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Silva PHBD, Barros LCND, Zambelli JDC, Barros NFD, Oliveira ESFD. The Invisibility of Integrative and Complementary Practices in Primary Healthcare. CIENCIA & SAUDE COLETIVA 2024; 29:e05132024. [PMID: 39140533 DOI: 10.1590/1413-81232024298.05132024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/26/2024] [Indexed: 08/15/2024] Open
Abstract
Invisibility is an issue that requires more attention among healthcare professionals, as some activities in Primary Care go unnoticed. One example is the offer of complementary therapies, whose implementation has been frail and, consequently, can be overlooked in the Unified Health System. This study aims to understand the factors contributing to the public invisibility of Integrative and Complementary Practices in Primary Care. It is a descriptive, exploratory, and qualitative research involving semi-structured interviews with 20 professionals in the Metropolitan Region of Goiânia. Thematic content analysis was applied to the interviews, revealing elements indicating the public invisibility of these practices, such as insufficient discussion in team meetings, inconsistency in the recording in user files, and low prioritization in implementation. In the interviews, social humiliation, a product of public invisibility, can also be perceived due to overload, embarrassments, and lack of physical space for the provision of practices to the users. It is concluded that Integrative and Complementary Practices are often overlooked in Primary Care.
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Affiliation(s)
- Pedro Henrique Brito da Silva
- Secretaria de Saúde do Município de Senador Canedo. Go 403 Km 9 - Morada do Morro. 75250-000 Senador Canedo GO Brasil.
| | | | - Janaína da Câmara Zambelli
- Programa de Pós-Graduação em Odontologia, Universidade Estadual de Campinas (Unicamp). Campinas SP Brasil
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Shen X, Dizon JIWT, Chong YKD, He Q, Fonseca G, Kwok TOT, Luk P, Chan SSC, Lee D, Ng LHZ, Orlu M, Ng TTW, Tipoe GL, Ganotice FA. Uncovering the factors underlying collaboration outcomes in interprofessional education: A preliminary investigation involving healthcare students. NURSE EDUCATION TODAY 2024; 141:106325. [PMID: 39106641 DOI: 10.1016/j.nedt.2024.106325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/17/2024] [Accepted: 07/28/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Interprofessional education (IPE) incorporates healthcare students from various disciplines to learn with, about, and from one another, aiming to foster effective collaboration. However, the factors that promote these collaboration outcomes remain elusive. Recognizing this knowledge gap, this study utilizes self-determination theory applied in a ten-day IPE programme. The study aims are twofold: to clarify the potential influence of personal factors (autonomy, competence, and relatedness) and environmental factors (clear goals and technology support) on collaboration outcomes (team goal achievement and team effectiveness) and to examine the effect of the IPE on these outcomes. METHODOLOGY The study utilized an IPE programme that integrated asynchronous and synchronous learning methods across two institutions in Hong Kong and the United Kingdom. This involved 147 students from diverse healthcare disciplines who were enrolled in the IPE programme. A pre- and post-test design was employed to examine programme effects. Multiple regression analysis was conducted to explore the factors influencing these outcomes, while paired samples t-tests were used to evaluate the effect of the IPE programme on collaboration outcomes. RESULTS Among the personal factors, a sense of relatedness emerged as an important predictor of team effectiveness and goal achievement. Clear goals and technology support positively influenced collaboration outcomes. A paired samples t-test indicated significant improvements in collaboration outcomes after the IPE simulation. CONCLUSION These findings highlight the importance of designing a large IPE programme that meets basic psychological needs (especially the sense of relatedness) and provides clear goals and adequate technology support in the IPE context. This study is helpful to understand how personal and environmental factors promote the collaboration outcomes in medical education and provide insights for future IPE curriculum development.
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Affiliation(s)
- Xiaoai Shen
- Bau Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - John Ian Wilzon T Dizon
- Bau Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Yin Kei Doris Chong
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Qing He
- Bau Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Gui Fonseca
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong
| | - Tai On Tyrone Kwok
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Pauline Luk
- Bau Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Sarah S C Chan
- Bau Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Diana Lee
- Academic Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong
| | - Lai Han Zoe Ng
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Mine Orlu
- UCL School of Pharmacy, University College London, United Kingdom
| | - Terry Tin Wai Ng
- UCL School of Pharmacy, University College London, United Kingdom
| | - George L Tipoe
- Bau Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Fraide A Ganotice
- Bau Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
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Edelist T, Friesen F, Ng S, Fernandez N, Bélisle M, Lechasseur K, Rochette A, Vachon B, Caty MÈ. Critical reflection in team-based practice: A narrative review. MEDICAL EDUCATION 2024. [PMID: 38973068 DOI: 10.1111/medu.15462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/08/2024] [Accepted: 05/29/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION Research on critical reflection (a process of recognising and challenging assumptions that frame health care practice) has demonstrated strong potential for making health care more collaborative and equitable, yet its enactment within team-based health care remains underexplored. We conducted a narrative review to advance understanding of how critical reflection develops, occurs in and impacts team-based practice and care. METHODS We searched three databases (Medline, CINAHL and Scopus) for articles related to the concepts of critical reflection and/or critically reflective practice in the context of team-based health care and examined how teams engage with those theoretical concepts, to inform ideas for a new approach to support critically reflective practice. FINDINGS The search identified 974 citations of which nine articles showed elements of critical reflection in team-based practice. However, since only one of the nine included articles explicitly used the term 'critical reflection' in their research, critical reflection as a theoretical concept was found to be largely missing from the current team-based health care literature. Instead, aspects of critical reflection were evident in terms of challenging power hierarchies and questioning practice assumptions through dialogue, with a goal of collaborative practice. This sharing of knowledge and skills allowed teams to push boundaries and innovate together in practice. The included articles also emphasised the importance of creating a purposeful environment for open dialogue and practice change to occur. CONCLUSION To support equitable care through collaborative practices, we suggest dialogue as and for critical reflection should be explicitly developed and researched within team-based health care.
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Affiliation(s)
- Tracey Edelist
- Département d'Orthophonie, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Farah Friesen
- Centre for Advancing Collaborative Healthcare and Education (CACHE), University Health Network, Toronto, Canada
| | - Stella Ng
- Centre for Advancing Collaborative Healthcare and Education (CACHE), University Health Network, Toronto, Canada
| | - Nicolas Fernandez
- Département de Médecine de Famille et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montreal, Canada
| | - Marilou Bélisle
- Faculté d'Éducation, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Annie Rochette
- École de Réadaptation, Faculté de Médecine, Université de Montréal, Montreal, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation de Montréal (CRIR), Montreal, Canada
| | - Brigitte Vachon
- École de Réadaptation, Faculté de Médecine, Université de Montréal, Montreal, Canada
| | - Marie-Ève Caty
- Département d'Orthophonie, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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Lingard L, Watling C. The writer's voice repertoire: Exploring how health researchers accomplish a distinctive 'voice' in their writing. MEDICAL EDUCATION 2024; 58:523-534. [PMID: 38233970 DOI: 10.1111/medu.15298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Much published research writing is dull and dry at best, impenetrable and off-putting at worst. This state of affairs both frustrates readers and impedes research uptake. Scientific conventions of objectivity and neutrality contribute to the problem, implying that 'good' research writing should have no discernible authorial 'voice'. Yet some research writers have a distinctive voice in their work that may contribute to their scholarly influence. In this study, we explore this notion of voice, examining what strong research writers aim for with their voice and what strategies they use. METHODS Using a combination of purposive, snowball and theoretical sampling, we recruited 21 scholars working in health professions education or adjacent health research fields, representing varied career stages, research paradigms and geographical locations. We interviewed participants about their approaches to writing and asked each to provide one to three illustrative publications. Iterative data collection and analysis followed constructivist grounded theory principles. We analysed interview transcripts thematically and examined publications for evidence of the writers' described approaches. RESULTS Participants shared goals of a voice that was clear and logical, and that engaged readers and held their attention. They accomplished these goals using approaches both conventional and unconventional. Conventional approaches included attention to coherence through signposting, symmetry and metacommentary. Unconventional approaches included using language that was evocative (metaphor, imagery), provocative (pointed critique), plainspoken ('non-academic' phrasing), playful (including humour) and lyrical (attending to cadence and sound). Unconventional elements were more prominent in non-standard genres (e.g. commentaries), but also appeared in empiric papers. DISCUSSION What readers interpret as 'voice' reflects strategic use of a repertoire of writing techniques. Conventional techniques, used expertly, can make for compelling reading, but strong writers also draw on unconventional strategies. A broadened writing repertoire might assist health professions education research writers in effectively communicating their work.
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Affiliation(s)
- Lorelei Lingard
- Department of Medicine and Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Chris Watling
- Department of Oncology and Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Sorensen D, Cristancho S, Soh M, Varpio L. Team Stress and Its Impact on Interprofessional Teams: A Narrative Review. TEACHING AND LEARNING IN MEDICINE 2024; 36:163-173. [PMID: 36625564 DOI: 10.1080/10401334.2022.2163400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
Phenomenon: Interprofessional healthcare team (IHT) collaboration can produce powerful clinical benefits for patients; however, these benefits are difficult to harness when IHTs work in stressful contexts. Research about stress in healthcare typically examines stress as an individual psychological phenomenon, but stress is not only a person-centered experience. Team stress also affects the team's performance. Unfortunately, research into team stress is limited and scattered across many disciplines. We cannot prepare future healthcare professionals to work as part of IHTs in high-stress environments (e.g., emergency medicine, disaster response) unless we review how this dispersed literature is relevant to medical education. Approach: The authors conducted a narrative review of the literature on team stress experienced by interprofessional teams. The team searched five databases between 1 Jan 1990 and 16 August 2021 using the search terms: teams AND stress AND performance. Guided by four research questions, the authors reviewed and abstracted data from the 22 relevant manuscripts. Findings: Challenging problems, time pressure, life threats, environmental distractors, and communication issues are the stressors that the literature reports that teams faced. Teams reacted to team stress with engagement/cohesion and communication/coordination. Stressors impact team stress by either hindering or improving team performance. Critical thinking/decision-making, team behaviors, and time for task completion were the areas of performance affected by team stress. High-quality communication, non-technical skills training, and shared mental models were identified as performance safeguards for teams experiencing team stress. Insights: The review findings adjust current models explaining drivers of efficient and effective teams within the context of interprofessional teams. By understanding how team stress impacts teams, we can better prepare healthcare professionals to work in IHTs to meet the demands placed on them by the ever-increasing rate of high-stress medical situations.
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Affiliation(s)
- Derek Sorensen
- Center for Health Professions Education & Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sayra Cristancho
- Department of Surgery and Faculty Education, Western University, London, Ontario, Canada
| | - Michael Soh
- Center for Health Professions Education & Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Lara Varpio
- Center for Health Professions Education & Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Bochatay N, Ju M, O'Brien BC, van Schaik SM. A Scoping Review of Interprofessional Simulation-Based Team Training Programs. Simul Healthc 2024:01266021-990000000-00117. [PMID: 38526045 DOI: 10.1097/sih.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
SUMMARY STATEMENT Interprofessional simulation-based team training (ISBTT) is promoted as a strategy to improve collaboration in healthcare, and the literature documents benefits on teamwork and patient safety. Teamwork training in healthcare is traditionally grounded in crisis resource management (CRM), but it is less clear whether ISBTT programs explicitly take the interprofessional context into account, with complex team dynamics related to hierarchy and power. This scoping review examined key aspects of published ISBTT programs including (1) underlying theoretical frameworks, (2) design features that support interprofessional learning, and (3) reported behavioral outcomes. Of 4854 titles identified, 58 articles met inclusion criteria. Most programs were based on CRM and related frameworks and measured CRM outcomes. Only 12 articles framed ISBTT as interprofessional education and none measured all interprofessional competencies. The ISBTT programs may be augmented by integrating theoretical concepts related to power and intergroup relations in their design to empower participants to navigate complex interprofessional dynamics.
