Professional equipoise: Getting beyond dominant discourses in an interprofessional team

Interprofessional identity in clinicians: A scoping review

Interprofessional collaborative practice (IPCP) has been recognized as invaluable in delivering safe, high-quality patient care with finite resources. However, despite a decade of advances in interprofessional (IP) research, policy, and competency frameworks, IPCP does not always occur in practice. One reason may be the influence of a clinician's identity in an IP context. The purpose of this scoping review was to understand the nature of IP identity in healthcare clinicians. The PRISMA framework was used to support a comprehensive search strategy and screening of 1746 articles. Inclusion criteria included original research, theses, and reviews, a primary focus on IP identity or professional identity (PI) in an IP team, and a focus on health professionals, including students transitioning to practice. Ninety-five papers met the eligibility criteria, though once charted, just four of the 95 papers focused on IP identity in clinicians. Three further papers examined shared team identity, 25 papers referred to, but did not focus on IP identity, and the remaining 63 papers explored PI in an IP team. While limited studies on clinician IP identity restrict conclusive findings, patterns were identified to direct further research on the nature of IP identity in clinicians. These include values and beliefs, individual and personal factors, profession and professional experience, education, socialization, context, leadership, and the process of IP identity development. While identity is undeniably central to being a clinician, the values, beliefs, attributes, and experiences that contribute to clinician IP identity, how clinician IP identity develops, and factors that influence IP identity remain unclear. The results of this review highlight the value of further investigation of the nature of IP identity, the interplay between PI and IP identity, and identity in an IP context.

Analysis of the Interprofessional Clinical Learning Environment for Quality Improvement and Patient Safety From Perspectives of Interprofessional Teams

BACKGROUND

In 2018 the Clinical Learning Environment Review (CLER) Program reported that quality improvement and patient safety (QIPS) programs in graduate medical education (GME) were largely unsuccessful in their efforts to transfer QI knowledge and substantive interprofessional QIPS experiences to residents, and CLER 2.0 called for improvement. However, little is known about how to improve the interprofessional clinical learning environment (IP-CLE) for QIPS in GME.

OBJECTIVE

To determine the current state of the IP-CLE for QIPS at our institution with a focus on factors affecting the IP-CLE and resident integration into interprofessional QIPS teams.

METHODS

We interviewed an interprofessional group of residents, faculty, and staff of key units engaged in IP QIPS activities. We performed thematic analysis through general inductive approach using template analysis methods on transcripts.

RESULTS

Twenty individuals from 6 units participated. Participants defined learning on interprofessional QIPS teams as learning from and about each other's roles through collaboration for improvement, which occurs naturally when patients are the focus, or experiential teamwork within QIPS projects. Resident integration into these teams had various benefits (learning about other professions, effective project dissemination), barriers (difficult rotations or program structure, inappropriate assumptions), and facilitators (institutional support structures, promotion of QIPS culture, patient adverse events). There were various benefits (strengthened relationships, lowered bar for further collaboration), barriers (limited time, poor communication), and facilitators (structured meetings, educational culture) to a positive IP-CLE for QIPS.

CONCLUSIONS

Cultural factors prominently affected the IP-CLE and patient unforeseen events were valuable triggers for IP QIPS learning opportunities.

Interprofessional Education: Current State in Psychology Training

Healthcare reform has led to the consideration of interprofessional team-based, collaborative care as a way to provide comprehensive, high-quality care to patients and families. Interprofessional education is the mechanism by which the next generation health professional workforce is preparing for the future of health care-team-based, collaborative care. This literature review explored the extent and content of published studies documenting Interprofessional Education (IPE) activities with psychology trainees across learner level. A systematic review following PRISMA guidelines was conducted of studies describing IPE involving psychology learners. Electronic databases (MEDLINE, CINAHL, PsychINFO, and EMBASE) were searched for the following terms: inter/multi-professional education/practice, inter/multidisciplinary education/practice, and psychology/psychologists. Thirty-seven articles were identified that included psychology in clinical outcome studies or other reviews of interprofessional education initiatives. The review addresses the nature of current IPE learning activities, the impact of IPE activities on participating trainees, opportunities for, and challenges of, involving psychology trainees in IPE, and future directions for research. This review illuminates the relative paucity of the literature about IPE in psychology training. Given the trend toward increasing team-based collaborative care, the limited inclusion of psychology in the IPE literature is concerning. The next generation of health professional trainees is learning about, from, and with each other with the objective of building collaboration and teamwork. Given the few articles documenting psychology trainees' involvement in IPE, future health professionals quite possibly will have limited understanding of, and contact with, psychologists. Our findings are a call to action for greater psychology involvement in IPE.

