Junior doctors' experiences with interprofessional collaboration: Wandering the landscape

Using theoretical engagement to understand workplace learning across contexts-Bringing worlds apart together

The pivotal importance of workplace learning (WPL) within health professions education has elevated its understanding and improvement to a major research priority. From a sociocultural learning theory perspective, WPL is inherently situated and context-specific. This means that the health care settings in which (future) health care professionals are trained will impact how and what is learned. However, to what extent is the research performed thus far transferable across professional contexts, cultures and borders? To what extent has WPL research sufficiently addressed the contextual characteristics of WPL to enable the evaluation of its transferability? To what extent have methodological and theoretical approaches enabled the building of understanding across contexts? We propose that heightening the transferability of WPL research as well as opening up the conversation to more diverse WPL contexts, settings and cultures will require mapping context and theoretical engagement. To explore what theoretical engagement may afford to our understanding of the influence of context on WPL, we use two theories: Landscapes of Practice and Figured Worlds. These theories with sociocultural groundings provide concrete lenses to understand the interplay between the individual and the context. We conclude with implications for research and practice and advocate for more attention to research practices that may deepen our understanding and heighten the transferability of workplace learning research.

Comparing intraprofessional and interprofessional workplace learning: Similar or not?

The authors demonstrate alignment between intraprofessional and interprofessional learning, highlighting their interconnectedness and underscoring the value of a balanced approach to address ingroup‐outgroup dynamics and foster optimal collaboration.

Unravelling underlying processes in intraprofessional workplace learning in residency

BACKGROUND

To deliver high-quality collaborative care, residents need to be trained across the boundaries of their medical specialty (intraprofessional learning). The current literature does not provide insights into the underlying processes that influence intraprofessional learning. The aim of this study was to gain insight into the processes that occur during intraprofessional workplace learning in residency training, by exploring everyday intraprofessional interactions experienced by residents, with the ultimate objective of improving collaborative practice.

METHOD

We conducted a focused ethnography using field observations and in-depth interviews with residents at an academic children's hospital in the Netherlands. In 2022, nine residents from four different medical specialties were shadowed and/or interviewed. In total, >120 hours of observation and 10 interviews were conducted. Data collection and analysis were conducted iteratively and discussed in a research team with diverse perspectives, as well as with a sounding board group of stakeholders.

RESULTS

Residents were involved in numerous intraprofessional interactions as part of their daily work. We identified three themes that shed light on the underlying processes that occur during intraprofessional workplace learning: (1) residents' agency, (2) ingroups and outgroups and (3) communication about intraprofessional collaboration.

CONCLUSIONS

Collaborative practice offers many intraprofessional learning opportunities but does not automatically result in learning from, with and about other specialties to improve intraprofessional collaborative care. Overarching the identified themes, we emphasise the pivotal role of the resident-supervisor dyad in facilitating residents' engagement in the learning opportunities of complex intraprofessional care. Furthermore, we propose that promoting deliberate practice and shared responsibility in collaborative care are crucial to better prepare residents for their roles and responsibilities in delivering high-quality collaborative patient care.

Using a boundary crossing lens to understand basic science educator and clinical educator collaboration in instructional design

PURPOSE

Collaborations between basic science educators (BE) and clinical educators (CE) in medical education are common and necessary to create integrated learning materials. However, few studies describe experiences of or processes used by educators engaged in interdisciplinary teamwork. We use the lens of boundary crossing to explore processes described by BE and CE that support the co-creation of integrated learning materials, and the impact that this work has on them.

MATERIALS AND METHODS

We conducted qualitative content analysis on program evaluation data from 27 BE and CE who worked on 12 teams as part of a multi-institutional instructional design project.

RESULTS

BE and CE productively engaged in collaboration using boundary crossing mechanisms. These included respecting diverse perspectives and expertise and finding efficient processes for completing shared work that allow BE and CE to build on each other's contributions. BE and CE developed confidence in connecting clinical concepts with causal explanations, and willingness to engage in and support such collaborations at their own institutions.

