“Collaborative-ready” students: Exploring factors that influence collaboration during a longitudinal interprofessional education practice experience

A qualitative study to explore student learning and development of interprofessional collaboration during an online interprofessional education intervention

Interprofessional education (IPE) during undergraduate education and training has been found to improve collaboration between health care students. This supports interprofessional working in clinical practice to enhance patient safety and care delivery.Undergraduate students from pharmacy and medical programmes worked online in pairs to review notes of hospital patients due to be discharged. Students were tasked to complete a discharge letter and undertake an online consultation with a simulated patient prior to discharge. Online interactions were recorded and assessed using a validated tool to measure interprofessional professionalism. Students undertook this intervention in different pairings with different patient cases for three iterations after receiving feedback and undertaking a reflective exercise.The aim was to investigate the student learning and development that could be used to inform intervention optimisation and scale-up.Qualitative data were collected from different sources. Method triangulation was employed to develop a comprehensive understanding of the student learning and development. Data was collected from written feedback provided by the assessment team, student reflections on their performance, and from semi-structured interviews conducted with the student pairs and one to one with the assessment team. Content and thematic analysis was used to analyse these data and the Kirkpatrick/Barr evaluation model provided a framework to organise the themes.Eighteen students (nine from each professional programme) completed the study and a total of 27 IPE sessions were conducted. The assessment team completed 54 assessment tools and 31 student reflections were received (from a maximum of 36). Students were interviewed in their interprofessional pairs to yield nine interview transcripts and one interview was conducted with the assessment team.Students reported and were observed to improve in interprofessional collaboration over the three iterations following feedback and rehearsal opportunities. Longitudinal observation and assessment of student interprofessional working in changing teams provided the opportunity to capture the influence of interdependence on student performance and assessment of competence.

Effect of an Educational Video Miniseries on Interprofessional Preceptor Development

OBJECTIVE

Experiential rotation preceptors may lack confidence in instructing interprofessional learners. This study examined the effect of a 12-episode, professionally produced video miniseries on attitudinal, satisfaction, and confidence outcomes in a cohort of interprofessional preceptors comprising pharmacy, medicine, nursing, and other allied health professionals.

METHODS

An invitation to view the miniseries was distributed to all health science preceptors within 1 large, public health science university. Participants were asked survey questions addressing their attitudes toward the miniseries, their comfort in precepting, and their satisfaction with the miniseries.

RESULTS

A total of 61 interprofessional preceptors enrolled in the study, with 33 completing the entire miniseries. Participants displayed highly positive attitudes toward the miniseries. In addition, members of all professions enrolled demonstrated an increase in precepting confidence after viewing the miniseries episodes (2.31 vs 2.7 on a 3-point Likert scale). Subgroup analyses demonstrated that preceptors with>10 years of professional experience displayed less positive attitudes toward the miniseries than those with 2-10 years of professional experience.

CONCLUSION

The miniseries model proved effective as a preceptor development strategy for a group of health professional preceptors. Given the diversity of learners, a collection of training options that allows preceptor self-selection of programming may be beneficial.

Determining the impact of an interprofessional learning in practice model on learners and patients

The Institute of Medicine recently expressed a need to measure the impact of interprofessional education (IPE) on health professions collaborative behavior in practice environments and patient outcomes, and the National Center for Interprofessional Practice and Education has focused research efforts to connect interprofessional practice and education. We describe a model intentionally designed to link interprofessional practice experience in ambulatory care setting and an IPE curriculum for students, called the Interprofessional Learning in Practice (ILIP) model. The study objective was to determine the impact of the ILIP model on student and patient outcomes during a 24-month intervention period. Student satisfaction was collected through a brief survey administered post-ILIP model. Patient outcomes were collected from before and after the intervention period through a retrospective chart review of patients who received care through the ILIP model. For the study, disease indicators for the top three chronic diagnoses of depression, hypertension, and type 2 diabetes mellitus were chosen as the patient outcomes. Student outcomes were analyzed using descriptive statistics and the Mann-Whitney U test. Patient outcomes were analyzed using McNemar's test and paired t-tests. Of the 382 students who participated in the ILIP model during the study period, 179 completed surveys, indicating that they valued the experience, valued learning from interprofessional preceptors, and gained interprofessional skills to use in their future practice. During the 24-month intervention, 401 patients were evaluated post-ILIP model, statistically significant results demonstrated HbA1c values for patients with diabetes were reduced by 0.5% and depression screening improved from 9% to 91%. Additionally, patients' hypertension control was similar to baseline and diabetes control (as defined as HbA1c ≤8%) was improved compared to baseline but did not reach statistical significance. By aligning interprofessional practice and education in the ILIP model, students had a positive experience, gained interprofessional collaboration skills, and provided value-added benefits to improve patient outcomes.

