Transition to practice: can rural interprofessional education make a difference? A cohort study

Curriculum Indigenization in oral health professions' education worldwide: A scoping review

OBJECTIVE

To explore the literature on Indigenous content within the oral health professions' education curricula.

METHODS

This scoping review included all types of literature on oral health care educational programs on Indigenous content, following the JBI (Joanna Briggs Institute) methodology. An initial search using "Indigenous," "education," and "oral health" as keywords informed a full search strategy for MEDLINE, CINAHL, Embase, Scopus, ERIC, EPPI, MedEdPORTAL, Google Scholar, ProQuest Dissertations and Theses Global, Australian Government Department of Health, and Australian Indigenous HealthInfoNet. The search included literature available until November 1, 2023, irrespective of language. Two reviewers independently screened the studies, and data were extracted and presented in tabular and narrative summary formats.

RESULTS

A total of 948 records were identified, and 101 studies were chosen for full-text review. Twenty-three studies met the criteria for data extraction. Of all studies, 95.6% were published between 2007 and 2021, mostly from Australia and New Zealand. The most frequently covered content included Indigenous culture, followed by history, Indigenous oral health, and Indigenous Peoples' health. Rural and clinical placements were the most employed delivery methods, and evaluation surveys were the most employed assessment technique. Barriers to delivering an Indigenous curriculum included students' disinterest and limited interaction with Indigenous communities, while facilitators included cultural immersion and supportive mentorship.

CONCLUSION

Despite progress in integrating Indigenous content into oral health education, challenges persist. Prioritizing Indigenous perspectives, community partnerships, and standardized assessment tools is needed. Future research should focus on long-term impacts and best practices for Indigenous curriculum development and delivery.

Efficacy of a student-led interprofessional health clinic in regional Australia for preventing and managing chronic disease

Increasing chronic disease rates in regional Australian communities necessitates innovative models of healthcare. We evaluated the efficacy of an interprofessional chronic disease program, delivered within a regional student-led nursing and allied health clinic in Southern Queensland, Australia. Changes to anthropometric, aerobic fitness and strength, and quality of life outcomes were examined at four time points spanning 16 months: intake, program transition (4 months), 6 and 12 months (post-transition). Our primary aim was to investigate whether the health improvements achieved during the program were sustained at 12 months in a subset of participants who provided complete data. Significant improvements were found in 6 of 11 measures, including the 6-minute walk test, grip strength, and self-reported quality of life across physical and psychosocial dimensions, with these improvements maintained to final review. No significant changes were found in body mass index (BMI), waist circumference, fat mass, or muscle mass. This is the first health clinic in regional Australia to deliver a student-led model of interprofessional and collaborative service to tackle the increasing burden of chronic disease in the community. The cost-effectiveness of this service and other potential clinical and social benefits remain to be investigated.

Findings, progress, and lessons learned during the first 3 years of a student-led interprofessional health clinic in regional Australia

We describe the establishment and operation of a student-led interprofessional chronic disease prevention and management clinic in regional Australia. Our aim was twofold. First, to report on service delivery, student placement, and health outcome data; and second, to discuss key lessons learned during the first 3½ years of clinic operations. Between July 2019 and December 2022, 146 (79.3%) clinic participants completed the 4-month program and participated in an average of 48.4 occasions of service (total 7,060). The clinic supported 1,060 clinical placement weeks across 147 health students. There was a significant improvement across health measures reported at program completion, with the largest changes observed for the 6-min walk test and preference-adjusted quality of life. Nine key challenges and lessons were identified that affected operations and service delivery, which should be of interest to healthcare teams considering establishing an interprofessional student-led clinic.

Effectiveness appraisal of interventions to increase retention of newly qualified nurses implemented in the final year of pre-registration programmes: A literature review

AIM

To understand the effectiveness of interventions to increase retention of early career nurses, implemented during the pre-registration programme.