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Affiliation(s)
- Naike Bochatay
- From the University of California San Francisco, San Francisco, CA
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Rogers L, Hughes Spence S, Aivalli P, De Brún A, McAuliffe E. A systematic review critically appraising quantitative survey measures assessing power dynamics among multidisciplinary teams in acute care settings. J Interprof Care 2024; 38:156-171. [PMID: 36708308 DOI: 10.1080/13561820.2023.2168632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/07/2023] [Indexed: 01/29/2023]
Abstract
By valuing the knowledge of each discipline holistic patient-centered care can be achieved as decisions arise from expertise rather than established hierarchies. While healthcare has historically operated as a hierarchical power structure (i.e., some voices have more influence), these dynamics are rarely discussed. This review addresses this issue by appraising extant quantitative measures that assess multidisciplinary team (MDT) power dynamics. By identifying psychometrically sound measures, change agents can uncover the collective thought processes informing power structures in practice and develop strategies to mitigate power disparities. Several databases were searched. English language articles were included if they reported on quantitative measures assessing power dynamics among MDTs in acute/hospital settings. Results were synthesized using a narrative approach. In total, 6,202 search records were obtained of which 62 met the eligibility criteria. The review reveals some promising measures to assess power dynamics (e.g., Interprofessional Collaboration Scale). However, the findings also confirm several gaps in the current evidence base: 1) need for further psychometric and pragmatic testing of measures; 2) inclusion of more representative MDT samples; 3) further evaluation of unmatured power dimensions. Addressing these gaps will support the development of future interventions aimed at mitigating power imbalances and ultimately improve collaborative working within MDTs.
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Affiliation(s)
- Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Shannon Hughes Spence
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Praveenkumar Aivalli
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Aoife De Brún
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Eilish McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
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de Medeiros Pereira AKA, Poletto PR, Forte FDS, Da Costa MV. Which factors influenced the adoption of interprofessionality in health based on the reports of the PET-Health Interprofessionality projects in Brazil? A document analysis. J Interprof Care 2024; 38:62-69. [PMID: 37078469 DOI: 10.1080/13561820.2023.2200796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/06/2023] [Indexed: 04/21/2023]
Abstract
The Program of Education through Work - Health (PET-Health) Interprofessionality is one of the strategic actions of the "Plan for the Strengthening of Interprofessionality" in healthcare in Brazil. Based on the experience of the program, this paperexamines the aspects that impact the adoption and strengthening of interprofessional education and collaborative practices, and issues recommendations for the strengthening of interprofessionality as a guiding principle of training and working in healthcare. This is a document analysis of partial reports from the six- and 12-months of execution of 120 PET-Health Interprofessionality projects in Brazil. The data were analyzed based on content analysis and the categories elaborated a priori. The aspects that impact the adoption and strengthening of interprofessionality in training and working in healthcare, and future recommendations, were organized in the relational, processual, organizational, and contextual dimensions, according to the framework by Reeves et al. The PET-Health Interprofessionality expanded the understanding of elements of interprofessional education and practice and showed that the discussion must take on a more political, critical, and reflexive character. The analysis points to the need for continuity of teaching-learning activities as a strategy to foster interprofessional capacity in healthcare services and consequent strengthening of the Unified Healthcare System in Brazil.
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Affiliation(s)
| | - Patrícia Rios Poletto
- Baixada Santista Campus, Federal University of São Paulo/Baixada Santista Campus, Santos, São Paulo, Brazil
| | | | - Marcelo Viana Da Costa
- Multi-campi School of Medical Sciences, Federal University of Rio Grande do Norte, Caicó, Rio Grande do Norte, Brazil
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Kerins J, Smith SE, Tallentire VR. "Ego massaging that helps": a framework analysis study of internal medicine trainees' interprofessional collaboration approaches. MEDICAL EDUCATION ONLINE 2023; 28:2243694. [PMID: 37535844 PMCID: PMC10402837 DOI: 10.1080/10872981.2023.2243694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Patient care depends on collaborative practice. Debate remains as to the best approach to providing education for collaboration, with educational interventions often far removed from the realities of the clinical workplace. Understanding the approaches used for collaboration in clinical practice could inform practical strategies for training. For internal medicine trainees, this involves collaboration with other professions but also with other specialties. This study aimed to explore the approaches that internal medicine trainees use for interprofessional collaboration and the ways that these approaches vary when internal medicine trainees interact with different healthcare provider groups. METHODS Following ethical approval and participant consent, interprofessional communication workshops between August 2020 and March 2021 were audio recorded and transcribed verbatim. Workshops involved groups of internal medicine trainees discussing collaboration challenges and the approaches they use in clinical practice. This framework analysis study used the interprofessional collaboration framework described by Bainbridge and Regehr (building social capital, perspective taking and negotiating priorities and resources), and cross-referenced the categorised data with the healthcare groups that trainees collaborate with, to look for patterns in the data. RESULTS Seventeen workshops, involving 100 trainees, were included. Trainees described relationship building, perspective taking and negotiating priorities and resources. Relationship building was a modification to the original framework domain of building social capital. Themes of power and civility transcended domains with evidence of using hierarchy as leverage when negotiating and employing civility as a tactical approach throughout. DISCUSSION This bi-dimensional analysis highlights patterns of perspective taking when collaborating with other specialties and professions, and the approaches to negotiation of courting favour and coercion when interacting with other specialties. This study provides evidence of the strategies currently utilised by internal medicine trainees, with different healthcare groups, and presents a modified framework which could inform the development of training for collaboration.
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Affiliation(s)
- Joanne Kerins
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
- Acute medicine, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Samantha Eve Smith
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
- Medical Education Directorate, NHS Lothian, Edinburgh, UK
| | - Victoria Ruth Tallentire
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
- Medical Education Directorate, NHS Lothian, Edinburgh, UK
- Medical Directorate, NHS Education for Scotland, Edinburgh, Scotland, UK
- College of Medicine and Vetinary Medicine, University of Edinburgh, Edinburgh, Scotland, UK
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Ferri P, Vivarelli C, Lui F, Alberti S, Rovesti S, Serafini A, Di Lorenzo R, Amati G, Padula MS. Evaluation of an interprofessional education intervention in partnership with patient educators. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023250. [PMID: 37850766 PMCID: PMC10644921 DOI: 10.23750/abm.v94i5.14825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND AIM Patient involvement in interprofessional education is a novel approach to building collaborative and empathic skills in students. However, this area of teaching is lacking in rigorous studies. The project aimed to evaluate whether an interprofessional education intervention in partnership with patient educators (IPE-PE) would increase readiness for interprofessional learning and empathy in health sciences students. METHODS This is the report of a didactic innovation project. Participants included 310 undergraduate health sciences students who took part in an IPE-PE intervention. Data were collected before and after the training, using the Readiness for Interprofessional Learning Scale (RIPLS) and the Jefferson Scale of Empathy-Health Professions Student version (JSE-HPS). Only at the end of the intervention, a data collection form was administered to explore the value of the patient educator in the training and to investigate the socio-demographic variables. RESULTS The mean age of participants was 21±3.2 SD years and 76% were female. A paired t-test showed significant changes from before to after the IPE-PE in the mean total RIPLS score (42.7±5.8 SD vs 44.62±5.9 SD, P<0.001) and the mean total JSE-HPS score (112.7±12.5 SD vs 116.03±12.8 SD, P<0.001). Conclusions: Our students reported that IPE-PE had helped them to become more effective healthcare team members, to think positively about other professionals, and to gain empathic understanding of the perspective of the person being cared for. The results of the project confirm that the intervention promoted the development of empathy, fostering a better understanding of the patient-centred perspective.
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Affiliation(s)
- Paola Ferri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia.
| | | | - Fausta Lui
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia.
| | | | - Sergio Rovesti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia.
| | - Alice Serafini
- EduCare Lab, University of Modena and Reggio Emilia, Modena.
| | | | - Gabriele Amati
- Rheumatology Unit, University Hospital of Modena; Department of Surgical, Medical, Dental and Morphological Sciences with Interest transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia.
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Liljedahl M, Björck E, Bolander Laksov K. How workplace learning is put into practice: contrasting the medical and nursing contexts from the perspective of teaching and learning regimes. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:811-826. [PMID: 36459259 PMCID: PMC10356663 DOI: 10.1007/s10459-022-10195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Health professions education places significant emphasis on learning in the clinical environment. While experiences of workplace learning have been extensively investigated, practices of workplace learning explored through field work have been less utilized. The theoretical framework of teaching and learning regimes acknowledges aspects of power and conflict in its consideration of what guides teachers and learners in their practice of workplace learning. This study aimed to explore practices of workplace learning in the two adjacent healthcare professions; medicine and nursing. We adopted an ethnographic qualitative design. Field observations and follow-up interviews were performed in three clinical departments and the data set comprised 12 full days of observations and 16 formal follow-up interviews. Thematic analysis was performed deductively according to the theoretical framework. Four teaching and learning regimes were found in the data. In the medical context, workplace learning was either practiced as reproduction of current practice or through stimulation of professional development. In the nursing context, workplace learning was either based on development of partnership between student and supervisor or on conditional membership in a professional community. The medical and nursing contexts demonstrated varying underpinnings and assumptions relating to teaching and learning. The respective practices of workplace learning in the medical and nursing context appear to hold substantial differences which might have implications for how we understand practices of workplace learning. We further conclude that the theoretical framework of teaching and learning regimes in this study proved useful in exploring workplace learning.
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Affiliation(s)
- Matilda Liljedahl
- Department of Oncology, The Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Erik Björck
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
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Janssen M, Fluit CRMG, Lubbers RR, Cornelissen SA, de Graaf J, Scherpbier ND. Learning collaboration at the primary-secondary care interface: a dual-method study to define design principles for interventions in postgraduate training programmes. BMC MEDICAL EDUCATION 2023; 23:308. [PMID: 37138295 PMCID: PMC10158135 DOI: 10.1186/s12909-023-04254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Collaboration between primary and secondary care (PSCC) is important to provide patient-centered care. Postgraduate training programmes should provide training to learn PSCC. With a design based research (DBR) approach design principles can be formulated for designing effective interventions in specific contexts. The aim of this study is to determine design principles for interventions aimed to learn PSCC in postgraduate training programmes. METHODS DBR is characterised by multi-method studies. We started with a literature review on learning collaboration between healthcare professionals from different disciplines within the same profession (intraprofessional) to extract preliminary design principles. These were used to inform and feed group discussions among stakeholders: trainees, supervisors and educationalists in primary and secondary care. Discussions were audiotaped, transcribed and analysed using thematic analysis to formulate design principles. RESULTS Eight articles were included in the review. We identified four preliminary principles to consider in the design of interventions: participatory design, work process involvement, personalised education and role models. We conducted three group discussions with in total eighteen participants. We formulated three design principles specific for learning PSCC in postgraduate training programmes: (1) The importance of interaction, being able to engage in a learning dialogue. (2) Facilitate that the learning dialogue concerns collaboration. (3) Create a workplace that facilitates engagement in a learning dialogue. In the last design principle we distinguished five subcategories: intervention emphasises the urge for PSCC and is based on daily practice, the presence of role models, the work context creates time for learning PSCC, learning PSCC is formalised in curricula and the presence of a safe learning environment. CONCLUSION This article describes design principles for interventions in postgraduate training programmes with the aim to learn PSCC. Interaction is key in learning PSCC. This interaction should concern collaborative issues. Furthermore, it is essential to include the workplace in the intervention and make adjacent changes in the workplace when implementing interventions. The knowledge gathered in this study can be used to design interventions for learning PSCC. Evaluation of these interventions is needed to acquire more knowledge and adjust design principles when necessary.
