1
|
Bornman J, Louw B. Leadership Development Strategies in Interprofessional Healthcare Collaboration: A Rapid Review. J Healthc Leadersh 2023; 15:175-192. [PMID: 37641632 PMCID: PMC10460600 DOI: 10.2147/jhl.s405983] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/19/2023] [Indexed: 08/31/2023] Open
Abstract
Background Contemporary healthcare practitioners require leadership skills for a variety of professional roles related to improved patient/client outcomes, heightened personal and professional development, as well as strengthened interprofessional collaboration and teamwork. Objective/Aim The aim of this study is to systematically catalogue literature on leadership in healthcare practice and education to highlight the leadership characteristics and skills required by healthcare practitioners for collaborative interprofessional service delivery and the leadership development strategies found to be effective. Methods/Design A rapid review was conducted. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) diagram shows that the 11 databases, yielded 465 records. A total of 147 records were removed during the initial screening phase. The remaining 318 records were uploaded onto Rayyan, an online collaborative review platform. Following abstract level screening, a further 236 records were removed with 82 records meeting the eligibility criteria at full text level, of which 42 were included in the data extraction. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal. Results Results showed variability in methodologies used, representing various healthcare disciplines with a range in population size (n = 6 to n = 537). Almost half of the results reported on new programs, with interprofessional collaboration and teamwork being the most frequently mentioned strategies. The training content, strategies used as well as the length of training varied. There were five outcomes which showed positive change, namely skills, knowledge, confidence, attitudes, and satisfaction. Conclusion This rapid review provided an evidence-base, highlighted by qualitative, quantitative, and mixed methods research, which presents distinct opportunities for curriculum development by focusing on both content and the methods needed for leadership programs. Anchoring this evidence-base within a systematic search of the extant literature provides increased precision for curriculum development.
Collapse
Affiliation(s)
- Juan Bornman
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Brenda Louw
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, Gauteng, South Africa
- Department Audiology and Speech-Language Pathology, East Tennessee State University, Johnson City, TN, USA
| |
Collapse
|
2
|
Gendelman R, Preis H, Chandran L, Blair RJ, Chitkara M, Pati S. Healthcare workforce transformation: implementing patient-centered medical home standards in an academic medical center. BMC MEDICAL EDUCATION 2021; 21:313. [PMID: 34078360 PMCID: PMC8173877 DOI: 10.1186/s12909-021-02775-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Large scale implementation of new strategies and healthcare delivery standards in academic medical centers (AMCs) requires training of healthcare workforce at different stages of their medical career. The patient-centered medical home (PCMH) model for healthcare delivery involves adoption by all members of the healthcare workforce, including seasoned professionals and trainees. Though widely known, the PCMH model has been implemented sporadically at large AMCs and methods to implement the model across healthcare workforce have not been well-documented. METHODS To meet all PCMH standards and achieve sustainable level 3 recognition, the authors implemented in 2014-2015 a multi-pronged approach that capitalized on existing educational infrastructure among faculty, residents, and medical students. Within 18 months, the authors applied new interdisciplinary practices and policies, redesigned residency training in continuity practices and extensively modified medical school curricula. RESULTS These innovative transformational education efforts addressed the six PCMH standards for faculty, residents, and undergraduate medical students. Faculty played a major role as system change agents and facilitators of learning. Residents learned to better understand patients' cultural needs, identify 'at-risk' patients, ensure continuity of care, and assess and improve quality of care. Medical students were exposed to PCMH core standards throughout their training via simulations, training in the community and with patients, and evaluation tasks. By implementing these changes across the healthcare workforce, the AMC achieved PCMH status in a short time, changed practice culture and improved care for patients and the community. Since then, the AMC has been able to maintain PCMH recognition annually with minimal effort. CONCLUSIONS Successful strategies that capitalize on existing strengths in infrastructure complemented by innovative educational offerings and inter-professional partnerships can be adapted by other organizations pursuing similar transformation efforts. This widespread transformation across the healthcare workforce facilitate a deep-rooted change that enabled our academic medical center to sustain PCMH recognition.