BACKGROUND

Retention of nurses is an issue of global concern. The transition period spanning the final year of pre-registration nurse education programmes and the first year of qualified practice is a point of high risk for attrition from the profession.

DESIGN

A systematic review without meta-analysis and a thematic synthesis of wider literature, reported using SWiM and ENTREQ guidelines.

METHODS

A convergent segregated approach was used to capture qualitative and quantitative study designs. A systematic review of quantitative papers reporting intervention and retention data and scoping review of a wider body of literature related to interventions supporting transition to qualified practice were conducted. Searches used Medline and CINAHL databases in October 2021. Data extracted from wider literature were inductively collated into themes relating to the intervention type and synthesised.

RESULTS

Six papers were included in the systematic review and 27 papers were included in the scoping review. Interventions included internships, externships, clinical immersion programmes, capstone projects, preceptorships and psychological wellbeing programmes. There was a lack of consensus about the benefits of implementing interventions during the final year of pre-registration programmes, but some evidence that interventions incorporating preceptors, expose students to the clinical environment and involve academic/clinical collaboration, report positive outcomes related to transition to qualified practice, which potentially has an impact on motivation to stay in the profession.

CONCLUSION

Greater understanding of interventions supporting student nurses to reduce likelihood of leaving once qualified has been achieved. There is some evidence these interventions lead to increases in retention, but this is limited by the quality of the reporting and the scarcity of data. Consideration should be given to maximizing students' exposure to clinical practice and the benefits that interventions with alternative approaches such as psychological wellbeing programmes may bring. This review has potential to influence effective implementation of interventions to increase retention of early career nurses if clinical practice and academic settings review proposed or actual interventions to maximise added value. REPORTING METHOD: the manuscript has been written in adherence with the EQUATOR guidelines following the SWiM reporting guidelines for the systematic review and the ENTREQ guidelines for the scoping review.

A Novel Interprofessional Education and Supervision Student Placement Model: Student and Clinical Educator Perspectives and Experiences

Interprofessional student placements can not only cater to the added pressures on student placement numbers but can also enhance the work readiness of new graduates. For rural areas, there is a potential for interprofessional student placements to attract the future healthcare workforce. However, tried and tested models of interprofessional placements in rural areas backed up by rigorous evaluation, remain scarce. The Rural Interprofessional Education and Supervision (RIPES) model was developed, implemented, and evaluated across four rural health services in Queensland to address this gap. Students from two or more professions undertook concurrent placements at RIPES sites, with a placement overlap period of at least five weeks. Eleven focus groups (n = 58) with clinical educators (CEs) and students were conducted to explore student and clinical educator experiences and perspectives. Content analysis of focus group data resulted in the development of the following categories: value of the RIPES placement model, unintended benefits to CEs, work units and rural areas, tension between uni-professional and IPE components, and sustainability considerations. Students and CEs alike valued the learning which arose from participation in the model and the positive flow-on effects to both patient care and work units. This unique study was undertaken in response to previous calls to address a gap in interprofessional education models in rural areas. It involved students from multiple professions and universities, explored perspectives and experiences from multiple stakeholders, and followed international best practice interprofessional education research recommendations. Findings can inform the future use and sustainability of the RIPES model.

Is interprofessional education a valued contributor to interprofessional practice and collaboration within allied health in Australia and New Zealand: A scoping review

Research on the value of interprofessional education (IPE), collaboration and practice in the health sector at both a pre- and post-registration level has increased in recent years. A scoping review of Australian and New Zealand studies was conducted on the value of IPE to interprofessional practice in allied health professionals from 2013 to 2019. A scoping review framework was used to identify 109 studies. Twenty-one articles met the eligibility criteria. The studies were grouped into undergraduate students in academic and WIL settings, allied health professionals and clinical educators. Results suggest that IPE is necessary for the maintenance of interprofessional practice and that it is strongly connected to the development of successful communication within the interprofessional environment. Authentic IPE experience and socialization opportunities appear to be major facilitators of interprofessional practice but no consensus regarding the ideal length of time or timing of IPE was found. The studies also provided an insight into facilitators and barriers to successful implementation of IPE and interprofessional practice in rural environments. As IPE has been shown to contribute to improved interprofessional practice and patient outcomes, future research should explore how to create IPE opportunities for implementation within rural communities where adequate resourcing is most challenged.