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Affiliation(s)
- Marijn Janssen
- Department of Internal Medicine Nijmegen, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO box 9101, postal route 463, Nijmegen, 6500 HB, The Netherlands.
| | - Cornelia R M G Fluit
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roel R Lubbers
- Department of Internal Medicine Nijmegen, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO box 9101, postal route 463, Nijmegen, 6500 HB, The Netherlands
- Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sylvia A Cornelissen
- Department of Internal Medicine Nijmegen, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO box 9101, postal route 463, Nijmegen, 6500 HB, The Netherlands
- Department Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacqueline de Graaf
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nynke D Scherpbier
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, Groningen, The Netherlands
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Papermaster AE, Whitney M, Vinas EK. Interprofessional Case Conference Enhances Group Learning and the Quality, Safety, Value, and Equity of Team-Based Care. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:4-11. [PMID: 36849427 DOI: 10.1097/ceh.0000000000000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 11/07/2022] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Patients seeking treatment for complex conditions require coordinated care from interprofessional clinicians. Collaborative engagement in an interprofessional community of practice is crucial to the collective competence of a team and the provision of high-quality, safe health care leading to improved patient outcomes. The objective of this descriptive, cross-sectional study was to describe interprofessional communication, coordination, and collaboration of participants in an integrated practice unit that was structured to include weekly case conferences as part of routine practice. METHODS Data were collected from October 2019 to February 2020. Web-based surveys were administered to a convenience sample that included 33 questions and followed the CHERRIES checklist for reporting results. Items focused on team knowledge, impact on patient care, and communication, and conference focus and effectiveness. Descriptive and survey item analysis included frequency, percentage, means and standard deviation, Chi-square, and Pearson correlation analysis. Patient outcome data were collected via a Patient Global Impression of Improvement scale and were analyzed using a paired sample t test. RESULTS Survey respondents (n = 161) included clinicians and administrative staff. Results demonstrated that interprofessional case conferences improved the collective competence of the team, including team knowledge and communication. Participants viewed case conferences as a means to enhance care delivery quality, value, safety, and equity. In the study period, there was also a statistically significant improvement between the patient's first follow-up and last visits. CONCLUSION Survey respondents indicated that case conferences were an effective means to deliver high-quality, patient-centered care through interprofessional collaboration and education.
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Affiliation(s)
- Amy E Papermaster
- Dr. Papermaster: Assistant Professor, School of Nursing, The University of Texas at Austin, Austin, TX, and Assistant Professor, Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX. Dr. Whitney: Assistant Professor, Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX. Ms. Vinas: Assistant Professor and Associate Chair of Education, Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX
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14
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Polansky MN, Koch U, Rosu C, Artino AR, Thompson A. Which learning experiences support an interprofessional identity? A scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022:10.1007/s10459-022-10191-x. [PMID: 36538278 DOI: 10.1007/s10459-022-10191-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
In recent years, health professions researchers have suggested that a dual identity that includes both a professional and interprofessional identity is essential to interprofessionality. This scoping review sought to describe the learning experiences that may support the development of an interprofessional identity, providing direction for future research. A scoping review was conducted to identify papers published between 2000 and 2020 that provided empiric evidence to support the impact of planned or spontaneous learning experiences involving two or more healthcare professions that fostered the development of an "interprofessional identity," or a sense of belonging to an interprofessional community. Twelve papers were identified for inclusion. Articles varied regarding both the professional groups studied and the developmental levels of their participants. A wide variety of learning experiences were described in the identified studies, including designed activities and programs, as well as those occurring spontaneously in authentic clinical environments. Examples of longitudinal and integrated programs were also identified. The construct of an interprofessional identity and its potential impact on interprofessional practice has yet to be sufficiently studied. The results of this scoping review suggest that a variety of experiences that occur throughout the professional development trajectory may foster an interprofessional identity. Longitudinal, integrated interprofessional learning programs may result in a more long-lasting impact on interprofessional identity and these types of programs should be the focus of future research.
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Affiliation(s)
- Maura N Polansky
- Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA.
| | - Ulrich Koch
- George Washington University, Washington, DC, USA
| | - Claudia Rosu
- Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | | | - Anne Thompson
- Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
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15
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Golz C, Oulevey Bachmann A, Defilippis TS, Kobleder A, Peter KA, Schaffert R, Schwarzenbach X, Kampel T, Hahn S. Preparing students to deal with the consequences of the workforce shortage among health professionals: a qualitative approach. BMC MEDICAL EDUCATION 2022; 22:756. [PMID: 36333793 PMCID: PMC9636659 DOI: 10.1186/s12909-022-03819-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/26/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Healthcare is facing a shortage of qualified healthcare professionals. The pandemic has brought to light the fragile balance that affects all healthcare systems. Governments have realized that these systems and the professionals working in them need support at different levels to strengthen the retention of the workforce. Health professionals' education can play an important role in ensuring that new generations of workers have sound personal and professional competencies to successfully face the challenges of professional practice. These challenges are described in the literature, but the extent to which they are considered in health professionals' education is less clear. METHODS This qualitative study compares the professional challenges and educational needs described in the literature with the current curricula for health professionals offered in Switzerland. Data were collected nationally through focus group interviews with 65% of Switzerland's directors of bachelor's and master's programs of health professions (nursing, physiotherapy, occupational therapy, midwifery, nutrition and dietetics, osteopathy, radiologic medical imaging technology, health promotion and prevention, and health sciences). The data attained were analyzed using knowledge mapping. RESULTS The results reveal a gap among education programs with regard to occupational health promotion and cultural diversity. Both topics are taught with a sole focus on patients, and students are expected to adopt similar strategies for their health promotion and stress management. Physicians are insufficiently involved in interprofessional education. The programs fail to enhance health professionals' political, economic and digital competencies. CONCLUSION The results of this study offer clear guidance about what topics need to be integrated into curricula to improve health professionals' well-being at work and their preparedness to face daily professional challenges.
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Affiliation(s)
- Christoph Golz
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.
| | - Annie Oulevey Bachmann
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Tiziana Sala Defilippis
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Locarno, Switzerland
| | - Andrea Kobleder
- Department of Health, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Karin Anne Peter
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - René Schaffert
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Xenia Schwarzenbach
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Thomas Kampel
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Sabine Hahn
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
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Cimino FM, Varpio L, W Konopasky A, Barker A, Stalmeijer RE, Ma TL. Can We Realize Our Collaborative Potential? A Critical Review of Faculty Roles and Experiences in Interprofessional Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S87-S95. [PMID: 35947466 DOI: 10.1097/acm.0000000000004909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Faculty within interprofessional education (IPE) are essential contributors to IPE implementation efforts. Although the majority of existing IPE literature consists of reports on IPE innovations, few insights are available into the experiences of the faculty members who deliver IPE. This critical narrative review was designed to synthesize the knowledge available about (1) roles assigned to IPE educators and (2) IPE faculty members' experiences of fulfilling these roles. METHOD Six databases for English-language studies published between 2000 and March 2021 were searched: PubMed, Embase, Web of Science, MEDLINE, CINAHL, PsycINFO, ERIC, and MedEdPortal. A total of 1,717 manuscripts were identified for possible inclusion. After applying inclusion/exclusion criteria, 214 articles constituted the final literature corpus. Harden and Crosby's original framework of 6 roles of medical educators augmented with the manager role introduced in Harden and Lilley's 2018 framework informed the analysis. RESULTS IPE faculty take on all 6 roles identified by Harden and Crosby: facilitator, planner, information provider, examiner, role model, and resource developer, as well as the manager role. Faculty were most commonly identified as facilitator and planner, and rarely as role models. The authors identified 3 main struggles experienced by IPE faculty: personal (e.g., confidence as a cross-professions educator), interpersonal (e.g., co-teaching IPE), and institutional (e.g., supporting IPE logistics). CONCLUSIONS This review highlights the complexity of the roles taken on by IPE faculty and the struggles they experience in the process. The results suggest that attention to the different roles that IPE faculty play in educational interventions and to equipping faculty with the necessary competencies, tools, and support, is fundamental to the success of IPE. Future research should harness the explanatory power of theories to help explain dynamics at play between personal, interpersonal, and institutional barriers to identify interventions that can aid IPE faculty in delivering collaboration-ready professionals.
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Affiliation(s)
- Francesca M Cimino
- F.M. Cimino is associate professor, Department of Family Medicine, Uniformed Services University, Bethesda, Maryland, and program director, National Capital Consortium Family Medicine Residency, Fort Belvoir, Virginia; ORCID: http://orcid.org/0000-0003-3674-2906
| | - Lara Varpio
- L. Varpio is professor of medicine and associate director of research, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0002-1412-4341
| | - Abigail W Konopasky
- A.W. Konopasky is assistant professor of medicine, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0002-3033-5552
| | - Andrea Barker
- A. Barker is adjunct assistant professor, Department of Family and Preventive Medicine, University of Utah, and program director, Center of Excellence in Musculoskeletal Care and Education, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah; ORCID: http://orcid.org/0000-0003-3619-9368
| | - Renée E Stalmeijer
- R.E. Stalmeijer is assistant professor, Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: http://orcid.org/0000-0001-8690-5326
| | - Ting-Lan Ma
- T.-L. Ma is assistant professor of medicine, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0001-8349-6432
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Looman N, de Graaf J, Thoonen B, van Asselt D, de Groot E, Kramer A, Scherpbier N, Fluit C. Designing the learning of intraprofessional collaboration among medical residents. MEDICAL EDUCATION 2022; 56:1017-1031. [PMID: 35791303 PMCID: PMC9543842 DOI: 10.1111/medu.14868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 05/21/2023]
Abstract
BACKGROUND To preserve quality and continuity of care, collaboration between primary-care and secondary-care physicians is becoming increasingly important. Therefore, learning intraprofessional collaboration (intraPC) requires explicit attention during postgraduate training. Hospital placements provide opportunities for intraPC learning, but these opportunities require interventions to support and enhance such learning. Design-Principles guide the design and development of educational activities when theory-driven Design-Principles are tailored into context-sensitive Design-Principles. The aim of this study was to develop and substantiate a set of theory-driven and context-sensitive Design-Principles for intraPC learning during hospital placements. METHODS Based on our earlier research, we formulated nine theory-driven Design-Principles. To enrich, refine and consolidate these principles, three focus group sessions with stakeholders were conducted using a Modified Nominal Group Technique. Next, two work conferences were conducted to test the feasibility and applicability of the Design-Principles for developing intraPC educational activities and to sharpen the principles into a final set of Design-Principles. RESULTS The theoretical Design-Principles were discussed and modified iteratively. Two new Design-Principles were added during focus group 1, and one more Design-Principle was added during focus group 2. The Design-Principles were categorised into three clusters: (i) Culture: building collaborative relations in a psychologically safe context where patterns or feelings of power dynamics between primary and secondary care physicians can be discussed; (ii) Connecting Contexts: making residents and supervisors mutually understand each other's work contexts and activities; and (iii) Making the Implicit Explicit: having supervising teams act as role models demonstrating intraPC and continuously pursuing improvement in intraPC to make intraPC explicit. Participants were unanimous in their view that the Design-Principles in the Culture cluster were prerequisites to facilitate intraPC learning. CONCLUSION This study led to the development of 12 theory-driven and context-sensitive Design-Principles that may guide the design of educational activities to support intraPC learning during hospital placements.
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Affiliation(s)
- Natasja Looman
- Department of Primary and Community CareRadboudumcNijmegenThe Netherlands
| | | | - Bart Thoonen
- Department of Primary and Community CareRadboudumcNijmegenThe Netherlands
| | | | - Esther de Groot
- Julius Center for Health Sciences and Primary CareUMC UtrechtUtrechtThe Netherlands
| | - Anneke Kramer
- Department of Public health and Primary CareLeiden UMCLeidenThe Netherlands
| | - Nynke Scherpbier
- Department of General Practice and Elderly CareUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Cornelia Fluit
- Department for Research in Learning and EducationRadboudumc Health AcademyNijmegenThe Netherlands
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Ganotice FA, Chan SSC, Chow AYM, Fan KKH, Khoo US, King RB, Lam MPS, Luk P, Ng AYM, Wang MN, Yeung SSS, Tipoe GL. What factors facilitate interprofessional collaboration outcomes in interprofessional education? A multi-level perspective. NURSE EDUCATION TODAY 2022; 114:105393. [PMID: 35567908 DOI: 10.1016/j.nedt.2022.105393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/19/2022] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Interprofessional education (IPE) harnesses the power of teams to facilitate collaborative learning across disciplines. However, prior research has not paid sufficient attention to the role of team-level factors on IPE outcomes, posing a major theoretical and methodological limitation. In response to this, using social interdependence theory (SIT), this study aimed to delineate the independent contributions of both team-level and student-level interprofessional attitudes (teamwork, roles, and responsibilities; patient-centeredness; and community-centeredness) in predicting IPE collaboration outcomes (goal achievement, team effectiveness, and team performance) employing multi-level analysis. METHODS To test whether interprofessional attitudes at the team and student levels predict IPE collaboration outcomes, conducted multilevel modeling. We used the pretest and posttest data from 323 healthcare students in Hong Kong from Chinese medicine, medicine, nursing, pharmacy, and social work programmes enrolled in the IPE Cancer module. RESULTS Among the interprofessional attitudes, "teamwork, roles, and responsibilities" was found to be the best predictor of IPE outcomes, both at the student and team levels. Students who recognized the benefits of shared learning had better goal achievement and team effectiveness. Furthermore, teams that emphasized shared learning also had better overall team performance. CONCLUSIONS Students' attitudes towards teamwork, roles, and responsibilities in interprofessional collaborative practice, both at the student and team levels, are important to attaining positive student- and team-level outcomes. The study contributes to the expansion of existing knowledge in medical education, theoretically, by adopting SIT as a lens through which collaborative learning in healthcare teams can be understood, and methodologically, by applying multi-level approaches and delineating important student- and team-level predictors of IPE outcomes.