Exploring the experiences of the team members in the interprofessional socialization process for becoming a interprofessional Collaborator

BACKGROUND

The current study aimed to explore the team members' experiences in the socialization process for becoming a collaborator in an interprofessional team.

METHOD

This qualitative study is conducted using an inductive qualitative content analysis approach. Participants consisted of 32 physicians (n = 16) and nurses (n = 16) who participated by purposeful sampling. Data were collected through in-depth semi-structured interviews and analyzed by Graneheim and Lundman approach.

RESULTS

In the study, "the perceived confrontation between interprofessional professionalism and uni-professionalism in the interprofessional socialization process" is explored as the theme, including two categories: "interprofessional professionalism commitment" as a facilitator and "uni-professional centrism" as a barrier.

CONCLUSION

A reciprocal dimension in interprofessional socialization was explored. Interprofessional professionalism adherence and team-centered accountability among team members were explored as a facilitator. The uni-professional culture and immature interprofessional collaboration competencies of team members disrupted the interprofessional socialization process.

Importance of Interprofessional Education for Occupational Therapy

The purpose of this position statement is to provide recommendations for educators on best practices to embed interprofessional education (IPE) into today's occupational therapy curricula, whether entry level or postprofessional, to bridge academic and clinical learning environments.

Enablers and barriers of first-year common semesters and semester-long courses aimed at interprofessional collaborative practice capability development: A scoping review

Designing a first-year undergraduate common semester aimed at developing interprofessional collaborative practice (IPCP) capabilities is challenging. A scoping review was conducted to identify enablers and barriers for common semesters. Due to limited numbers of eligible studies, the review was expanded to include studies of semester-long first-year courses aimed at IPCP development. Key enablers of common semesters or courses in 35 included studies were: real-world, problem-solving, hands-on, interprofessional teamwork aligned with graduate practice capabilities relevant across disciplines; continuous feedback and critical evaluation; relationship building amongst students and staff; cohesive, well-trained interprofessional teams of staff and leaders; secure, supportive institutional policies and structures. Key barriers included: students' lack of preparation, perceptions of irrelevance, and misaligned expectations; variable student capability and response amongst professions; miscommunicated or misaligned course outcomes; course, faculty or institutional non-integration; and cost, logistic, and evaluation issues. Outcomes were mainly positive improvements in self-evaluated student IPCP skills and understanding, variability between professions, and persistent misconceptions. Scales measuring capabilities lacked uniformity, and few studies were comparative or observational. Overall, the review suggests noncompetitive undergraduate first-year common semesters or courses positively impact IPCP capability development when robustly assessed, clearly evaluated, and supported by an integrated IPE culture.

Assessment of teamwork in interprofessional education

The aim of this study was to offer new insight into assessments of interprofessional education (IPE) by evaluating the association between students' self-assessment for teamwork and expert assessment of simulation and team-based writing examination. We also evaluated the relationship between students' demographic factors and their teamwork skill. A total 112 of medical and pharmacology students were divided into 36 interprofessional groups and participated interprofessional patient safety session. During the session, all students answered self-assessment for teamwork (SAT) individually. Teamwork skill of the student groups were rated by simulation assessment (SA) and team-based writing examination (WX). As a result, there was a weak correlation between the score of SAT and SA and no correlation between the score of SAT and WX. Also, as a demographic analysis, medical students assessed their teamwork higher than pharmacology students, and male students assessed their teamwork higher than female students. The duration of club activities including sports and arts correlated negatively with the score of WX. From this result, student's high self-assessment for teamwork could be an indication of good team performance in simulation assessment, but not in team-based writing examination.