Exploring Pharmacy Trainee Experiential Learning in a Full Scope Collaborative Rural Primary Care Practice: A Retrospective Chart Review

Despite reported benefits of pharmacy trainees (e.g., pharmacy students, pharmacy residents) in hospital settings, limited research on the impact of these trainees has been conducted in rural primary care. To explore the potential benefits and impact of pharmacy trainees practicing in a supervised collaborative rural primary care setting, a retrospective chart review was conducted. Drug therapy problems (DTPs) were classified using the Pharmaceutical Care Network Europe (PCNE V9) system. Valuation was measured using a validated tool developed by Overhage and Lukes (1999). Over 16 weeks on a part-time basis, pharmacy trainees (n = 3) identified 366 DTPs during 153 patient encounters. The most common causes for DTPs were related to patient transfers and the need for education. Drug level interventions carried out directly by trainees under supervision accounted for 13.1% of total interventions. Interventions that required prescriber authorization had an acceptance rate of 83.25%, 25% higher than previous acceptance rates found in urban primary care settings. About half (51%) of the interventions proposed and made by pharmacy trainees were classified as significant or very significant, suggesting these trainees added significant value to the pharmacy service provided to rural community residents. This study suggests that pharmacy trainees can be effective resources and contribute meaningfully to patient care in a collaborative rural primary care team setting.

Interprofessional education and collaboration among healthcare students and professionals: a systematic review and call for action

Interprofessional education (IPE) is a prerequisite to building a collaborative practice environment and optimizing patient care. The purpose of this systematic review was to assess the impact of IPE on outcomes related to health-care pre-licensure learners and professionals, including: changes in attitudes/perceptions; acquisition of knowledge regarding other disciplines' roles and development of collaborative skills; and change in collaborative behavior. We searched PubMed, CINAHL, Embase, and ERIC for studies published from 2007 to 2017 in English; 19 studies were eligible. The Joanna Briggs Institute appraisal tool was used to assess the quality of the studies. Thirteen studies used a quasi-experimental design. The studies varied in terms of setting, teaching methods, assessment measures, and quality. Seventeen of the 19 studies (89%) that assessed change in attitudes toward other disciplines and value placed on a team-based approach for improving patient care, found statistically significant improvements. All seven of the studies that assessed change in collaborative behavior found statistically significant improvements. Among the 12 studies that assessed the development of collaborative skills, there were mixed results. Future directions include: conducting more studies among health-care professionals, assessing the long-term impact of IPE, objectively assessing change in collaborative behavior, and assessing the impact of IPE on patient-centered outcomes.

Trusting me, trusting you: Creating conditions for successful pre-registration interprofessional education in rural New Zealand workplace settings

There is a growing body of evidence supporting the provision of interprofessional education for pre-registration health science students. Furthermore, there is emergent evidence supporting the provision of interprofessional opportunities in rural workplaces. The strategies used by tertiary education providers in establishing and sustaining these rural interprofessional initiatives currently remain unclear, including how to foster authentic engagement with indigenous rural communities. This short commentary seeks to provide some practical guidance on how to successfully implement and maintain rural interprofessional experiences for pre-registration students.

Five years on: Influences on early career health professionals from a rural interprofessional pre-registration immersion program

OBJECTIVE

To ascertain former students' perceptions of and influences from a final-year pre-registration, rurally located, clinically based, 5 week interprofessional program on their subsequent work and career in the health professions.

DESIGN

Online survey delivered 5 years post-program (4 years post-graduation).