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Affiliation(s)
- Fraide A Ganotice
- Bau Institute of Medical and Health Sciences Education, The University of Hong Kong, Hong Kong.
| | - Sarah So Ching Chan
- Bau Institute of Medical and Health Sciences Education, The University of Hong Kong, Hong Kong
| | - Amy Yin Man Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Kelvin Kai Hin Fan
- Bau Institute of Medical and Health Sciences Education, The University of Hong Kong, Hong Kong
| | - Ui Soon Khoo
- Department of Pathology, The University of Hong Kong, Hong Kong
| | - Ronnel B King
- Faculty of Education, The University of Hong Kong, Hong Kong
| | - May Pui San Lam
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Pauline Luk
- Bau Institute of Medical and Health Sciences Education, The University of Hong Kong, Hong Kong
| | | | | | | | - George L Tipoe
- Bau Institute of Medical and Health Sciences Education, The University of Hong Kong, Hong Kong.
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van Duin TS, de Carvalho Filho MA, Versluis MAC. From islander to team player: How to make professional silos more fluid. MEDICAL EDUCATION 2022; 56:586. [PMID: 35156220 DOI: 10.1111/medu.14747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Titia S van Duin
- Lifelong Learning, Education and Assessment Research Network (LEARN), University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Department of Critical Care, University Medical Centre Groningen, Groningen, the Netherlands
| | - Marco Antonio de Carvalho Filho
- Lifelong Learning, Education and Assessment Research Network (LEARN), University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Marco A C Versluis
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, the Netherlands
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Manworren RCB, Basco M. Effectiveness and Dissemination of the Interprofessional Pediatric Pain PRN Curriculum. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:135-143. [PMID: 34862335 PMCID: PMC9133003 DOI: 10.1097/ceh.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Cultural transformation is needed for health care to be sensitive to children's pain. The Pediatric Pain Practice Registered Nurses (PRN) Curriculum is the first free, open access, downloadable, interprofessional pain continuing education (IPPCE) curriculum developed to empower health care professionals to translate evidence-based pain care into clinical practice. To evaluate the curriculum and its experiential flipped-learning strategies, we used a mixed methods approach. METHODS Interprofessional pediatric teams from eight health care systems evaluated the curriculum after attending Pediatric Pain PRN Courses in the Fall of 2017 (N = 90). Qualitative methods were used to evaluate the acceptability, feasibility, and utility of the curriculum and IPPCE strategies. Pain knowledge and attitudes were measured pre-IPPCE/post-IPPCE with the Pediatric Healthcare Provider's Knowledge & Attitude Survey Regarding Pain (PHPKAS). Web analytics were used to describe dissemination for the first year after the curriculum's webpage launch. RESULTS Learners rated their achievement of course objectives as moderate-great. PHPKAS scores significantly increased (P < .0005); but significant differences in physician and nurse PHPKAS question responses pre-IPPCE/post-IPPCE were found. Within 2 years of the IPPCE, three health care systems were certified as Childkind Hospitals, five Pediatric Pain PRN Programs were established, and various practice changes and improved patient outcomes, such as decreased hospital lengths of stay and emergency department returns for pain, were realized. Curriculum dissemination was global. DISCUSSION Results support the acceptability, effectiveness, feasibility, utility, and global dissemination of the curriculum and IPPCE strategies. More rigorous patient outcome data are needed; however, this study demonstrated the benefit of a free, open-access, downloadable, interprofessional health care provider continuing education curriculum.
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Affiliation(s)
- Renee C B Manworren
- Dr. Manworren: Associate Professor, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, and the Posy and Fred Love Chair in Nursing Research, Director of Nursing Research and Professional Practice, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. Basco: Undergraduate Student at Doisy College of Health Sciences, Saint Louis University, St. Louis, MO, and 2020 Summer Research Intern at Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Looman N, van Woezik T, van Asselt D, Scherpbier‐de Haan N, Fluit C, de Graaf J. Exploring power dynamics and their impact on intraprofessional learning. MEDICAL EDUCATION 2022; 56:444-455. [PMID: 34841565 PMCID: PMC9300127 DOI: 10.1111/medu.14706] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 05/12/2023]
Abstract
BACKGROUND During postgraduate training, considerable efforts for intraprofessional education are in place to prepare primary care residents (PC residents) and medical specialty residents (MS residents) for intraprofessional collaboration (intraPC). Power dynamics are inherently present in such hierarchical medical contexts. This affects intraPC (learning). Yet little attention has been paid to factors that impact power dynamics. This study aims to explore power dynamics and their impact on intraPC learning between PC residents and MS residents during hospital placements. METHODS This study expands on previously published ethnographic research investigating opportunities and barriers for intraPC learning among residents in five Dutch hospitals. We analysed transcripts of observations and in-depth interviews using template analysis. A critical theory paradigm was employed. Discourse analysis additionally informed the data. RESULTS We defined five interrelated themes that describe characteristics of power dynamics in intraPC learning during hospital placements: beliefs; power distribution; interaction style; subjection; and fearless learning. Power dynamics operate both within and between the themes: power distribution between PC residents, MS residents and MS supervisors seemed to be an attribution affected by underlying beliefs about professional norms or about other professions; beliefs influenced the way PC residents, MS residents and MS supervisors interacted; power distribution based on inequity could lead to subjection of PC residents; power distribution based on equity could lead to fearless learning; and open interactions enabled fearless intraPC learning. CONCLUSIONS Power dynamics have an impact on intraPC learning among residents in hospitals. Constructive power dynamics occur when power distribution is based on equity, combined with sincere open interactions, actively inviting each other into discussions and enlisting the support of MS supervisors to foster fearless learning. This can be achieved by creating awareness of implicit beliefs and making them explicit, recognising interaction that encourages intraPC learning and creating policies that support fearless intraPC learning.
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Affiliation(s)
- Natasja Looman
- Department of Primary and Community CareRadboudumcNijmegenThe Netherlands
| | - Tamara van Woezik
- Department of Primary and Community CareRadboudumcNijmegenThe Netherlands
| | | | - Nynke Scherpbier‐de Haan
- Department of General Practice and Elderly CareUniversity Medical Centre GroningenThe Netherlands
| | - Cornelia Fluit
- Department for Research in Learning and EducationRadboudumc Health AcademyNijmegenThe Netherlands
| | - Jacqueline de Graaf
- Department of Internal MedicineRadboudumc Health AcademyNijmegenThe Netherlands
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Barbosa Detoni K, Lopes André A, Rezende CDP, Furtado BT, de Araújo Medina Mendonça S, Ramalho-de-Oliveira D. Interprofessional education for shared decision making in drug therapy: a scoping review. J Interprof Care 2022; 37:491-503. [PMID: 35285394 DOI: 10.1080/13561820.2022.2039598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The current complex scenario of medication use calls for the implementation of interprofessional education (IPE) initiatives focused on shared decision making (SDM) in drug therapy. A scoping review was conducted to collate, summarize, and report the evidence available on IPE teaching and learning approaches in this context, involving pre-licensure healthcare students. Searches were conducted in seven electronic databases, with 21 articles meeting the inclusion criteria. This review examines educational strategies employed for interprofessional SDM as well as characteristics of students, teachers, and tutors involved in IPE interventions. The reviewed studies lack detailed description of the students' decision-making process, and none addresses aspects related to patient preferences as a part of learning outcomes. We identified shortcomings in how IPE interventions are assessed and reported. Only a few of the studies explicitly describe the use of competency-based frameworks proposed by national and international organizations, and less than 60% describe learning outcomes. The absence of experiences focused on interprofessional SDM in drug therapy suggests a gap that needs to be addressed with future studies evaluated in a robust way. We argue that such experiences enable students, as a team, to learn to share decisions with the patient as an effective team member.
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Affiliation(s)
- Kirla Barbosa Detoni
- Graduate Program in Medicines and Pharmacy Practice – Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ariane Lopes André
- Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Cristiane de Paula Rezende
- Graduate Program in Medicines and Pharmacy Practice – Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Bárbara Taciana Furtado
- Graduate Program in Medicines and Pharmacy Practice – Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Djenane Ramalho-de-Oliveira
- Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Robertson K, Ju M, O'Brien BC, van Schaik SM, Bochatay N. Exploring the role of power during debriefing of interprofessional simulations. J Interprof Care 2022:1-9. [PMID: 35109751 DOI: 10.1080/13561820.2022.2029371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/09/2021] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
Interprofessional simulation aims to improve teamwork and patient care by bringing participants from multiple professions together to practice simulated patient care scenarios. Yet, power dynamics may influence interprofessional learning during simulation, which typically occurs during the debriefing. This issue has received limited attention to date but may explain why communication breakdowns and conflicts among healthcare teams persist despite widespread adoption of interprofessional simulation. This study explores the role of power during interprofessional simulation debriefings. We collected data through observations of seven interprofessional simulation sessions and debriefings, four focus groups with simulation participants, and four interviews with simulation facilitators. We identified ways in which power dynamics influenced discussions during debriefing and sometimes limited participants' willingness to share feedback and speak up. We also found that issues related to power that arose during interprofessional simulations often went unacknowledged during the debriefing, leaving healthcare professionals unprepared to navigate power discrepancies with other members of healthcare teams in practice. Given that the goal of interprofessional simulation is to allow professionals to learn together about each other, explicitly addressing power in debriefing after interprofessional simulation may enhance learning.
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Affiliation(s)
- Kathryn Robertson
- Department of Pediatrics, University of California, San Francisco, CA, USA
- Department of Pediatrics, Kaiser Permanente, Santa Clara, CA, USA
| | - Mindy Ju
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California San Francisco, CA, USA
| | | | - Naike Bochatay
- Department of Pediatrics, University of California, San Francisco, CA, USA
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24
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Marcellus L, Tonmyr L, Jack SM, Gonzalez A, Sheenan D, Varcoe C, Kurtz Landy C, Campbell K, Catherine N, MacMillan H, Waddell C. Public health nurses' perceptions of their interactions with child protection services when supporting socioeconomically disadvantaged young mothers in British Columbia, Canada. CHILD ABUSE & NEGLECT 2022; 124:105426. [PMID: 34995927 DOI: 10.1016/j.chiabu.2021.105426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/10/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Children of girls and young women experiencing socioeconomic disadvantage are at risk of maltreatment and associated health and developmental problems. Nurse-Family Partnership (NFP) is an early intervention program designed to improve child and maternal health outcomes. The effectiveness of NFP is being evaluated in British Columbia (BC) through a randomized controlled trial, augmented by a process evaluation to identify influences on how NFP was implemented. OBJECTIVE To describe how public health nurses providing NFP perceived their interactions with child protection professionals. PARTICIPANTS AND SETTING Forty-seven public health nurses across BC. METHODS The principles of interpretive description informed the qualitative component of the process evaluation. Data from interviews and focus groups were analyzed using the framework analysis approach. A thematic framework was generated through processes of coding, charting and mapping, with a focus on organizational and systems influences. RESULTS Nurses' practice in supporting families often involved engagement with child protection services. Four themes about the nature of this work were identified: 1) developing a deeper understanding of the disciplinary perspectives of child protection, 2) striving for strengthened collaboration, 3) navigating change and uncertainty, and 4) responding to family and community complexity. CONCLUSIONS Participants valued the contribution of child protection professionals and expressed willingness to collaborate to support families. However, collaboration was constrained by multiple structural barriers. Collaborative models offer possibilities for integrated practice, although can be difficult to implement within current health and child protection systems and child protection regulatory contexts.
