Creating a Collaborative Care Curriculum Framework

Culture and context in Interprofessional education: Expectations in Australia and Japan

The attributes of collaborative practice in health care vary across contexts, necessitating the adaptation of interprofessional education curricula to prepare students for the collaborative practice expected in their respective health care systems. Culture, when conceptualised through an organisational lens, allows an analysis of the shared assumptions, beliefs and values, without seeking to reduce to a uniform construct. This article explores the differences in interprofessional education competencies between Australia and Japan and considers the systems and patient expectations, which underpin each. While collaborative competence exhibits some similarities across contexts, competency frameworks differ in emphasis, language and key terminology, which highlight multiple points of difference in the expectations of interprofessional collaborative practice across contexts. There are education and practice consequences of these different perspectives of collaborative practice, in an increasingly mobile international workforce.

Exploring a revised interprofessional learning curriculum in undergraduate health education programs at Linköping University

BACKGROUND

Interprofessional education aiming at providing competencies require evaluation in order to ensure that outcomes match the needs and ambitions. Health professionals today need a broad range of skills and competencies in order to provide high quality care, including interprofessional competence. Linköping University has been a pioneer in interprofessional learning for decades and this study provides one example of how a curriculum revision can be carried out. The aim of this study was to study the intentions and outcomes of a revised interprofessional learning curriculum in health professions education programs.

METHODS

This was a qualitative study, including documents (n = 143) and complementary interviews with key individuals (n = 4). Data included syllabuses, study guides, educational program plans, supervisor guides, and interview transcripts. A qualitative document analysis and a content analysis with a directed approach was used, applying a theoretical framework for curriculum development that guided the analysis.

RESULTS

The analysis resulted in one overarching theme named "A planned, lived, and attended curriculum" including four main categories inspired by a theoretical framework. The findings demonstrate a variety of aspects relating to the why and how of curriculum revision. The introduction of a programme director in interprofessional learning, with a mandate equal to respective program directors, seemed to contribute to legitimacy. Further, the partnership between the university and the healthcare sector had an impact on the curriculum revision, in that healthcare had a say in the revision regarding what suggestions to implement or not. The expectations of the teachers involved were high, although clear support structures seemed to be lacking.

CONCLUSIONS

This study has identified some of the important links between teachers, organizational prerequisites, and healthcare when revising an existing fully integrated curriculum in interprofessional learning for health professions education programs. The aim of this curriculum revision was to legitimize and provide education that is up to date with current healthcare needs and to provide students with competencies to collaborate in teams to ensure patient safety. When redesigning a curriculum there seems to be a fine balance between pedagogical innovation and pragmatism. This study identified that the links provided between organizational support structures and the expectations on teachers were not aligned.

A teamwork OSCE station - Encompassing shared decision making between a doctor, pharmacist and patient

BACKGROUND AND PURPOSE

Teamwork with a focus on incorporating interprofessional education (IPE) is a core skill taught in pharmacy curriculum. Including the patient in shared decision making has become a more empathetic and holistic approach to care. Teamwork skills and approaches are usually assessed by peers via group work.

EDUCATIONAL ACTIVITY AND SETTING

A teamwork Objective Structured Clinical Examination (OSCE) station was implemented in 2022 in two countries, conducted in final year pharmacy students where students had to solve a clinical scenario with a doctor and patient in the room and manage any resistances to therapy recommendations. Students were marked on their collaborative skills and how they articulated clinical evidence to justify their therapy recommendations to reach an optimal goal to suit the team. Perception data from students simulated patients and doctors were also collected.

FINDINGS

Across both countries (n = 414), the overall mean score was 79.1% (24.0%SD) across six different OSCE cases. Students generally struggled with the concept of engaging in a two-way conversation, and often presented their full recommendations without any breaks to confirm understanding or agreement. Simulated patients appreciated the OSCE showing a patient role in decision making. Simulated doctors valued the OSCE for its assessment of clinical justification in times of disagreement. Overall, 86.2% of students (n = 354) agreed or strongly agreed the station assessed their teamwork skills adequately.