SETTING

The Tairāwhiti interprofessional education program was first undertaken in 2012/2013 by students from six health professional degree programs (dentistry, dietetics, medicine, nursing, pharmacy and physiotherapy) in the Tairāwhiti region, New Zealand.

PARTICIPANTS

Health professionals who attended the Tairāwhiti interprofessional education program in 2012/2013 as students were invited to participate; 70 of 86 (81%) responded in 2017/2018.

RESULTS

Five years on, most respondents (91%;64/70) were working as health professionals, with a fifth (23%;15/64) working overseas. Of those currently practising in New Zealand, 51% (24/47) were working in hospital practice and 49% (23/47) in the community, with 56% (27/48) working in metropolitan areas and 44% (21/48) in regional/rural locations. Of the 51 respondents who provided free-text comments about perceived influences of program participation, the majority described positive influences on their clinical practice as health professionals or their subsequent career choices. Five themes emerged from the free-text data: 'made me a better clinician'; 'made me consider rural/regional work'; 'collaborating for care'; 'choosing an area of practice to work in,' and 'little or no impact.'

CONCLUSION

This work reports positive influences on subsequent careers among respondents who had previously participated as final-year students in a rurally located IPE program, particularly with respect to interprofessional working, rural health, and contextual and cultural influences.

Existing models of interprofessional collaborative practice in primary healthcare: a scoping review

Educating students to provide interprofessional collaborative practice (IPCP) in primary healthcare (PHC) requires a robust rigorous model relevant to future practice. A scoping review was undertaken to identify existing models of IPCP in PHC, the interprofessional or collaborative theories on which the models were based, reported outcomes, and enablers of and barriers to IPCP in PHC. The 35 eligible studies included 27 models, most of which were designed for a specific PHC site or program. Although almost half of the studies cited established interprofessional competencies in support of the models, only 13 included theoretical support, and only two cited interprofessional theory. Outcomes for clients, practitioners, practices, and students were primarily experiential and positive. A few researchers reported negative experiences or no difference between comparison groups. Key enablers of IPCP in PHC were strong supportive, inclusive relationships and practices. The most common barriers were time and resource constraints and poor understanding of IPCP. The review suggests a need for a stronger theoretical basis for IPCP in PHC that can accommodate different settings, and for more observational research that links relationship factors to outcomes at the practice, population, and wider health system levels.

The evolution of New Zealand's health workforce policy and planning system: a study of workforce governance and health reform

INTRODUCTION

While considerable attention has been given to improving health workforce planning practice, few articles focus on the relationship between health workforce governance and health reform. By outlining a sequence of health reforms, we reveal how New Zealand's health workforce governance and practices came under pressure, leading to a rethink and the introduction of innovative approaches and initiatives.

CASE DESCRIPTION

New Zealand's health system was quite stable up to the late 1980s, after which 30 years of structural and system reform was undertaken. This had the effect of replacing the centralised medically led health workforce policy and planning system with a market-driven and short-run employer-led planning approach. The increasing pressures and inconsistencies this approach produced ultimately led to the re-centralisation of some governance functions and brought with it a new vision of how to better prepare for future health needs. While significant gain has been made implementing this new vision, issues remain for achieving more effective innovation diffusion and improved integrated care orientations.

DISCUSSION AND EVALUATION

The case reveals that there was a failure to consider the health workforce in almost all of the reforms. Health and workforce policy became increasingly disconnected at the central and regional levels, leading to fragmentation, duplication and widening gaps. New Zealand's more recent workforce policy and planning approach has adopted new tools and techniques to overcome these weaknesses that have implications for the workforce and service delivery, workforce governance and planning methodologies. However, further strengthening of workforce governance is required to embed the changes in policy and planning and to improve organisational capabilities to diffuse innovation and respond to evolving roles and team-based models of care.

