analysis of thematic concepts to understand the learners' perspectives on designing and delivering AIPE. Out of the 13 institutions that took part in the survey, eight did not offer an AIPE program. Between the remaining five institutions that deliver AIPE programs, 10 different modules are offered with the majority involving healthcare professions. The AIPE component is rated highly by students. The themes from the case studies highlight how valuable AIPE is from the student perspective both in terms of engaging them in anatomy as well as in the broader skills of teamwork and communication. The case studies also revealed how AIPE can be engaging for groups of students who might not have previously had access to cadaveric anatomy, for example, engineers and archeologists. The results of this study have implications for curriculum design in medicine and healthcare but also for further engagement of professional groups from non-healthcare backgrounds.

Frank Netter's legacy: Interprofessional anatomy instruction

Several medical schools have recently described new innovations in interprofessional interactions in gross anatomy courses. The Frank H. Netter MD School of Medicine at Quinnipiac University in Hamden, CT has developed and implemented two contrasting interprofessional experiences in first-year medical student gross anatomy dissection laboratories: long-term, informal visits by pathologists' assistant students who work with the medical students to identify potential donor pathologies, and a short-term, formal visit by fourth-year dental students who teach craniofacial anatomy during the oral cavity dissection laboratory. A survey of attitudes of participants was analyzed and suggest the interprofessional experiences were mutually beneficial for all involved, and indicate that implementing multiple, contrasting interprofessional interactions with different goals within a single course is feasible. Two multiple regression analyses were conducted to analyze the data. The first analysis examined attitudes of medical students towards a pathologists' assistant role in a health care team. The question addressing a pathologists' assistant involvement in the anatomy laboratory was most significant. The second analysis examined attitudes of medical students towards the importance of a good foundation in craniofacial anatomy for clinical practice. This perceived importance is influenced by the presence of dental students in the anatomy laboratory. In both instances, the peer interprofessional interactions in the anatomy laboratory resulted in an overall positive attitude of medical students towards pathologists' assistant and dental students. The consequences of these interactions led to better understanding, appreciation and respect of the different professionals that contribute to a health care team.

Dissecting through barriers: A mixed-methods study on the effect of interprofessional education in a dissection course with healthcare professional students

Healthcare delivery is reliant on a team-based approach, and interprofessional education (IPE) provides a means by which such collaboration skills can be fostered prior to entering the workplace. IPE within healthcare programs has been associated with improved collaborative behavior, patient care and satisfaction, reduced clinical error, and diminished negative professional stereotypes. An intensive interprofessional gross anatomy dissection course was created in 2009 to facilitate IPE at McMaster University. Data were collected from five cohorts over five years to determine the influence of this IPE format on the attitudes and perceptions of students towards other health professions. Each year, 28 students from the medicine, midwifery, nursing, physician's assistant, physiotherapy, and occupational therapy programs were randomly assigned into interprofessional teams for 10 weeks. Sessions involved an anatomy and scope-of-practice presentation, a small-group case-based session, and a dissection. A before/after design measured changes in attitudes and perceptions, while focus group data elaborated on the student experience with the course. Pre- and postmatched data revealed significant improvements in positive professional identity, competency and autonomy, role clarity and attitudes toward other health professions. Qualitative analysis of intraprofessional focus group interviews revealed meaningful improvements in a number of areas including learning anatomy, role clarity, and attitudes towards other health professions.

Interprofessional education in anatomy: Learning together in medical and nursing training

Teamwork and the interprofessional collaboration of all health professions are a guarantee of patient safety and highly qualified treatment in patient care. In the daily clinical routine, physicians and nurses must work together, but the education of the different health professions occurs separately in various places, mostly without interrelated contact. Such training abets mutual misunderstanding and cements professional protectionism, which is why interprofessional education can play an important role in dismantling such barriers to future cooperation. In this article, a pilot project in interprofessional education involving both medical and nursing students is presented, and the concept and the course of training are described in detail. The report illustrates how nursing topics and anatomy lectures can be combined for interprofessional learning in an early phase of training. Evaluation of the course showed that the students were highly satisfied with the collaborative training and believed interprofessional education (IPE) to be an important experience for their future profession and understanding of other health professionals. The results show that the IPE teaching concept, which combines anatomy and nursing topics, provides an optimal setting for learning together and helps nurses and doctors in training to gain knowledge about other health professionals' roles, thus evolving mutual understanding.