SUMMARY

A teamwork OSCE station is a valuable assessment for assessing shared decision making skills and more work around prepare students to engage in two-way conversations is needed.

Teaching digital interprofessional collaboration

BACKGROUND

Interprofessional communication in Australian clinical practice has recently shifted from paper records to electronic medical records (EMRs), and there is therefore a need for universities to prepare health graduates for digital communication.

APPROACH

An interprofessional team co-designed and co-facilitated an online interprofessional activity for third year pharmacy and fifth year medical students utilising a simulated EMR (EHR Go™). Students completed a series of profession-specific tasks relating to a simulated patient, then came together in interprofessional groups of 10-12 to establish a collaborative medication charting plan.

EVALUATION

A total of 640 students participated in the activity, of which 60% (386/640) were medical students. Immediately after the interprofessional workshop, students were invited to complete a voluntary anonymous evaluation. Five-point Likert scales were used to rate the relevance to practice, achievement of learning outcomes, organisation and overall quality of the activity. Students were also asked to contribute qualitative feedback. Of the participants, 28% (180/640) completed the survey, and 53% (96/180) of respondents were medical students. A majority of survey respondents agreed or strongly agreed that the activity was relevant to practice (94%; 170/180), achieved the learning outcomes (84%; 151/180), was well organised (74%; 133/180) and was a quality learning experience (79%; 143/180). The positive feedback focused on appreciating the opportunity to discuss with interdisciplinary colleagues the rationale for admission medications. Constructive feedback included the need for clearer directives regarding pre-workshop activities.

IMPLICATIONS

This interprofessional education (IPE) activity presents a feasible, innovative approach to teaching pharmacy and medical students digital communication and collaboration using a simulated EMR. Overall, a majority of learners were satisfied with the learning experience and felt that the IPE activity achieved the learning outcomes and was relevant to practice.

Introspective Learning From Interprofessional Virtual Grand Rounds

BACKGROUND

Interprofessional collaboration in health care settings improves patient safety and outcomes, yet collaboration among health professionals requires specific competencies and skills. Providing nursing students with interprofessional learning experiences with multiple health professions is possible yet challenging.

PROBLEM

Opportunities for effective online interprofessional learning are lacking.

APPROACH

This article explores nursing students' reflections on how an interprofessional learning experience, Virtual Grand Rounds (VGRs), influenced their personal development and provided meaningful learning that they can use in their practices as professional nurses. Thematic analysis was done on the open-ended questions in students' final reflection assignment.

OUTCOMES

Analysis of student reflections identified 5 learning themes including the value of teamwork and collaboration, the importance of communication skills, professional identity, plans to engage diverse health professions, and the desire for future learning.

CONCLUSIONS

Student reflections indicate the VGR was an effective method for nursing students to experience collaboration with multiple health professions without disrupting curriculums.

Realist review of interprofessional education for health care students: What works for whom and why

Interprofessional education (IPE) programs, are complex, logistically challenging, and can be expensive to deliver, but these matters are offset by the perceived benefits of IPE. There is little clarity regarding how IPE contributes to the desirable development of collaborative practitioners. To guide educators in the design of IPE programs there is a need to understand the elements that promote optimal learning. A realist review was conducted to identify the mechanisms and resources that contribute to IPE outcomes. Four databases were searched until April 2020 for empirical studies describing mandatory IPE for pre-registration medical, nursing and other health professional students. Twelve articles met the inclusion criteria. Two novel learning design elements were identified; interdependence, where there is a need for genuine contribution of skills and knowledge from the professions learning together to successfully complete tasks, and embodiment, where through being immersed in an authentic scenario, learners feel what it is like to work in their professions. Other observations supported previous research findings such as the importance of skilled facilitators to promote interaction and reflection. Interprofessional interventions incorporating these specific learning design features seem likely to enhance the impact of IPE, thus making the best use of limited institutional resources and student time.