CONCLUSION

The case reveals that disconnecting the workforce from reform policy leads to a range of debilitating effects. By addressing how it approaches workforce planning and policy, New Zealand is now better placed to plan for a future of integrated and team-based health care. The case provides cues for other countries considering reform agendas, the most important being to include and consider the health workforce in health reform processes.

Reshaping public hospitals: an agenda for reform in Asia and the Pacific

Hospitals in the Asia-Pacific today face the 'triple aim' challenge, proposed by the Institute for Healthcare Improvement, of how to improve quality of care and population health, while at the same time controlling healthcare costs. Yet, pursuing these challenges in combination is presently a remote prospect for many hospitals and, indeed, in a majority of countries in the region. The roles and functions of the public hospital sector within local health systems need redefinition and reform in the context of demographic and epidemiological transitions. Policymakers, managers and health professionals have an obligation to reshape the future of public hospitals. This article outlines actions for how public hospitals can be reshaped from a health system perspective. First, hospitals should be integrated into the fabric of the local health system; they can lead in this through working in alliances with other healthcare facilities, including primary care and private hospitals. Policymakers have a role in facilitating this as it contributes to health improvement of the population. Second, investments in system innovation, management improvement and information systems are required and their impact assessed. Such investments can contribute to cost control and efficiency. Public hospital sector investments should be strategic, efficient and should not bias investment in broader determinants of health. Third, reorienting health workforce competencies and appropriate skills should be central to hospital sector reforms, from policy to frontline services delivery. Creative thinking is needed to build and support flexible care delivery arrangements for services designed to respond to patients ' and providers' needs. Pivotal to achievement of each of these three areas of reform is good governance and leadership.

Compounding medications in a rural setting: an interprofessional perspective

Background

Interprofessional learning (IPL) which focuses on the pharmacist's role in specialty practices as part of a multidisciplinary health care team has not been explored. This study aimed to determine health care students' understanding of the role of the pharmacist in compounding medications to optimize health outcomes for patients in rural and remote health care services.

Methods

Four workshops followed by focus group interviews were conducted with undergraduate pharmacy, medical, nursing, physiotherapy, dentistry, Aboriginal public health, and speech pathology students (n=15). After an introductory lecture, students working in multidisciplinary teams undertook to compound three products. Focus groups were held at the end of the compounding workshops to explore students' understanding and perceptions of these compounding activities. Thematic analysis was undertaken on the qualitative data obtained from the focus groups.

Results

Student participants responded positively both to the opportunity to undertake a compounding exercise and being part of an interprofessional team, perceiving benefit for their future rural and remote health practice. Four major themes emerged from the qualitative analysis: improved knowledge and understanding; application to practice; interprofessional collaboration; and rural, remote, and Indigenous context. Students acknowledged that the workshops improved their understanding of the role of the pharmacist in compounding and how they, as part of a multidisciplinary team, could deliver better health outcomes for patients with special needs, especially in a rural and remote context.

Conclusion

This study highlights that workshops of this nature have a role to play in developing collaborative interprofessional practice and increasing awareness of pharmaceutical services among undergraduate health students. However, further evidence is needed to assess whether positive perceptions of specialty practice IPL workshops will translate into improved patient outcomes in practice.

Longitudinal impact of interprofessional education on attitudes, skills and career trajectories: a protocol for a quasi-experimental study in New Zealand

INTRODUCTION

Interprofessional practice is recognised as an important element of safe and effective healthcare. However, few studies exist that evaluate how preregistration education contributes to interprofessional competencies, and how these competencies develop throughout the early years of a health professional's career. This quasiexperimental study will gather longitudinal data during students' last year of preregistration training and their first 3 years of professional practice to evaluate the ongoing development of interprofessional competencies and the influence that preregistration education including an explicit interprofessional education (IPE) programme may have on these.