Appraisal of the entrustable professional activities interprofessional team member domain performed by North Dakota pharmacists

OBJECTIVE

To quantify the use of the interprofessional team member (ITM) domain of entrustable professional activities (EPAs) by North Dakota pharmacists across practice sites, roles in practice, and by preceptor status.

METHODS

Survey methods were used to characterize the self-reported frequency with which pharmacists undertake core EPAs and supporting tasks in the ITM domain. The survey was administered to registered pharmacists practicing in North Dakota (n=990) during the fall of 2018, of which 457 (46.1%) responded. After eliminating responses with incomplete or missing information, 119 responses were available for analysis.

RESULTS

For the overall EPA ITM domain, "Collaborate as a member of an interprofessional team population" pharmacists reported performing these activities an average (mean) of 3.3 times per month (SD=2.3). Within this domain, the highest reported example activity was "Use setting appropriate communication skills when interacting with others" (mean=4.1, SD 1.8), followed by "Communicate a patient's medication-related problem(s) to another health professional" (mean=3.3, SD 2.0), and "Contribute medication-related expertise to the team's work" (mean=3.1, SD=2.2). ITM domain and supporting example activities were performed at a greater rate in hospitals, community health centers and long-term-care facilities. For most items, preceptors reported a greater use of activities, than did non-preceptors.

CONCLUSIONS

North Dakota pharmacists currently complete tasks outlined in the ITM domain of the EPAs, although their contributions are varied by task, role, and preceptor status.

Interprofessional communication (IPC) for medical students: a scoping review

BACKGROUND

Effective Interprofessional Communication (IPC) between healthcare professionals enhances teamwork and improves patient care. Yet IPC training remains poorly structured in medical schools. To address this gap, a scoping review is proposed to study current IPC training approaches in medical schools.

METHODS

Krishna's Systematic Evidence Based Approach (SEBA) was used to guide a scoping review of IPC training for medical students published between 1 January 2000 to 31 December 2018 in PubMed, ScienceDirect, JSTOR, Google Scholar, ERIC, Embase, Scopus and PsycINFO. The data accrued was independently analysed using thematic and content analysis to enhance the reproducibility and transparency of this SEBA guided review.

RESULTS

17,809 titles and abstracts were found, 250 full-text articles were reviewed and 73 full text articles were included. Directed Content analysis revealed 4 categories corresponding to the levels of the Miller's Pyramid whilst thematic analysis revealed 5 themes including the indications, stages of trainings and evaluations, content, challenges and outcomes of IPC training. Many longitudinal programs were designed around the levels of Miller's Pyramid.

CONCLUSION

IPC training is a stage-wise, competency-based learning process that pivots on a learner-centric spiralled curriculum. Progress from one stage to the next requires attainment of the particular competencies within each stage of the training process. Whilst further studies into the dynamics of IPC interactions, assessment methods and structuring of these programs are required, we forward an evidenced based framework to guide design of future IPC programs.

The influence of culture, structure, and human agency on interprofessional learning in a neurosurgical practice learning setting: a case study

The World Health Organization supports the notion that interprofessional learning (IPL) improves healthcare outcomes and contributes to safe, effective, and high-quality care. Consequently, IPL is an integral component within most UK undergraduate healthcare programs. Although much is written about IPL, research to date has mainly focused on the classroom or simulation lab as a setting for IPL. Less is known about how the practice learning environment influences the experiences and outcomes for those involved. A case study research design, situated within a critical realist framework, was undertaken which aimed to better understand how IPL was facilitated for undergraduate healthcare students within a neurosurgical practice learning setting. Interviews, non-participatory observations, and secondary documentary data were used as the methods of data collection to inform the case. Thematic analysis was undertaken, and the findings clustered into overarching themes of culture, structure, and human agency, facilitating a more in-depth exploration of the complex interplay between the factors influencing IPL in the study setting. IPL was supported within the setting which operated as an 'interprofessional community of practice,' facilitating student engagement and investing in its staff for the benefit of the patients who had complex neurological needs. A practice-based IPL Multi-Dimensional Assessment Tool was also created to enable colleagues in practice learning environments worldwide to better understand their capability and capacity for the facilitation of practice-based IPL.