Preceptor Perceptions of Pharmacy Student Performance Before and After a Curriculum Transformation

Objective. To explore preceptors' perceptions about the performance of undergraduate pharmacy students during experiential placements in Australia, before and after curricular transformation.Methods. Using a semi-structured approach, we interviewed 26 preceptors who had recently supervised students who took part in the transformed curriculum and students from the previous curriculum. A directed content analysis approach was used to analyze the transcripts.Results. Preceptors described students from the transformed curriculum as having improved professional skills, behaviors, and attitudes and as having an increased ability to perform clinical activities compared to students of the previous curriculum. Preceptors also perceived that students in the transformed curriculum had improved clinical knowledge and knowledge application. They less frequently expressed that students in the transformed curriculum had lower-than-expected knowledge levels.Conclusion. The results of this study suggest that curricular transformation with a focus on skill-based and active learning can improve the performance of pharmacy students in terms of their professional behaviors and attitudes, skills, knowledge, and clinical abilities, as perceived by preceptors.

The utility of an interprofessional education framework and its impacts upon perceived readiness of graduates for collaborative practice. A multimethod evaluation using the context, input, process, product (CIPP) model

BACKGROUND

Frameworks in higher education can support strategic curriculum change in complex systems. The impact of these frameworks in achieving their stated purpose is less known. An interprofessional education (IPE) framework and related multi-activity curriculum designed to develop health profession graduates with the requisite skills for collaborative care, was introduced in a large university, across eleven health professions.

OBJECTIVE

To determine the utility of an interprofessional framework and impact upon perceived work readiness for collaborative practice.

METHOD

A multimethod design using the context, input, process, product (CIPP) evaluation model was selected taking a social constructivist theoretical stance. Data collection included staffing allocation to IPE, curriculum audit, and reflections from representatives of all health professions courses offered at the institution. Data was analyzed using framework analysis.

PARTICIPANTS

Interviews or focus groups were undertaken with academic Faculty (n = 13), recent graduates (n = 24) and clinical supervisors/employers of recent graduates (n = 17).

RESULTS

The framework assisted the systematic implementation of interprofessional curriculum across the different health courses at the university. Collaborative work-ready learning outcomes were identified in graduates where targeted curriculum had been implemented across all four domains of the framework. Gaps identified in framework implementation were consistent with gaps identified in graduate knowledge and skills related to collaborative practice. The combination of formal university-based IPE and informal workplace learning as part of clinical placements contributed to achieving the desired learning outcomes.

CONCLUSIONS

These findings offer insights into the use of shared frameworks to drive specific learning activities related to collaborative practice.

Determining a common understanding of interprofessional competencies for pre-registration health professionals in Aotearoa New Zealand: A Delphi study

There is growing awareness that factors such as the growing incidence of co-morbidity and increasing complexity of patient health needs cannot be addressed by health professionals practicing in isolation. Given this, there is an increasing emphasis on preparing students in health-related programs for effective interprofessional practice. Less clear, however, are the specific skills and clinical or learning opportunities necessary for students to develop effectiveness in interprofessional practice. These factors drove a team associated with a tertiary health education provider in Hamilton, New Zealand to transform traditional clinical student experiences in the form of an interprofessional student-assisted clinic. The clinic was intended, in part, to provide students with opportunities to learn and experience interprofessionalism in practice but was hampered by limited information available regarding the specific skill requirements necessary for students in New Zealand to learn in this context. In this Delphi study, we synthesize national expert opinion on student competency indicators necessary for effective interprofessional practice. The resultant set of indicators is presented and opportunities for application and further research discussed. The paper offers guidance to others seeking to innovate health curricula, develop novel service-oriented learning experiences for students, and foster interprofessional practice competence in the future health workforce.