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Affiliation(s)
- Lenora Marcellus
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada.
| | - Lil Tonmyr
- Public Health Agency of Canada, Family Violence Surveillance, 785 Carling, AL 6807B, Ottawa, ON K1A 0K9, Canada.
| | - Susan M Jack
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
| | - Debbie Sheenan
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada
| | - Colleen Varcoe
- School of Nursing, T201-2211 Wesbrook Mall, University of British Columbia, Vancouver, BC V6T 2B5, Canada.
| | | | - Karen Campbell
- School of Nursing, Western University, London, ON N6A 3K7, Canada.
| | - Nicole Catherine
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada.
| | - Harriet MacMillan
- Offord Centre for Child Studies, McMaster Innovation Park, Suite 201A, McMaster University, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada.
| | - Charlotte Waddell
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada.
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Herchline D, Tenney-Soeiro R, Mehta JJ. Impact of hospitalists' social identities on perceptions of teamwork. J Interprof Care 2022:1-8. [PMID: 34979857 DOI: 10.1080/13561820.2021.1991291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 10/19/2022]
Abstract
Interprofessional teamwork provides unique opportunities for improving patient care. This study used Social Identity Theory as a conceptual framework to characterize the relationships between the social identities of pediatric hospitalists and their perceptions of interprofessional teamwork. We used qualitative methods including free-listing and semi-structured interviews to examine these relationships. We identified five key themes: (a) Pediatric hospitalists' identities fall along a spectrum ranging from profession-centered to team-centered; (b) Familiarity is conducive to formation of team identity; (c) Co-creation of a shared vision and practice of creating shared mental models strengthens sense of team; (d) Institutional culture acts as both a facilitator for and barrier to formation of team identity; (e) High-functioning teams often epitomize the concept of "flexible leadership." We conclude that Social Identity Theory can be a useful theoretical lens for examining interprofessional teamwork in healthcare settings, including among pediatric hospitalists.
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Affiliation(s)
- Daniel Herchline
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, Pa, USA
| | - Rebecca Tenney-Soeiro
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, Pa, USA
| | - Jay J Mehta
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, Pa, USA
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26
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Vanstone M, Grierson L. Thinking about social power and hierarchy in medical education. MEDICAL EDUCATION 2022; 56:91-97. [PMID: 34491582 DOI: 10.1111/medu.14659] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Social power has been diversely conceptualised in many academic areas. Operating on both the micro (interactional) and macro (structural) levels, we understand power to shape behaviour and knowledge through both repression and production. Hierarchies are one organising form of power, stratifying individuals or groups based on the possession of valued social resources. DISCUSSION Medicine is a highly organised social context where work and learning are contingent on interaction and thereby influenced greatly by social power and hierarchy. Despite the relevance of power to education research, there are many unrealized opportunities to use this construct to expand our understanding of how physicians work and learn. Hierarchy, when considered in our field, is typically gestured to as an omnipresent feature of the clinical environment that harms low-status individuals by repressing their ability to communicate openly and exercise their agency. This may be true in many circumstances, but this conceptualization of hierarchy neglects consideration of other aspects of hierarchy that may be generative for understanding the experiences of medical learners. For example, medical learners may experience the superimposition of multiple hierarchies, some of which are fluid and some of which are calcified, some of which are productive and helpful and some of which are oppressive and harmful. Power may work 'up' and 'across' hierarchical ranks, rather than just from higher status to lower status individuals. CONCLUSION The conceptualizations of how social power shapes human behaviour are diverse. Often paired with hierarchy, or social arrangement, these social scientific ideas have much to offer our collective study of the ways that health professionals learn and practice. Accordingly, we posit that a consideration of the ways social power works through hierarchies to nurture or harm the growth of learners should be granted explicit consideration in the framing and conduct of medical education research.
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Affiliation(s)
- Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster FHS Program for Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Grierson
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster FHS Program for Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada
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Stalmeijer RE. Knowledgeability and Identification: Explaining Military Interprofessional Healthcare Teams' Excellence and Readiness. Mil Med 2021; 186:48-50. [PMID: 34724054 PMCID: PMC8559908 DOI: 10.1093/milmed/usab234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
The importance of successful interprofessional collaboration for effective patient care is generally acknowledged. Research into interprofessional collaboration has thus far been mainly situated in the civilian context and has mostly indicated barriers that prevent successful interprofessional collaboration. However, military interprofessional healthcare teams (MIHTs) seem to be exceptionally successful. Building on the overarching finding of the studies within this special edition-i.e., that MIHTs' readiness and excellence are in part due to healthcare professionals' "shared understanding" of what is needed to effectively serve on an MIHT-this commentary uses the theory of Landscape of Practice as a lens to further explain the processes through which healthcare professionals attain this shared understanding. Used within the fields of Health Professions Education and workplace learning, Landscapes of Practice (LoP) helps to explain how learning occurs within practice. It highlights how, by engaging within the various working environments belonging to a profession, social interactions between the various professionals within that environment form the conduit for learning. LoP highlights that the outcome of this learning process is "knowledgeability," i.e., understanding of how to engage within the field and with its players, resulting in being an acknowledged member of the field. Fostered through a process called "identification," professionals learn to see how their professional practice aligns with that of others and how to effectively collaborate with others. The commentary explains how the findings of the separate studies within this special edition strongly resonate with knowledgeability and identification. It is concluded that civilian interprofessional healthcare teams may benefit from incorporating characteristics of MIHTs in their training programs.
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Affiliation(s)
- Renée E Stalmeijer
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO BOX 616, Maastricht 6200MD, the Netherlands
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Sukhera J, Bertram K, Hendrikx S, Chisolm MS, Perzhinsky J, Kennedy E, Lingard L, Goldszmidt M. Exploring implicit influences on interprofessional collaboration: a scoping review. J Interprof Care 2021; 36:716-724. [PMID: 34602007 DOI: 10.1080/13561820.2021.1979946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Interprofessional collaboration (IPC) is fraught with multiple tensions. This is partly due to implicit biases within teams, which can reflect larger social, physical, organizational, and historical contexts. Such biases may influence communication, trust, and how collaboration is enacted within larger contexts. Despite the impact it has on teams, the influence of bias on IPC is relatively under-explored. Therefore, the authors conducted a scoping review on the influence of implicit biases within interprofessional teams. Using scoping review methodology, the authors searched several online databases. From 2792 articles, two reviewers independently conducted title/abstract screening, selecting 159 articles for full-text eligibility. From these, reviewers extracted, coded, and iteratively analyzed key data using a framework derived from socio-material theories. Authors found that many studies demonstrated how biases regarding dominance and expertise were internalized by team members, influencing collaboration in predominantly negative ways. Articles also described how team members dynamically adapted to such biases. Overall, there was a paucity of research that described material influences, often focusing on a single material element instead of the dynamic ways that humans and materials are known to interact and influence each other. In conclusion, implicit biases are relatively under-explored within IPC. The lack of research on material influences and the relationship among racial, age-related, and gender biases are critical gaps in the literature. Future research should consider the longitudinal and reciprocal nature of both positive and negative influences of bias on collaboration in diverse settings.
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Affiliation(s)
- Javeed Sukhera
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kaitlyn Bertram
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Shawn Hendrikx
- Western University Libraries, Western University, London, Ontario, Canada
| | - Margaret S Chisolm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Erin Kennedy
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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29
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Kirkham L. Providing interprofessional education for pre and post-registration nurses. Nurs Stand 2021; 36:45-50. [PMID: 33645169 DOI: 10.7748/ns.2021.e11590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 11/09/2022]
Abstract
During an episode of care, a patient may be attended by a variety of healthcare professionals. In addition, healthcare service provision can be complex, and patients may feel that elements of their care have been missed or delayed due to inadequate collaboration and communication between the staff involved. Interprofessional education (IPE) involves students from two or more professions learning about each other's roles and skills. Increasing calls for integrated and joined-up healthcare services mean that staff will be increasingly required to collaborate with colleagues, with the aim of providing joined-up care. This article explains the background to IPE, how it can be implemented in practice and the barriers that nurses should consider to ensure effective implementation.
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30
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Thomas J, Kumar K, Chur-Hansen A. How pharmacy and medicine students experience the power differential between professions: "Even if the pharmacist knows better, the doctor's decision goes". PLoS One 2021; 16:e0256776. [PMID: 34437641 PMCID: PMC8389418 DOI: 10.1371/journal.pone.0256776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/15/2021] [Indexed: 11/26/2022] Open
Abstract
Interprofessional Education (IPE) is one approach to improving communication and collaborative practice between professions, which are essential for the optimal delivery of healthcare. Common barriers include negative attitudes, professional stereotypes, professional cultures and power differentials between professional groups. The aim of this qualitative study was to explore how professional hierarchies and power differentials shape interprofessional interactions between preregistration pharmacy and medicine students. Data were gathered via semi-structured interviews and subject to thematic analysis. Four main themes were identified: Reproducing traditional hierarchies; Social norms around respect; Hierarchies in care values and goals; and Challenging the narrative is possible. Students' interactions with and views of the other profession largely reflected traditional stereotypes and power differentials. Hierarchy was evident in how respect was accorded and in how care values and goals were managed. Despite this, students overwhelmingly perceived and reported a sense of agency in changing the status quo. Emerging professional identity and conceptualisation of future roles is heavily influenced by the hierarchical relationship between the professions and can pose a significant barrier to collaborative practice. Greater support for collaborative interprofessional practice is needed at the level of policy and accreditation in health education and healthcare to ensure greater commitment to change.
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Affiliation(s)
- Josephine Thomas
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Koshila Kumar
- Prideaux Centre for Research in Health Professions Education, Flinders University, Bedford Park, South Australia, Australia
| | - Anna Chur-Hansen
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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31
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Baker LR, Phelan S, Woods NN, Boyd VA, Rowland P, Ng SL. Re-envisioning paradigms of education: towards awareness, alignment, and pluralism. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1045-1058. [PMID: 33742339 PMCID: PMC8338841 DOI: 10.1007/s10459-021-10036-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
In this article we introduce a synthesis of education "paradigms," adapted from a multi-disciplinary body of literature and tailored to health professions education (HPE). Each paradigm involves a particular perspective on the purpose of education, the nature of knowledge, what knowledge is valued and included in the curriculum, what it means to learn and how learning is assessed, and the roles of teachers and learners in the learning process. We aim to foster awareness of how these different paradigms look in practice and to illustrate the importance of alignment between teaching, learning and assessment practices with paradigmatic values and assumptions. Finally, we advocate for a pluralistic approach that purposefully and meaningfully integrates paradigms of education, enhancing our ability to drive quality in HPE.