METHODS AND ANALYSIS

Participants are students and graduates from the disciplines of dentistry, dietetics, medicine, nursing, occupational therapy, oral health, pharmacy and physiotherapy recruited before their final year of study. A subset of these students attended a 5-week IPE immersion programme during their final year of training. All data will be collected via five written or electronic surveys completed at 12-month intervals. Each survey will contain the Attitudes Towards Health Care Teams Scale and the Team Skills Scale, as well as quantitative and free-text items to explore vocational satisfaction, career trajectories and influences on these. Students who attend the IPE programme will complete additional free-text items to explore the effects of this programme on their careers. Quantitative analysis will compare scores at each time point, adjusted for baseline scores, for graduates who did and did not participate in the IPE programme. Associations between satisfaction data and discipline, professional setting, location and IPE participation will also be examined. Template analysis will explore free-text themes related to influences on career choices including participation in preregistration IPE.

ETHICS AND DISSEMINATION

This study has received approval from the University of Otago Ethics Committee (D13/019). Results will be disseminated through peer-reviewed publications, conferences and stakeholder reports. Findings will inform future IPE developments and health workforce planning.

The use of virtual communities of practice to improve interprofessional collaboration and education: findings from an integrated review

The recent growth in online technology has led to a rapid increase in the sharing of health related information globally. Health and social care professionals are now using a wide range of virtual communities of practice (VCoPs) for learning, support, continuing professional education, knowledge management and information sharing. In this article, we report the findings from a review of the literature that explored the use of VCoPs by health and social care professionals to determine their potential for interprofessional education and collaboration. We employed integrated review methods to search and identify relevant VCoP articles. We undertook searches of PubMed and Google Scholar from 2000, which after screening, resulted in the inclusion of 19 articles. A thematic analysis generated the following key issues related to the use of VCoPs: 'definitions and approaches', 'technological infrastructure', 'reported benefits', 'participation issues', 'trust and privacy and 'technical ability'. Based on the findings from this review, there is some evidence that VCoPs can offer an informal method of professional and interprofessional development for clinicians, and can decrease social and professional isolation. However, for VCoPs to be successful, issues of privacy, trust, encouragement and technology need to be addressed.

Training a medical workforce to meet the needs of diverse minority communities

BACKGROUND

The growing demand for a competent health workforce to meet the needs of increasingly diverse societies has been widely acknowledged. One medical school in New Zealand explored the integration of the commonly used patient-centred model approach, with an intersectional framework in the development of a cultural competency training programme. In the Pacific Immersion Programme, medical students in their fourth year of training are given the opportunity to learn about different factors that influence the health and health care of a minority community through immersion in that community. The programme objectives include enabling students to learn through experience living within the local community context, and supporting them to re-evaluate their own personal beliefs, assumptions and/or prior prejudices. This study evaluates the usefulness of this programme in the training of medical students to work in diverse communities.

METHODS

Two analytical approaches were used for evaluation. Deductive and inductive analyses were conducted on 235 reflective essays completed by three cohorts of students from 2011 to 2013 to ascertain the value of the programme for student learning. In addition, one cohort was invited to complete a pre and post-programme questionnaire.

RESULTS

Overall, the students found the programme to be a valued learning environment. They found living within a Pacific family environment to be an eye opening experience. It increased students comfort level in cross cultural engagement and emphasised the importance of patient's perspectives in health care provision. Students' self-reported knowledge about Pacific cultural values, protocols, traditional beliefs and the main health challenges increased significantly after the programme. They appreciated learning directly from community members, and through observations about how culture, beliefs and the socio-economic environment influence peoples' health and wellbeing.

CONCLUSIONS

Medical schools are required to train a competent health workforce to meet the needs of diverse communities. The Pacific Immersion Programme provides a unique learning environment which can improve the training of doctors to work in diverse communities. The key to its success is enabling students to be engaged learners from "the inside" rather than an "outsider looking in". The Programme enables experiential learning in a sensitive and meaningful way and can be useful for training in other institutions.