Transforming postgraduate GP teaching through collaborative course design and peer-facilitated small-group, reflective learning

Shropshire Vocational Training Scheme's (VTS) traditional structure of peer-delivered teaching had received poor feedback from trainees. There is good evidence in the literature for stakeholder engagement in training design and participation in small group learning and case discussion as a bedrock of GP learning in the VTS. We introduced three new initiatives to improve half-day release (HDR): 1. collaborative course design; 2. reflective, case-based learning with flipped learning resources; and 3. peer-facilitated, small groups. The aim was to marry trainees' desire for clinical context with the need to comprehensively cover the professional knowledge, skills and attitudes of the 'Being a GP' Royal College of General Practitioner's curriculum.The new collaborative model has improved feedback, facilitated high-level small group reflection and resulted in a smooth transition to virtual HDR during Covid-19. We now have a cohort of highly motivated facilitators, with the opportunity to develop leadership skills, and a bank of complex clinical cases developed to facilitate useful, trainee-led, case-based discussion.Our model is deliverable in other VTS areas and could enhance trainee experience of HDR. Future challenges will be maintaining facilitator training, quality control for cases and discussion and how to ensure our near-peer facilitators successfully become future leaders in primary care.

Occupational therapists’ experiences of implementing occupation-based practice in neurology, and its impact on professional identity

Introduction

Facilitating engagement in meaningful occupations underpins occupational therapy intervention. Occupation-based practice, while linked to improved professional identity and job satisfaction for occupational therapists, is challenging to implement, particularly in hospital settings. This study aimed to explore occupational therapists’ perceptions of their role, and facilitators and challenges to implementing occupation-based practice in neurology.

Method

This qualitative descriptive study included semi-structured interviews with seven occupational therapists working in Australian acute/sub-acute neurology settings.

Findings

Three themes identified: Conceptualisation versus implementation of occupation-based practice; Use of occupation-based practice impacts role satisfaction; Promoting the profession. Participants described using occupations in their practice as important, however, reported that the challenges of the neurology environment hindered their ability to carry out occupation-based practice.

Conclusion

This study provides insights into occupational therapist’s perceptions regarding occupation-based practice in neurology settings, finding there is a need for occupational therapists to promote their role and use of occupations in neurology settings, and that occupation-based practice impacts job satisfaction. The study highlights occupational therapists working in neurology settings would benefit from a number of approaches including student interprofessional activities, potential buddy system for new graduates and experienced clinicians, and increased support by the profession to maintain their identity as occupation-based specialists.

Interprofessional learning about medication safety

BACKGROUND

Safe medication management requires collaboration between health professionals.

APPROACH

A mixed academic and clinician team co-designed and co-facilitated a 2-h interprofessional medication safety workshop, covering medication history taking, perioperative medication management, discharge planning, incident review and dosing and administration calculations. Three workshop sessions were delivered across three sites during September 2019 at a large metropolitan healthcare network. Senior nursing, medical and pharmacy students were invited to participate in the workshops and evaluation.

EVALUATION

We evaluated satisfaction, learning experience and perceived clinical application for medical, pharmacy and nursing students. Surveys were conducted immediately after each workshop and at 4 weeks. Quantitative data was analysed descriptively and qualitative data analysed using thematic analysis. Forty-five students participated in the evaluative component of the workshops. Mean student response scores demonstrated a high level of satisfaction with the workshop's relevance and utility to their learning. Students expressed strong agreement that the workshop promoted communication across professions for medication safety. Analysis of the qualitative data identified seven key themes, with consistently positive responses provided in each: interactions within the interprofessional team; recognising the importance of teams; learning the process of medication use; acknowledging and working with difference; role playing; thinking patient safety; and authenticity.

IMPLICATIONS

A 2-h interprofessional workshop about medication safety provided positive learning experiences with high satisfaction to medical, nursing and pharmacy students, and had strong perceived applicability to their future clinical practice.

Development of a Vertically Integrated Pharmacy Degree

Whilst curriculum revision is commonplace, whole degree transformation is less so. In this paper we discuss the rationale, design and implementation of a unique pharmacy program by a research-intensive faculty. The new Monash pharmacy curriculum, which had its first intake in 2017, was built using a range of key innovations that aimed to produce graduates that demonstrate key conceptual understanding and all the skills required to deliver world-best patient outcomes. The key elements of the re-design are outlined and include the process and principles developed, as well as key features such as a student-centred individualised program of development arranged around specific, authentic tasks for each skill and earlier enhanced experiential placements where students become proficient in entrustable professional activities. It is hoped the dissemination of this process, as well as the lessons learnt in the process, will be useful to others looking to transform a health curriculum.