CONCLUSIONS

BE and CE report the use of boundary crossing mechanisms that support collaboration in instructional design. Such practices could be harnessed in future collaborations between BE and CE.

Harnessing student feedback to transform teachers: Role of emotions and relationships

INTRODUCTION

Feedback is crucial to promote learning and improve performance. However, we lack a nuanced understanding of how medical teachers reflect on and internalise (or not) student feedback (SF). This study aims to fill this gap by exploring how teachers make sense of SF to improve their performance and nurture their personal and professional development.

METHODS

In this cross-sectional qualitative study based on a constructivist paradigm, 14 medical teachers individually drew a Rich Picture (RP) of a feedback experience in which they received informal or formal feedback from students, resulting in a personal or professional change. After the drawing, we interviewed the participants to deepen our understanding of teachers' experiences. We analysed the drawings and interview transcripts using an iterative process of thematic analysis.

RESULTS

SF that culminated in personal or professional change is a highly emotional experience for teachers, often with long-lasting consequences. It may threaten or reassure their self-concept and professional identity, generating feedback avoidance or feedback-seeking behaviour. SF is particularly powerful in transforming teaching practices when teachers feel connected to students through an honest and constructive relationship. Remarkably, some teachers intentionally build relationships with certain (selected) students to get 'qualified' feedback. SF acceptance also increases when teachers are open to receiving feedback and there is an institutional culture that values feedback. Finally, medical teachers believe that formal (planned) feedback is relevant to improve the curriculum, while informal (spontaneous) feedback is important for promoting teachers' personal and professional development.

DISCUSSION

SF has the potential to become a transformative learning experience for teachers. The student-teacher relationship and teachers' emotional reactions affect the way teachers make sense of and internalise SF and enact behavioural change. Understanding the complexity surrounding SF is vital for supporting teachers in seizing opportunities for growth and in nurturing a meaningful relationship with the act of teaching.

Comparison of medical students' considerations in choosing a specialty: 2020 vs. 2009/10

BACKGROUND

Workforce shortage in healthcare and particularly in physicians poses a threat to healthcare delivery and its quality. In comparison to other OECD countries, Israel currently has a small number of medical graduates relative to its number of physicians, naturally emphasizing the importance of ensuring that this population chooses to remain in medicine. Understanding what is most important to medical students can help improve working conditions in residency. Such information is particularly needed to facilitate policy planning that will encourage the next generation of physicians to specialize in medical fields that are experiencing shortages. We hypothesized that between 2009/2010 and 2020, there were significant changes in medical students' preferences regarding their considerations for choosing a medical specialty.

METHODS

We compared cross-sectional data from questionnaire-based surveys of 5th year medical students performed in 2009-2010 and 2020 at two Israeli universities.

RESULTS

Of the 335 medical students who responded (237 and 98 in 2009/2010 and 2020, respectively) those in 2020 were 2.26 less likely vs. those in 2009/2010, to choose a residency for its high-paying potential (P < 0.05), and had significantly more interest in residencies with greater teaching opportunity (98.8% vs 82.9%, P < 0.05), increased responsibility and chances to make clinical decisions on their own (67.9% vs 51.6%, P < 0.05). Criteria important to both the 2009/2010 and 2020 students were choosing a bedside specialty (70.2%vs 67.9%, NS), and an interesting and challenging specialty (95.2%v s 91.3%, NS).

CONCLUSIONS

These results partially supported our hypothesis that medical students' preferences have changed over the years, though there are fundamental factors that apparently reflect medical students' nature that do not change over time.

Do you see what I see? Feeding interprofessional workplace learning using a diversity of theories

In this Commentary, Stalmeijer and Varpio highlight the importance of using different theoretical frameworks to make visible the potential of and need for research into interprofessional learning and guidance during workplace-based learning in the health professions.