Taking a closer look at undergraduate acute care interprofessional simulations: lessons learnt

Interprofessional undergraduate/pre-registration simulations (UIPSims) are growing in popularity but remain under researched and without pedagogic instruction. We report on an evaluation of final year healthcare student UIPSims, focussed on safe practice using a mixed methods study. The evaluation combines traditional methods with direct observations of students. Students completed a pre and post-course questionnaire with scored and free text questions and in addition an ethnographer observed the UIPSims supported with video recordings. Final year students participated (medical, nursing, operating department practitioner, pharmacy; n = 230). The scored questions were significant (p < .01) with student comments confirming the value of the learning. The observations identified strengths and weaknesses. The students were professional and patient-centered, but were unable to function as a team, communicate effectively for shared decision making or recognize and highlight patient safety concerns. The facilitators mainly guided rather than facilitated proceedings. Despite having completed a theme of interprofessional education (IPE) designed to develop team working abilities, final year healthcare students were unable to function as a student team in order to apply theory to practice. The findings highlight how an interprofessional simulation at the end of an undergraduate curriculum offers a litmus test on student readiness for teamworking. The findings support an IPE curriculum with a set of theoretical principles aligned to a set of team working skills in readiness for participating in an UIPSims. In addition, facilitators should be trained on the principles for IPE as well as on best practice for simulations. Briefing is vital, enabling students to come together to form a team and find their collective voice. Observational research offers a powerful evaluation tool illuminating what is happening in these teaching situations. More research on the constituent components of UIPSims is required.

The contribution of theory to the design, delivery, and evaluation of interprofessional curricula: BEME Guide No. 49

BACKGROUND

Interprofessional curricula have often lacked explicit reference to theory despite calls for a more theoretically informed field that illuminates curricular assumptions and justifies curricular practices.

AIM

To review the contributions of theory to the design, delivery, and evaluation of interprofessional curricula.

METHODS

Four databases were searched (1988-2015). Studies demonstrating explicit and a high-quality contribution of theory to the design, delivery or evaluation of interprofessional curricula were included. Data were extracted against a comprehensive framework of curricular activities and a narrative synthesis undertaken.

RESULTS

Ninety-one studies met the inclusion criteria. The majority of studies (86%) originated from the UK, USA, and Canada. Theories most commonly underpinned "learning activities" (47%) and "evaluation" (54%). Theories of reflective learning, identity formation, and contact hypothesis dominated the field though there are many examples of innovative theoretical contributions.

CONCLUSIONS

Theories contribute considerably to the interprofessional field, though many curricular elements remain under-theorized. The literature offers no "gold standard" theory for interprofessional curricula; rather theoretical selection is contingent upon the curricular component to which theory is to be applied. Theories contributed to interprofessional curricula by explaining, predicting, organizing or illuminating social processes embedded in interprofessional curricular assumptions. This review provides guidance how theory might be robustly and appropriately deployed in the design, delivery, and evaluation of interprofessional curricula.

Counseling Psychology Model Training Program

The counseling psychology Model Training Program (MTP) was written to reflect new developments in counseling psychology, the American Psychological Association, and the world. The updated MTP is aspirational, intended to guide the development and maintenance of counseling psychology programs. The MTP conforms to the American Psychological Association’s and the Society of Counseling Psychology’s standards and guidelines. A strategic task group appointed by 2015 Society president James W. Lichtenberg sought feedback from the field to assist in its formulation, and the executive boards of the Society and the Council of Counseling Psychology Training Programs approved the final version. The 2017 MTP consists of four core values (i.e., growth toward full potential, holistic and contextual, diversity and social justice, communitarian perspective) as well as 20 principles grouped into six clusters: counseling psychology identity; multiculturalism, diversity, and social justice; health service psychology; developmental, prevention, and strengths orientation; science–practice integration; and relationships within and between professional communities.

Twelve tips for delivering successful interprofessional case conferences

Interprofessional case conferences (ICCs) offer an interactive, practical way to engage members of two or more health professions in discussions that involve learning and working together to improve patient care. Well-orchestrated ICCs provide opportunities to integrate interprofessional (IP) education into routine clinical practice. The authors provide 12 tips to support the conceptualization, planning, implementation, facilitation, evaluation, and sustainability of ICCs. They draw from extensive experience as IP educators and facilitators of ICCs and from literature on IP education, case-based learning, small-group facilitation, peer-assisted learning, and learner engagement - all of which offer insights into ICCs but have not been integrated and applied to this context.