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Affiliation(s)
- Lindsay R Baker
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Centre for Faculty Development, Faculty of Medicine, University of Toronto At St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 2W8, Canada.
| | - Shanon Phelan
- School of Occupational Therapy, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Nicole N Woods
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- The Wilson Centre, Unviersity of Toronto At University Health Network, Toronto, Canada
| | - Victoria A Boyd
- The Wilson Centre, Unviersity of Toronto At University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Paula Rowland
- The Wilson Centre, Unviersity of Toronto At University Health Network, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, Toronto, Canada
| | - Stella L Ng
- Centre for Faculty Development, Faculty of Medicine, University of Toronto At St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 2W8, Canada
- The Wilson Centre, Unviersity of Toronto At University Health Network, Toronto, Canada
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada
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Stalmeijer RE, Varpio L. The wolf you feed: Challenging intraprofessional workplace-based education norms. MEDICAL EDUCATION 2021; 55:894-902. [PMID: 33651450 PMCID: PMC8359828 DOI: 10.1111/medu.14520] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/29/2021] [Accepted: 02/26/2021] [Indexed: 05/26/2023]
Abstract
CONTEXT The trajectory towards becoming a medical professional is strongly situated within the clinical workplace. Through participatory engagement, medical trainees learn to address complex health care issues through collaboration with the interprofessional health care team. To help explain learning and teaching dynamics within the clinical workplace, many scholars have relied on socio-cultural learning theories. In the field of medical education, this research has largely adopted a limited interpretation of a crucial dimension within socio-cultural learning theory: the expert who guides the trainee into the community is almost exclusively from the same profession. We contend that this narrow interpretation is not necessary. This limited focus is one we choose to maintain-be that choice intentional or implicit. In this cross-cutting edge paper, we argue that choosing an interprofessional orientation towards workplace learning and guidance may better prepare medical trainees for their future role in health care practice. METHODS By applying Communities of Practice and Landscapes of Practice , and supported by empirical examples, we demonstrate how medical trainees are not solely on a trajectory towards the Community of Physician Practice (CoPP) but also on a trajectory towards various Landscapes of Healthcare Practice (LoHCP). We discuss some of the barriers present within health care organisations and professions that have likely inhibited adoption of the broader LoHCP perspective. We suggest three perspectives that might help to deliberately and meaningfully incorporate the interprofessional learning and teaching dynamic within the medical education continuum. CONCLUSION Systematically incorporating Landscapes of Competence, Assessment, and Guidance in workplace-based education-in addition to our current intraprofessional approach-can better prepare medical trainees for their roles within the LoHCP. By advocating and researching this interprofessional perspective, we can embark on a journey towards fully harnessing and empowering the health care team within workplace-based education.
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Affiliation(s)
- Renée E. Stalmeijer
- School of Health Professions EducationFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Lara Varpio
- Center for Health Professions EducationDepartment of MedicineUniformed Services University of the Health SciencesBethesdaMDUSA
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Gillespie H, Dornan T. The wolf shall dwell with the lamb: The power dynamics of interprofessional education. MEDICAL EDUCATION 2021; 55:883-885. [PMID: 34002870 DOI: 10.1111/medu.14568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Hannah Gillespie
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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De Baetselier E, Dilles T, Batalha LM, Dijkstra NE, Fernandes MI, Filov I, Friedrichs J, Grondahl VA, Heczkova J, Helgesen AK, Jordan S, Keeley S, Klatt T, Kolovos P, Kulirova V, Ličen S, Lillo-Crespo M, Malara A, Padysakova H, Prosen M, Pusztai D, Riquelme-Galindo J, Rottkova J, Sino CG, Talarico F, Tziaferi S, Van Rompaey B. Perspectives of nurses' role in interprofessional pharmaceutical care across 14 European countries: A qualitative study in pharmacists, physicians and nurses. PLoS One 2021; 16:e0251982. [PMID: 34043650 PMCID: PMC8158867 DOI: 10.1371/journal.pone.0251982] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/07/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To understand healthcare professionals' experiences and perceptions of nurses' potential or ideal roles in pharmaceutical care (PC). DESIGN Qualitative study conducted through semi-structured in-depth interviews. SETTING Between December 2018 and October 2019, interviews were conducted with healthcare professionals of 14 European countries in four healthcare settings: hospitals, community care, mental health and long-term residential care. PARTICIPANTS In each country, pharmacists, physicians and nurses in each of the four settings were interviewed. Participants were selected on the basis that they were key informants with broad knowledge and experience of PC. DATA COLLECTION AND ANALYSIS All interviews were conducted face to face. Each country conducted an initial thematic analysis. Consensus was reached through a face-to-face discussion of all 14 national leads. RESULTS 340 interviews were completed. Several tasks were described within four potential nursing responsibilities, that came up as the analysis themes, being: 1) monitoring therapeutic/adverse effects of medicines, 2) monitoring medicines adherence, 3) decision making on medicines, including prescribing 4) providing patient education/information. Nurses' autonomy varied across Europe, from none to limited to a few tasks and emergencies to a broad range of tasks and responsibilities. Intended level of autonomy depended on medicine types and level of education. Some changes are needed before nursing roles can be optimised and implemented in practice. Lack of time, shortage of nurses, absence of legal frameworks and limited education and knowledge are main threats to European nurses actualising their ideal role in PC. CONCLUSIONS European nurses have an active role in PC. Respondents reported positive impacts on care quality and patient outcomes when nurses assumed PC responsibilities. Healthcare professionals expect nurses to report observations and assessments. This key patient information should be shared and addressed by the interprofessional team. The study evidences the need of a unique and consensus-based PC framework across Europe.
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Affiliation(s)
- Elyne De Baetselier
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Tinne Dilles
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luis M. Batalha
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Nienke E. Dijkstra
- Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Maria I. Fernandes
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Izabela Filov
- University "St. Kliment Ohridski" Bitola, Bitola, Republic of North-Macedonia
| | - Juliane Friedrichs
- Medical Faculty, Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Vigdis A. Grondahl
- Faculty of Health and Welfare, Østfold University College, Halden, Norway
| | - Jana Heczkova
- Institute of Nursing Theory and Practice, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ann Karin Helgesen
- Faculty of Health and Welfare, Østfold University College, Halden, Norway
| | - Sue Jordan
- Department of Nursing, Swansea University, Swansea, Wales, United Kingdom
| | - Sarah Keeley
- Department of Nursing and Clinical Science, Bournemouth University, Bournemouth, England, United Kingdom
| | - Thomas Klatt
- Medical Faculty, Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Petros Kolovos
- Department of Nursing, Laboratory of Integrated Health Care, University of Peloponnese, Sparti, Greece
| | - Veronika Kulirova
- Institute of Nursing Theory and Practice, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sabina Ličen
- Faculty of Health Sciences, Department of Nursing, University of Primorska, Izola, Slovenia
| | - Manuel Lillo-Crespo
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | | | - Hana Padysakova
- Faculty of Nursing and Professional Health Studies, Slovak Medical University in Bratislava, Bratislava, Slovak Republic
| | - Mirko Prosen
- Faculty of Health Sciences, Department of Nursing, University of Primorska, Izola, Slovenia
| | - Dorina Pusztai
- Institute of Nursing Sciences, Basic Health Sciences and Health Visiting, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Jorge Riquelme-Galindo
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | - Jana Rottkova
- Faculty of Nursing and Professional Health Studies, Slovak Medical University in Bratislava, Bratislava, Slovak Republic
| | - Carolien G. Sino
- Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | | | - Styliani Tziaferi
- Department of Nursing, Laboratory of Integrated Health Care, University of Peloponnese, Sparti, Greece
| | - Bart Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Luebbers E, Thomas N, Fennimore T, Demko C, Aron D, Dolansky M. Back to basics for curricular development: A proposed framework for thinking about how interprofessional learning occurs. J Interprof Care 2021; 36:300-309. [PMID: 33955806 DOI: 10.1080/13561820.2021.1897002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The persistent difficulty of defining the mechanisms of interprofessional learning that can lead to collaborative behavior poses a challenge to evidence-based curricular design. To begin the process of building a framework for curricular development we used an inductive approach to better understand the lived experience of students engaged in an interprofessional activity. Utilizing methods from grounded theory, we analyzed reflective essays from an interprofessional classroom-based workshop for early learners at Case Western Reserve University. Students from four professional schools (medicine, nursing, social work, and dentistry) participated in facilitator guided small groups for an interactive, case-based, tabletop simulation workshop. Written reflections (N = 245) were collected, and a coding scheme was iteratively developed through constant comparison analysis in the review of a random subsample of essays (n = 19), and saturation was achieved in the second subset (n = 15). Second-order themes and four aggregate dimensions arose from the data. Aggregate dimensions were integrated into a proposed framework for the interprofessional learning process, including factors identified as necessary for the learning to occur. In this report, we describe the development of this preliminary framework, examine its components, and demonstrate potential utility in relation to established theory and research.
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Affiliation(s)
- Ellen Luebbers
- The Center for Medical Education, Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, OH, USA
| | - Njoke Thomas
- Boston College Carroll School of Management, Chestnut Hill, MA, USA
| | - Todd Fennimore
- The Center for Medical Education, Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, OH, USA
| | - Catherine Demko
- Case Western Reserve University School of Dental Medicine, Health Education Campus, Cleveland, OH, USA
| | - David Aron
- The Center for Medical Education, Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, OH, USA
| | - Mary Dolansky
- Frances Payne Bolton School of Nursing, Health Education Campus, Cleveland, OH, USA
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Goldman J, Kuper A, Whitehead C, Baker GR, Bulmer B, Coffey M, Shea C, Jeffs L, Shojania K, Wong B. Interprofessional and multiprofessional approaches in quality improvement education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:615-636. [PMID: 33113055 DOI: 10.1007/s10459-020-10004-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
The imperative for all healthcare professionals to partake in quality improvement (QI) has resulted in the development of QI education programs with participants from different professional backgrounds. However, there is limited empirical and theoretical examination as to why, when and how interprofessional and multiprofessional education occurs in QI and the outcomes of these approaches. This paper reports on a qualitative collective case study of interprofessional and multiprofessional education in three longitudinal QI education programs. We conducted 58 interviews with learners, QI project coaches, program directors and institutional leads and 135 h of observations of in-class education sessions, and collected relevant documents such as course syllabi and handouts. We used an interpretive thematic analysis using a conventional and directed content analysis approach. In the directed content approach, we used sociology of professions theory with particular attention to professional socialization, hierarchies and boundaries in QI, to understand the ways in which individuals' professional backgrounds informed the planning and experiences of the QI education programs. Findings demonstrated that both interprofessional and multiprofessional education approaches were being used to achieve different education objectives. While each approach demonstrated positive learning and practice outcomes, tensions related to the different ways in which professional groups are engaging in QI, power dynamics between professional groups, and disconnects between curricula and practice existed. Further conceptual clarity is essential for a more informed discussion about interprofessional and multiprofessional education approaches in QI and explicit attention is needed to professional processes and tensions, to optimize the impact of education on practice.
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Affiliation(s)
- Joanne Goldman
- Centre for Quality Improvement and Patient Safety, University of Toronto, 525 University Ave., Suite 630, Toronto, ON, M5G 2L3, Canada.
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Wilson Centre for Research in Education, University of Toronto, Toronto, Canada.
| | - Ayelet Kuper
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Wilson Centre for Research in Education, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Cynthia Whitehead
- Wilson Centre for Research in Education, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Beverly Bulmer
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maitreya Coffey
- Department of Paediatrics, University of Toronto, Toronto, Canada
- The Hospital for Sick Children, Toronto, Canada
- Children's Hospitals Solutions for Patient Safety, Cincinnati, OH, USA
| | - Christine Shea
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Lianne Jeffs
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Kaveh Shojania
- Centre for Quality Improvement and Patient Safety, University of Toronto, 525 University Ave., Suite 630, Toronto, ON, M5G 2L3, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Brian Wong
- Centre for Quality Improvement and Patient Safety, University of Toronto, 525 University Ave., Suite 630, Toronto, ON, M5G 2L3, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
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Miles A, Ginsburg S, Sibbald M, Tavares W, Watling C, Stroud L. Feedback from health professionals in postgraduate medical education: Influence of interprofessional relationship, identity and power. MEDICAL EDUCATION 2021; 55:518-529. [PMID: 33259070 DOI: 10.1111/medu.14426] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/13/2020] [Accepted: 11/27/2020] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Capitalising on direct workplace observations of residents by interprofessional team members might be an effective strategy to promote formative feedback in postgraduate medical education. To better understand how interprofessional feedback is conceived, delivered, received and used, we explored both feedback provider and receiver perceptions of workplace feedback. METHODS We conducted 17 individual interviews with residents and eight focus groups with health professionals (HPs) (two nurses, two rehabilitation therapists, two pharmacists and two social workers), for a total of 61 participants. Using a constructivist grounded theory approach, data collection and analysis proceeded as an iterative process using constant comparison to identify and explore themes. RESULTS Conceptualisations and content of feedback were dependent on whether the resident was perceived as a learner or a peer within the interprofessional relationship. Residents relied on interprofessional role understanding to determine how physician competencies align with HP roles. The perceived alignment was unique to each profession and influenced feedback credibility judgements. Residents prioritised feedback from physicians or within the Medical Expertise domain-a role that HPs felt was over-valued. Despite ideal opportunities for direct observation, operational enactment of feedback was influenced by power differentials between the professions. DISCUSSION Our results illuminate HPs' conceptualisation of feedback for residents and the social constructs influencing how their feedback is disseminated. Professional identity and social categorisation added complexity to feedback acceptance and incorporation. To ensure that interprofessional feedback can achieve desired outcomes, education programmes should implement strategies to help mitigate intergroup bias and power imbalance.