Training the trainers: A preceptor development program targeting interprofessional collaboration competencies

INTRODUCTION

Faculty and preceptor development have been noted to be areas of need within the expansion of interprofessional education (IPE). The primary objective of this pilot study was to evaluate the impact of a preceptor development program on pharmacy preceptors' self-reported competence toward interprofessional collaboration.

METHODS

Pharmacy preceptors were invited to participate in a two-hour preceptor development program followed by a brief survey. Preceptor development program objectives were to: define IPE and interprofessional collaborative practice (IPCP); describe the benefits of IPCP for patients/clients, healthcare providers, and health systems; discuss the four Interprofessional Education Collaborative (IPEC) Core Competencies; and describe IPE student experiences aimed at increasing collaborative practice. The Interprofessional Collaborative Competencies Attainment Survey (ICCAS) was administered after the preceptor development program. Descriptive statistics were used to characterize the data and paired t-tests were used to analyze pre-/post-program scores.

RESULTS

Thirty (35%) preceptors completed the survey. Mean scores for all twenty items in the ICCAS instrument increased from pre- to post-(p < 0.05). The mean total ICCAS score pre- was 5.28 ± 1.12 and post- was 6.17 ± 1.11 (p < 0.01) out of a possible total score of seven.

CONCLUSIONS

A preceptor development program targeting IPE and IPCP increased pharmacy preceptors' self-reported competence toward interprofessional collaboration.

Professionalism dilemmas experienced by health professions students: a cross-sectional study

Health professions students will invariably confront professionalism dilemmas. These early encounters significantly influence future professional attitudes and behaviours. Heretofore, studies concerning professionalism dilemmas experienced by health professions students across disciplines have been limited. To address this issue, we recruited 56 students with clinical experience from the National Taiwan University College of Medicine in the nursing, dentistry, pharmacy, medical technology, occupational therapy, and physiotherapy programs to participate in this research to compare health professions students' understandings of professionalism and their experiences of professionalism dilemmas. We used group interviews to uncover students' experiences of professionalism dilemmas. We identified the six most commonly reported professionalism dilemmas and found that interprofessional dilemmas were the dominant workplace professionalism dilemma for health professions students. We also identified significant disciplinary differences regarding dilemma types and frequencies. We employed the framework of dual identity development to better understand the role of professional and interprofessional identities in interprofessional dilemmas. The professionalism dilemmas that individual students encountered were shaped by disciplinary differences. Our findings suggest that the development of a sense of belonging to both their own profession and a broader interprofessional care team in health professions students can increase the effectiveness of interprofessional healthcare teams.

A Reflective Assignment Assessing Pharmacy Students' Interprofessional Collaborative Practice Exposure During Introductory Pharmacy Practice Experiences

Objective. To assess the effectiveness of a required reflective writing assignment to document students' exposure to and experience with interprofessional collaborative practice (IPCP) during introductory pharmacy practice experiences (IPPEs). Methods. Pharmacy students completed the assignment during their community or institutional pharmacy IPPE and electronically submitted their written reflections. Twelve codes were created to indicate opportunities, barriers, and patient-centered care identified in the community pharmacy reflections. Fourteen codes were created to indicate interprofessional communication, roles, patient-centered care, and teamwork identified in the institutional pharmacy reflections. The reflections were then qualitatively analyzed to identify and code themes related to IPCP. Results. Two hundred twenty-eight reflections were submitted. Exposure to an observed IPCP was described in 51% of the community pharmacy reflections and in 100% of the institutional pharmacy reflections. Identified opportunities to improve IPCP in community pharmacy were extended pharmacy services, expanded networking and relationships, making more phone calls to other health professionals, and greater use of technology. The identified barriers to IPCP in community pharmacy were difficulty accessing patient health data, lack of direct access to prescribers, hierarchy, pharmacy workload, and lack of timely communication. The identified themes that impacted IPCP in institutional settings included dysfunctional communication, technology use, mutual respect, role overlap, teamwork, nonphysician leadership, and personal relationships. Conclusion. Implementing a reflective assignment during IPPEs was an effective way to document student exposure to and experience in IPCP in two types of pharmacy practice settings and helped to meet pharmacy accreditation standards of having IPE included in early experiential education settings.