Effect and Nursing Satisfaction of Bedside Nursing Combined with Detail Nursing in Clinical Nursing of Gastroenterology Department

Objective

The purpose of the study was to investigate the therapeutic effect and nursing satisfaction of bedside nursing combined with detail nursing in the gastroenterology department.

Methods

112 patients with gastrointestinal diseases admitted to our hospital from November 2018 to November 2019 were selected as the study subjects and randomly divided into a research group (n = 56) and reference group (n = 56). The reference group received routine clinical nursing, while on this basis, the research group received bedside nursing combined with detail nursing. After that, the clinical nursing effects of the two groups were compared.

Results

There were no significant differences in sex ratio, age, BMI, smoking history, drinking history, marital status, and disease types between the two groups (P > 0.05). The VAS scores in the two groups after intervention were significantly lower than those before intervention (P < 0.01), and the VAS scores in the research group after intervention were significantly lower than those in the reference group (P < 0.01). The nursing ability, nursing skills, and nursing responsibility in the research group were significantly higher than those in the reference group (P < 0.01). There were no significant differences between the two groups in the number of patients who were satisfied and needed improvement (P > 0.05). Besides, the number of very satisfied cases in the research group was significantly higher than that in the reference group (P < 0.05), and the number of unsatisfied cases was significantly lower than that in the reference group (P < 0.05). The total incidence of clinical adverse events in the research group was significantly lower than that in the reference group (P < 0.01). The gastrointestinal diseases related knowledge scores after intervention were significantly higher than those before intervention (P < 0.01), and the gastrointestinal diseases related knowledge scores after intervention in the research group were significantly higher than those in the reference group (P < 0.01). The GQOLI-74 scores after intervention in the two groups were significantly higher than those before intervention (P < 0.01), and the GQOLI-74 scores after intervention in the research group were significantly higher than those in the reference group (P < 0.01).

Conclusion

The application of bedside nursing mode combined with detail nursing in gastrointestinal diseases can effectively reduce patients' pains, as well as the incidence of clinical adverse events, and improve patients' life quality, with definite curative effect, which is worthy of promotion and application.

Implementing a collaborative medicine and pharmacy educational activity in two countries

BACKGROUND

To promote better collaboration for patient care, interprofessional education (IPE) is required in many health professions courses. However, successful IPE implementation at scale can be challenging because of complicated logistics and competing priorities. Implementing across multiple geographies adds further complexity.

OBJECTIVE

This paper describes the implementation of a full cohort IPE activity for medical and pharmacy students delivered at both the Australian and Malaysian campuses of Monash University.

DESIGN

We designed a 150-minute, blended learning activity centred around asthma care for second-year medical and pharmacy students. Student perceptions were measured with a pre- and post-activity survey using the validated ten-item, three-factor, SPICE-R2 instrument. Analysis focused on differences between professions and countries.

RESULTS

All second-year medicine (N = 301 in Australia and N = 107 in Malaysia) and pharmacy students (N = 168 in Australia and N = 117 in Malaysia) participated in the learning activity. A total of 326/693 (47%) students participated in the associated research by completing both the pre- and post-activity surveys. The pre-activity survey showed significant differences in four items between medicine and pharmacy students in Australia and two items in Malaysia. Post-activity, we observed significant changes in 8/10 items when the two professions were combined. Specifically, we noted changes across the countries in perceptions of roles and responsibilities for collaborative practice and patient outcomes from collaborative practice.

CONCLUSIONS

IPE across different professions and countries is feasible. Positive outcomes in role understanding and perceived patient outcomes are achievable through a context-sensitive, locally driven approach to implementation. Longitudinal experiences may be required to influence perceptions of teamwork and team-based care.