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Affiliation(s)
- Amy Miles
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shiphra Ginsburg
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Matthew Sibbald
- Department of Medicine, Centre for Simulation-Based Learning, McMaster University, Hamilton, ON, Canada
| | - Walter Tavares
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Chris Watling
- Department of Oncology, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lynfa Stroud
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto, ON, Canada
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Paton M, Kuper A, Paradis E, Feilchenfeld Z, Whitehead CR. Tackling the void: the importance of addressing absences in the field of health professions education research. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:5-18. [PMID: 32144528 DOI: 10.1007/s10459-020-09966-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/02/2020] [Indexed: 05/28/2023]
Abstract
Many processes and practices in the field of health professions education have been based more on tradition and assumption than on evidence and theory. As the field matures, researchers are increasingly seeking evidence to support various teaching and assessment methods. However, there is a tendency to focus on a limited set of topics, leaving other areas under-examined and limiting our understanding of the field. By explicitly examining areas that are undescribed, i.e. absences in the literature, researchers and scholars have the potential to enrich our practice and our field's understanding of what counts as legitimate research. Using the theoretical framework of Bourdieu's concept of field, we conducted an instrumental case study of three published research projects that each had a finding of absence. We examined each case individually, and then analyzed across cases. Our dataset included published papers, peer-review feedback, and reflective notes. Each of the cases interrogated a different form of absence: absence of content, absence of research, and absence of evidence. While the typology suggests that each absence was different, there were similarities across cases in terms of challenges in 'proving' the reality of the absence and some disbelief or discomfort with accepting the findings as rigorous and/or legitimate. Absence research has potential to add to our theoretical and methodological approaches to the field. This type of research is potentially an exciting and productive new way for scholars to shed light on aspects of health professions education that have received limited attention to date.
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Affiliation(s)
- Morag Paton
- Continuing Professional Development, PostMD Education, Faculty of Medicine, University of Toronto, 500 University Avenue, 6th Floor, Toronto, ON, M5G 1V7, Canada.
- Department of Leadership, Higher and Adult Education, Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada.
| | - Ayelet Kuper
- The Wilson Centre for Research in Education, University Health Network/University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Elise Paradis
- The Wilson Centre for Research in Education, University Health Network/University of Toronto, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Department of Sociology, Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zac Feilchenfeld
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Cynthia R Whitehead
- The Wilson Centre for Research in Education, University Health Network/University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
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Neubert A, Kellar J, Miller D, Kulasegaram K(M, Paradis E. Relational professional identity: How do pharmacy students see themselves in relation to others? Can Pharm J (Ott) 2021; 154:36-41. [PMID: 33598058 PMCID: PMC7863286 DOI: 10.1177/1715163520964500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND As the pharmacy profession moves towards patient-centred care, pharmacy schools have updated their curricula to prepare students for a full scope of practice. A critical objective of the new curricula is the professional socialization of pharmacy students into relational aspects of the profession: how pharmacists should interact with patients and other health care professionals. Through an examination of how one cohort of pharmacy students perceives its relationship to patients and physicians, this study aims to determine how these relational aspects of professional identity evolve with time spent in the program. METHODS At 3 time points over a 2-year period, pharmacy students were asked to detail in writing how they would communicate with a physician concerning a hypothetical drug allergy scenario. A directed content analysis of their responses was conducted based on 3 main analytic categories: patient-centredness, physician collaboration and physician deference. These categories were further divided into 6 subcategories that were used as the variables for analysis. Statistical analyses examined longitudinal group trends for these variables. RESULTS Over the 2 years of observation, an examination of the proportion of messages demonstrating the subcategories of interest showed that the only measure of the pharmacy students' relational professional identity that changed significantly over time occurred for the perception of a sense of shared care for the patient. All other aspects of their relational identity were stagnant and did not change as they progressed through training (χ2; 12.772, df = 2, p < 0.002). CONCLUSION Our results suggest that the relational professional identity of participants was poorly developed with regards to both patients and physicians. Pharmacy educators must reexamine the methods currently being employed to foster students' professional identity development to ensure that new graduates are prepared to meet the challenges of a changing scope of practice. Can Pharm J (Ott) 2021;154:xx-xx.
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Affiliation(s)
| | - Jamie Kellar
- Leslie Dan Faculty of Pharmacy, University of Toronto
| | - Daniel Miller
- Leslie Dan Faculty of Pharmacy, University of Toronto
| | | | - Elise Paradis
- Leslie Dan Faculty of Pharmacy, University of Toronto
- The Wilson Centre, Toronto, Ontario
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Bochatay N, Kuna Á, Csupor É, Pintér JN, Muller-Juge V, Hudelson P, Nendaz MR, Csabai M, Bajwa NM, Kim S. The Role of Power in Health Care Conflict: Recommendations for Shifting Toward Constructive Approaches. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:134-141. [PMID: 33394664 DOI: 10.1097/acm.0000000000003604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE The combination of power and conflict is frequently reported to have a detrimental impact on communication and on patient care, and it is avoided and perceived negatively by health care professionals. In view of recent recommendations to explicitly address power and conflict in health professions education, adopting more constructive approaches toward power and conflict may be helpful. This study examined the role of power in conflicts between health care professionals in different cultural contexts to make recommendations for promoting more constructive approaches. METHOD The authors used social bases of power (positional, expert, informational, reward, coercive, referent) identified in the literature to examine the role of power in conflicts between health care professionals in different cultural settings. They drew upon semistructured interviews conducted from 2013 to 2016 with 249 health care professionals working at health centers in the United States, Switzerland, and Hungary, in which participants shared stories of conflict they had experienced with coworkers. The authors used a directed approach to content analysis to analyze the data. RESULTS The social bases of power tended to be comparable across sites and included positional, expert, and coercive power. The rigid hierarchies that divide health care professionals, their professions, and their specialties contributed to negative experiences in conflicts. In addition, the presence of an audience, such as supervisors, coworkers, patients, and patients' families, prevented health care professionals from addressing conflicts when they occurred, resulting in conflict escalation. CONCLUSIONS These findings suggest that fostering more positive approaches toward power and conflict could be achieved by using social bases of power such as referent power and by addressing conflicts in a more private, backstage, manner.
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Affiliation(s)
- Naike Bochatay
- N. Bochatay is a postdoctoral scholar, School of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-6098-4262
| | - Ágnes Kuna
- Á. Kuna is assistant professor, Department of Applied Linguistics and Phonetics, Eötvös Loránd University, Budapest, Hungary
| | - Éva Csupor
- É. Csupor is a clinical psychologist, Department of Child and Adolescent Psychiatry, Pediatric Clinic, University of Szeged, Szeged, Hungary
| | - Judit Nora Pintér
- J.N. Pintér is associate professor, Department of Psychology of Counseling, Eötvös Loránd University, Budapest, Hungary; ORCID: https://orcid.org/0000-0002-2580-588X
| | - Virginie Muller-Juge
- V. Muller-Juge is an associate specialist, School of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-2346-8904
| | - Patricia Hudelson
- P. Hudelson is a medical anthropologist, Department of Primary Care, Geneva University Hospitals, and lecturer, Faculty of Medicine, University of Geneva, Geneva, Switzerland; ORCID: https://orcid.org/0000-0003-2601-7479
| | - Mathieu R Nendaz
- M.R. Nendaz is professor and vice-dean, Department of Medicine and Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland; ORCID: https://orcid.org/0000-0003-3795-3254
| | - Marta Csabai
- M. Csabai is professor and head of department, Department of Personality, Clinical, and Health Psychology, University of Szeged, Szeged, Hungary
| | - Nadia M Bajwa
- N.M. Bajwa is residency program director, Department of General Pediatrics, Children's Hospital, Geneva University Hospitals, and faculty member, Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland; ORCID: https://orcid.org/0000-0002-1445-4594
| | - Sara Kim
- S. Kim is research professor, Department of Surgery, School of Medicine, University of Washington, Seattle, Washington; ORCID: https://orcid.org/0000-0002-6623-5393
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Ten Cate O, Pool IA. The viability of interprofessional entrustable professional activities. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:1255-1262. [PMID: 31872327 DOI: 10.1007/s10459-019-09950-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/18/2019] [Indexed: 06/10/2023]
Abstract
Interprofessional education (IPE) and entrustable professional activities (EPAs) represent two topics in health professions education that have attracted significant attention in recent years. IPE (when different health professionals learn with, from and about each other with the aim of optimal care) has an inherent focus on the collective. EPAs (units of professional practice that can be fully entrusted to a trainee, once he or she has demonstrated the necessary competence to execute this activity unsupervised) have a focus on the individual. Attempts to relate the two may cause friction and the question is: can they be reconciled? Are interprofessional EPAs or team-EPAs useful concepts and if so what should they look like? The authors argue that most work in modern healthcare involves interprofessional collaboration. Some EPAs have an inherent strong interprofessional nature, such as emergency teamwork, running multidisciplinary team meetings, and surgery. Other EPAs are less inherently dependent on interprofessional collaboration. The authors conclude that neither interprofessional team-EPAs (for which a team can or should be certified), nor IP-EPAs for individuals, as opposed to other EPAs, are viable concepts. However, the authors do not question that certifying health care professionals and entrusting trainees with most clinical tasks will require to ascertain their competence in interprofessional collaboration. This must be included when assessing learners for most EPAs and making entrustment decisions. This can help to strengthen interprofessional competence in the clinical workplace.
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Affiliation(s)
- Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, P.O. Box # 85500, 3508 GA, Utrecht, The Netherlands.
| | - Inge A Pool
- Center for Research and Development of Education, University Medical Center Utrecht, P.O. Box # 85500, 3508 GA, Utrecht, The Netherlands
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Looman N, Fluit C, van Wijngaarden M, de Groot E, Dielissen P, van Asselt D, de Graaf J, Scherpbier‐de Haan N. Chances for learning intraprofessional collaboration between residents in hospitals. MEDICAL EDUCATION 2020; 54:1109-1119. [PMID: 32564390 PMCID: PMC7754101 DOI: 10.1111/medu.14279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 05/13/2023]
Abstract
CONTEXT Intraprofessional collaboration (intraPC) between primary care (PC) doctors and medical specialists (MSs) is becoming increasingly important. Patient safety issues are often related to intraPC. In order to equip doctors well for their task of providing good quality and continuity of care, intraPC needs explicit attention, starting in postgraduate training. Worldwide, PC residents undertake a hospital placement during their postgraduate training, where they work in proximity with MS residents. This placement offers the opportunity to learn intraPC. It is yet unknown whether and how residents learn intraPC and what barriers to and opportunities for exist in learning intraPC during hospital placements. METHODS We performed an ethnographic non-participatory observational study in three emergency departments and three geriatric departments of five hospitals in the Netherlands. This was followed by 42 in-depth interviews with the observed residents and supervisors. The observations were used to feed the questions for the in-depth interviews. We analysed the interviews iteratively following the data collection using template analysis. RESULTS Hospital wards are rich in opportunities for learning intraPC. These opportunities, however, are seldom exploited for various reasons: intraPC receives limited attention when formulating placement goals, so purposeful learning of intraPC hardly takes place; residents lack awareness of the learning of intraPC; MS residents are not accustomed to searching for expertise from PC residents; PC residents adapt to the MS role and they contribute very little of their PC knowledge, and power dynamics in the hospital department negatively influence the learning of intraPC. Therefore, improvements in mindset, professional identity and power dynamics are crucial to facilitate and promote intraPC. CONCLUSIONS Intraprofessional collaboration is not learned spontaneously during hospital placements. To benefit from the abundant opportunities to learn intraPC, adjustments to the set-up of these placements are necessary. Learning intraPC is promoted when there is a collaborative culture, hierarchy is limited, and there is dedicated time for intraPC and support from the supervisor.