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

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

Exploring nurses' role in guiding residents' workplace learning: A mixed-method study

INTRODUCTION

Understanding residents' workplace learning could be optimized by not only considering attending physicians' role but also the role of nurses. While previous studies described nurses' role during discrete activities (e.g. feedback), a more profound understanding of how nurses contribute to residents' learning remains warranted. Therefore, we used the educational concept of guidance and explored the extent to which residents' and nurses' perceptions align regarding nurses' guiding role and which reasons they provide for their perceptions.

METHODS

This mixed-method study was conducted at four Dutch university medical centres in 2021. We simultaneously collected quantitative and qualitative data from 103 residents and 401 nurses through a theory-informed questionnaire with a Likert-scale and open-ended questions. We analyzed quantitative data to explore respondents' perceptions of nurses' guiding role by using anova. The thematically analyzed qualitative open comments explored respondents' reasons for their perceptions.

RESULTS

Nurses indicated to provide significantly more support (p = .01) and guidance on learning from patient care (p < .01) than perceived by residents. Moreover, nurses indicated that attending physicians did not always involve them in guiding residents, whereas residents perceived nurses were being involved (p < .001). Themes suggest that nurses and residents could be divided into two groups: (i) respondents who felt that guiding was inextricably linked to good interprofessional collaboration and patient care and (ii) respondents who saw the guiding role as limited and emphasised the distinct fields of expertise between nurses and physicians.

CONCLUSIONS

Residents and nurses felt that nurses played an important role in guiding residents' workplace learning. However, some residents did not always perceive to be guided. To further capitalise on nurses' guiding role, we suggest that residents can be encouraged to engage in the learning opportunities nurses provide to achieve optimal team-based patient care.

The ‘Rich Pictures’ Method: Its Use and Value, and the Implications for HRD Research and Practice

Embracing new and innovative qualitative methods has helped researchers in a number of fields to access aspects of the lived experience that traditional methods cannot easily reach. This paper explores the use and value of one such method – ‘rich pictures’: a technique whose origins lie in ‘soft systems’ engineering but which has been successfully applied in a broader range of contexts in recent years including health, medicine and education. Despite its use in these disciplines, however, recent studies suggest that HRD research continues to rely on established methods and that uptake of visual methods – and ‘rich pictures’ in particular – is virtually non-existent. The aim of this paper therefore is to shed light on this underused method and encourage HRD researchers to recognize its potential for studying human development.

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

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

Together or not together: Paving the way to boundary crossing

The authors discuss how interprofessional education could ease the transition into collaborative practice by laying the foundation for interprofessional boundary crossing, suggesting that virtual IPE be used to nurture interprofessional feedback‐seeking behaviours.

'We just did it as a team': Learning and working on a paediatric interprofessional training ward improves interprofessional competencies in the short- and in the long-term

PURPOSE

Interprofessional (IP) education is essential for healthcare professionals to prepare them for future IP collaboration. IP training wards (ITWs) have been established for work-based IP education. Short-term effects of ITW placements have been published but long-term results are scarce. There are no reports on ITWs in paediatrics. We established the Interprofessional Training Ward in Paediatrics (IPAPAED) for paediatric nursing trainees and medical students. The aim of the study is to evaluate both short- and long-term outcomes regarding IP competencies of IPAPAED participants.

METHODS

The study was designed as a prospective, non-randomized trial, using a mixed-methods design. The Interprofessional Socialization and Valuing Scale (ISVS-9A/B) and the Interprofessional Collaboration Scale (ICS) were used for quantitative evaluation, qualitative data were gathered from structured group discussions and free-text comments. Data were collected from 68 IPAPAED participants, before and after the rotation, and 6-34 months later.Results: IPAPAED participants showed increased global scores in the ISVS 9 A/B and rated their communication competencies and their accommodation in IP teams better (ICS). Improvements in communication competency and accommodation persisted at 6-34 months.Conclusions: IP learning and working on IPAPAED had positive short-term effects on interprofessional competencies. Some of these effects persisted on a long-term.