Designing and Evaluating an Interprofessional Practice Experience Involving Dental and Pharmacy Students

Objective. To prepare pharmacy and dental students to collaborate as members of an interprofessional team by participating in an interprofessional practice experience. Methods. An interprofessional practice experience was implemented within a dental admissions clinic. Pharmacy and dental students collaboratively conducted medical histories and provided tobacco cessation education. Pharmacy student performance was measured using a standardized assessment rubric; pharmacy and dental student perceptions were measured using the SPICE-R tool; and faculty feedback was captured for evaluation purposes. Results. Pharmacy students achieved performance expectations upon completion. There was a statistically significant increase in the mean scores for a majority of the SPICE-R factors for pharmacy and dental students. Overall, faculty perceptions of the practice experience were positive. Conclusion. A collaboration between pharmacy and dental schools is a novel approach to meeting interprofessional and experiential curricular goals. Evaluating performance in practice experiences and perceptions can be used to demonstrate learner outcomes within interprofessional education. Furthermore, faculty feedback should be used to improve practice experiences.

Intentional Interprofessional Experiential Education

The experiential component of a doctor of pharmacy curricula is an ideal, yet underutilized vehicle to advance interprofessional education (IPE) initiatives. To date, most experiential-based IPE initiatives occur in a naturally occurring, non-deliberate fashion. The American Association of Colleges of Pharmacy (AACP) Experiential Education Section formed the Task Force on Intentional Interprofessional Education in Experiential Education in academic year 2015-2016 to explore the issue. This commentary describes the work of the task force, including the following elements: defining intentional interprofessional experiential education as "the explicit effort by preceptors and practice sites to create/foster educational opportunities or activities designed specifically to achieve interprofessional educational competencies;" conducting a systematic literature review to identify examples of intentional interprofessional experiential education in the published literature; surveying faculty with oversight of experiential education programs and preceptors within those programs; and generating recommendations to stakeholders including AACP, pharmacy schools, and experiential education administrators.

An interprofessional objective structured teaching experience (iOSTE): An interprofessional preceptor professional development activity

There has been a recent shift to develop and implement interprofessional education for learners during their "clinical" years. With this shift comes a specific need to develop preceptors in the area of interprofessional precepting. The interprofessional objective structured teaching experience (iOSTE) is one method for developing preceptors. The iOSTE was developed from experience with an interprofessional teaching clinic. Full and short versions of the iOSTE were implemented across multiple universities. The iOSTE gives preceptors an opportunity to gain experience with key skills associated with precepting interprofessional learners in clinical settings. Participants evaluated the iOSTE after the session using Likert scale ratings and open-ended questions. Descriptive statistics, independent samples T-tests, and content analysis were used to analyse the data. A total of 96 individuals from 15 different professions and three different universities participated in the iOSTE, with 59.4% (n = 57) completing the iOSTE evaluation. The iOSTE was highly rated with significant differences between the full and short versions of the iOSTE for three evaluation items. Content analysis revealed common themes that preceptors took away from the experience were of "all voices included" and "interprofessional precepting skills". Overall, the iOSTE appears to a feasible and effective method for developing interprofessional preceptors.

Interprofessional Education (IPE) and Pharmacy in the UK. A Study on IPE Activities across Different Schools of Pharmacy

Interprofessional education (IPE) has been recognised internationally as a way to improve healthcare professional interactions and team working in order to enhance patient care. Since pharmacists are increasingly part of multi-professional healthcare teams and are expanding their clinical roles, many pharmacy regulators have stipulated IPE must be included in educational curricula. This study aimed to examine how different Schools of Pharmacy (SOPs) in the UK implement IPE within their pharmacy course. Information about IPE was mainly obtained through interviews with staff from various SOPs. Nine telephone interviews were conducted which were analysed using a thematic analysis approach in order to derive common categories. These were identified as students, activities, barriers and facilitators and benefits of IPE. It was found that teaching methods used for IPE varied across SOPs. No standard strategy to deliver IPE was identified. Students were thought to value the IPE experience, especially the interaction with other professionals. The main barriers to implementing IPE arose from limited financial and organisational support. In general, many SOPs in the UK are undertaking IPE but challenges remain in establishing it as a routine part of the course, something which seems to echo difficulties in implementation of IPE both nationally and internationally.