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Affiliation(s)
- Natasja Looman
- Department of Primary and Community CareRadboudumcNijmegenthe Netherlands
| | - Cornelia Fluit
- Department for Research in Learning and EducationRadboudumc Health AcademyNijmegenthe Netherlands
| | - Marielle van Wijngaarden
- Department of Primary and Community CareRadboudumcNijmegenthe Netherlands
- Department of Geriatric MedicineRadboudumcNijmegenthe Netherlands
| | - Esther de Groot
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Patrick Dielissen
- Department of Primary and Community CareRadboudumcNijmegenthe Netherlands
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Haidet P, Madigosky WS. Towards an evolution of interprofessional practice: Lessons learned from two jazz piano trios. PATIENT EDUCATION AND COUNSELING 2020; 103:2173-2177. [PMID: 32593556 PMCID: PMC7292945 DOI: 10.1016/j.pec.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 05/03/2023]
Abstract
Interprofessional practice has been of great interest to both health systems and educational institutions, but has been slow to develop in actual practice. Important efforts to speed adoption have mostly focused on changes in structure or educational interventions. It turns out that the field of jazz music was grappling with similar issues in the early 1960s. In this essay, we draw lessons from the experiences of jazz musicians during a time of transition. We conclude that significant cultural transformation, focused on two paradoxes, and the barriers and contexts that flow from them, will be necessary to achieve ideal interprofessional healthcare practice.
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Affiliation(s)
- Paul Haidet
- Woodward Center for Excellence in Health Sciences Education and the Departments of Medicine, Humanities, and Public Health Sciences at the Penn State University College of Medicine, Hershey, PA, USA.
| | - Wendy S Madigosky
- The Center for Interprofessional Practice and Education and the Department of Family Medicine at the University of Colorado School of Medicine, Anschutz Medical Campus, Denver, CO, USA
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Competencies to promote collaboration between primary and secondary care doctors: an integrative review. BMC FAMILY PRACTICE 2020; 21:179. [PMID: 32878620 PMCID: PMC7469099 DOI: 10.1186/s12875-020-01234-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 07/29/2020] [Indexed: 12/02/2022]
Abstract
Background In a society where ageing of the population and the increasing prevalence of long-term conditions are major issues, collaboration between primary and secondary care is essential to provide continuous, patient-centred care. Doctors play an essential role at the primary-secondary care interface in realising ‘seamless’ care. Therefore, they should possess collaborative competencies. However, knowledge about these collaborative competencies is scarce. In this review we explore what competencies doctors need to promote collaboration between doctors at the primary-secondary care interface. Methods We conducted an integrative literature review. After a systematic search 44 articles were included in the review. They were analysed using a thematic analysis approach. Results We identified six themes regarding collaborative competencies: ‘patient-centred care: a common concern’, ‘roles and responsibilities’, ‘mutual knowledge and understanding’, ‘collaborative attitude and respect’, ‘communication’ and ‘leadership’. In every theme we specified components of knowledge, skills and attitudes as found in the reviewed literature. The results show that doctors play an important role, not only in the way they collaborate in individual patient care, but also in how they help shaping organisational preconditions for collaboration. Conclusions This review provides an integrative view on competencies necessary for collaborative practice at the primary-secondary care interface. They are part of several domains, showing the complexity of collaboration. The information gathered in this review can support doctors to enhance and learn collaboration in daily practice and can be used in educational programmes in all stages of medical education.
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Brown ME, Whybrow P, Kirwan G, Finn GM. Professional identity formation within Longitudinal Integrated Clerkships: a scoping review protocol. Syst Rev 2020; 9:166. [PMID: 32709252 PMCID: PMC7382026 DOI: 10.1186/s13643-020-01422-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/06/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Professional identity development is an area of contemporary interest within medical education. It can be defined as 'the foundational process one experiences during the transformation from lay person to physician'. In order for this transformation to occur, medical values and principles are internalised. A robust professional identity is key to confident practice as a medical professional. As such, research regarding what works to encourage identity development is popular. New models of educational delivery, such as the increasingly popular Longitudinal Integrated Clerkship model (LICs), present an interesting opportunity to investigate impact on identity. As no previous literature reviews focus on identity development within LICs, it is unclear what is already known about their impact. Therefore, a scoping review synthesising current knowledge and mapping areas for future research is necessary. METHODS Arksey and O'Malley's scoping review steps will be used as a methodological framework. MEDLINE, EMBASE, PubMed, Web of Knowledge, ERIC, PsychINFO, Google Scholar, JSTOR, Scopus, and Web of science will be searched (from inception onwards). We will include single studies of any design (e.g. quantitative and qualitative) and reviews examining professional identity within Longitudinal Integrated Clerkships involving health profession students. Two reviewers will complete all screening and data abstraction independently. Deductive coding will be presented as a quantitative textual meta-analysis. Inductive coding will be presented in narrative format. DISCUSSION This scoping review will explore professional identity formation within LICs, evaluating any known impact of the educational model and mapping the ways in which identity within LICs has been researched. Mapping of current knowledge should highlight whether LICs as an educational model can influence professional identity development and outline gaps in what is known about their impact to date. Theory used in LIC-based identity research will also be mapped, in order to summarise the main theoretical orientations of research to date. It is anticipated that through such evidence synthesis, directions for future research will become clear. SYSTEMATIC REVIEW REGISTRATION Open Science Framework: osf.io/hk83p.
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Affiliation(s)
- Megan El Brown
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK.
| | - Paul Whybrow
- Academy for Primary Care, Hull York Medical School, University of Hull, Hull, UK
| | | | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
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Cahn PS. How interprofessional collaborative practice can help dismantle systemic racism. J Interprof Care 2020; 34:431-434. [DOI: 10.1080/13561820.2020.1790224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Peter S. Cahn
- Center for Interprofessional Studies and Innovation, MGH Institute of Health Professions, Boston, MA 02129, USA
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Johnson JM, Hermosura BJ, Price SL, Gougeon L. Factors influencing interprofessional team collaboration when delivering care to community-dwelling seniors: A metasynthesis of Canadian interventions. J Interprof Care 2020; 35:376-382. [PMID: 32400226 DOI: 10.1080/13561820.2020.1758641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The rapid growth in the proportion of adults over the age of 65 translates into greater need of complex, highly specialized care. Hence, coupled with other factors, healthcare expenditures in Canada have grown exponentially, creating tension for a high-quality care while managing costs. Interventions with community-based interprofessional teams have been piloted across Canada as a means to provide efficient specialized care. These teams must, however, work collaboratively for a more comprehensive and patient-centered care. This metasynthesis aimed to identify common factors or characteristics found to be essential for a collaborative practice among members of an interdisciplinary team delivering coordinated care to community-dwelling seniors in both rural and urban centers in Canada. Six databases (Medline, CINAHL, Sage, JSTOR, ProQuest, Web of Science) were searched for qualitative peer-reviewed articles on community-based interventions with interprofessional teams in Canada and published between 2005-2018. Six articles were included and appraised using the COREQ guidelines for quality, followed by a thematic analysis for common themes related to team collaboration. Overarching themes related to practices of interprofessional collaboration were trust and respect, communication, and shared vision. Sub-themes included trust in the relationship between health care professional, professional identity and role clarity, interprofessional communication, communication with the client or family, and common goals. Interprofessional teams work collaboratively when trust and respect, communication, and shared vision are valued and present. Agencies coordinating interprofessional teams for community-based care could be pivotal in ensuring an environment conducive to collaboration, such as learning and team building opportunities.
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Affiliation(s)
- J M Johnson
- Faculty of Nursing, University of Calgary in Qatar
| | - B J Hermosura
- Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
| | - S L Price
- Faculty of Health, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - L Gougeon
- Alberta Cancer Prevention Legacy Fund, Alberta Health Services, Calgary, Alberta, Canada
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Castanelli DJ, Weller JM, Molloy E, Bearman M. Shadow systems in assessment: how supervisors make progress decisions in practice. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:131-147. [PMID: 31485893 DOI: 10.1007/s10459-019-09913-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
Medical educators are tasked with decisions on trainee progression and credentialing for independent clinical practice, which requires robust evidence from workplace-based assessment. It is unclear how the current promotion of workplace-based assessment as a pedagogical approach to promote learning has impacted this use of assessments for decision-making; meeting both these purposes may present unforeseen challenges. In this study we explored how supervisors make decisions on trainee progress in practice. We conducted semi-structured interviews with 19 supervisors of postgraduate anesthesia training across Australia and New Zealand and undertook thematic analysis of the transcripts. Supervisors looked beyond the formal assessment portfolio when making performance decisions. They instead used assessment 'shadow systems' based on their own observation and confidential judgements from trusted colleagues. Supervisors' decision making involved expert judgement of the perceived salient aspects of performance and the standard to be attained while making allowances for the opportunities and constraints of the local learning environment. Supervisors found making progress decisions an emotional burden. When faced with difficult decisions, they found ways to share the responsibility and balance the potential consequences for the trainee with the need to protect their patients. Viewed through the lens of community of practice theory, the development of assessment 'shadow systems' indicates a lack of alignment between local workplace assessment practices and the prescribed programmatic assessment approach to high-stakes progress decisions. Avenues for improvement include cooperative development of formal assessment processes to better meet local needs or incorporating the information in 'shadow systems' into formal assessment processes.
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Affiliation(s)
- Damian J Castanelli
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
- Department of Anaesthesia and Perioperative Medicine, Monash Health, Clayton, VIC, Australia.
| | - Jennifer M Weller
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Elizabeth Molloy
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Margaret Bearman
- Centre for Research and Assessment in Digital Learning (CRADLE), Deakin University, Geelong, VIC, Australia
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Rauvola RS, Briggs EP, Hinyard LJ. Nomology, validity, and interprofessional research: The missing link(s). J Interprof Care 2020; 34:545-556. [DOI: 10.1080/13561820.2020.1712333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Rachel S. Rauvola
- Center for Interprofessional Education and Research, Saint Louis University, St. Louis, MO, USA
- Department of Psychology, Saint Louis University, St. Louis, MO, USA
| | - Erick P. Briggs
- Department of Psychology, Saint Louis University, St. Louis, MO, USA
| | - Leslie J. Hinyard
- Center for Interprofessional Education and Research & Center for Health Outcomes Research, Saint Louis University, St. Louis, MO, USA
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Ju M, van Schaik SM. Effect of Professional Background and Gender on Residents' Perceptions of Leadership. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:S42-S47. [PMID: 31365402 DOI: 10.1097/acm.0000000000002925] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To examine the impact of professional background and gender of a resuscitation team leader on residents' perceptions of leadership skills. METHOD The authors video-recorded a scripted, simulated resuscitation scenario twice, with either a male or a female team leader. They copied each video and labeled the leader as physician (MD) or nurse practitioner (NP), creating 4 conditions: female NP, female MD, male NP, or male MD. The authors recruited resident participants from 5 specialties at 4 institutions; they randomly assigned residents to view one version of the video and rate the team leader's performance using the Ottawa Crisis Resource Management Global Rating Scale (Ottawa CRM) in an online survey. The authors conducted 2-way ANOVA to examine interactions between team leader gender and profession on Ottawa CRM ratings. RESULTS One hundred sixty residents responded (89 females, 71 males). A statistically significant main effect of team leader gender on residents' ratings was found in 2 of the 6 Ottawa CRM domains, leadership (F1,156 = 6.97, P = .009) and communication skills (F1,156 = 8.53, P = .004), due to lower ratings for female than male leaders (5.29 ± 0.95 vs 5.74 ± 1.17; 5.05 ± 1.20 vs 5.57 ± 1.06). There was no effect of profession on ratings and no significant interaction between profession and gender of the team leader on ratings for any of the domains. CONCLUSIONS These findings indicate bias among residents against females as team leaders. Mitigating such bias is essential to successfully establish shared leadership models in health care.
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Affiliation(s)
- Mindy Ju
- M. Ju is assistant professor of pediatrics, Division of Pediatric Critical Care Medicine, University of California, San Francisco, San Francisco, California. S.M. van Schaik is professor of pediatrics, Division of Pediatric Critical Care Medicine, University of California, San Francisco, San Francisco, California
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