Collapse
Affiliation(s)
- Rebecca Gendelman
- Renaissance School of Medicine, Stony Brook University, NY, Stony Brook, USA
| | - Heidi Preis
- Department of Psychology, Stony Brook University, NY, Stony Brook, USA
- Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, Health Sciences Center Level 11, Suite 20, NY, 11794-8111, Stony Brook, USA
| | - Latha Chandran
- Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, Health Sciences Center Level 11, Suite 20, NY, 11794-8111, Stony Brook, USA
| | - Robyn J Blair
- Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, Health Sciences Center Level 11, Suite 20, NY, 11794-8111, Stony Brook, USA
| | - Maribeth Chitkara
- Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, Health Sciences Center Level 11, Suite 20, NY, 11794-8111, Stony Brook, USA
| | - Susmita Pati
- Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, Health Sciences Center Level 11, Suite 20, NY, 11794-8111, Stony Brook, USA.
| |
Collapse
|
3
|
Experiences of Patient-Centered Medical Home Staff Team Members Working in Interprofessional Training Environments. J Gen Intern Med 2020; 35:2976-2982. [PMID: 32728958 PMCID: PMC7573084 DOI: 10.1007/s11606-020-06055-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence is growing that interprofessional team-based models benefit providers, trainees, and patients, but less is understood about the experiences of staff who work beside trainees learning these models. OBJECTIVE To understand the experiences of staff in five VA training clinics participating in an interprofessional team-based learning initiative. DESIGN Individual semi-structured interviews with staff were conducted during site visits, qualitatively coded, and analyzed for themes across sites and participant groups. PARTICIPANTS Patient-centered medical home (PCMH) staff members (n = 32; RNs, Clinical and Clerical Associates) in non-primary care provider (PCP) roles working on teams with trainees from medicine, nursing, pharmacy, and psychology. APPROACH Benefits and challenges of working in an interprofessional, academic clinic were coded by the primary author using a hybrid inductive/directed thematic analytic approach, with review and iterative theme development by the interprofessional author team. KEY RESULTS Efforts to improve interprofessional collaboration among trainees and providers, such as increased shared leadership, have positive spillover effects for PCMH staff members. These staff members perceive themselves playing an educational role for trainees that is not always acknowledged. Playing this role, learning from the "fresh" knowledge imparted by trainees, and contributing to the future of health care all bring satisfaction to staff members. Some constraints exist for full participation in the educational efforts of the clinic. CONCLUSIONS Increased recognition of and expanded support for PCMH staff members to participate in educational endeavors is essential as interprofessional training clinics grow.
Collapse
|
4
|
McInerney P, Green-Thompson LP. Theories of learning and teaching methods used in postgraduate education in the health sciences: a scoping review. JBI Evid Synth 2019; 18:1-29. [PMID: 31567525 DOI: 10.11124/jbisrir-d-18-00022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review was to determine the theories of learning and methods used in teaching in postgraduate education in the health sciences. The longer-term objective was to use the information gathered to design a workshop for teachers of postgraduate students. INTRODUCTION Whilst undergraduate teaching in the health sciences has received considerable attention in the literature in terms of methods used, innovative ideas and outcomes, the same cannot be said of postgraduate education. A considerable amount of postgraduate teaching takes place in the workplace and often in the form of informal teaching. The increasing complexity of health problems calls for innovative teaching. INCLUSION CRITERIA Papers included in this review were those that considered postgraduate education in the health science disciplines, including but not limited to medicine, nursing, occupational therapy, physiotherapy, pharmacy and dentistry, and that described theories of learning and/or teaching methods used in teaching. METHODS Five databases were searched for the period 2001 through 2016. PubMed yielded the most records (3142). No relevant papers were identified through hand searching of the references of the included papers. A data extraction table was developed and used to extract relevant information from included papers. RESULTS Sixty-one papers were included in the review. Most of the included papers were from the USA, with 17 published in 2015. Descriptive study designs were the most frequently identified study design. Most of the papers were from the medical disciplines. Twenty-seven papers did not refer to a teaching and learning theory, a further group referred to a theory but often towards the end of the paper, and seven papers had as their focus the importance of theories in medical education. The theories named were of a wide variety. Likewise, a wide range of teaching methods were identified. CONCLUSIONS It is clear that a range of theories and teaching methods are used in postgraduate health science education, with educators feeling the need to explore more innovative methods.
Collapse
Affiliation(s)
- Patricia McInerney
- The Wits-JBI Centre for Evidence-based Practice: a Joanna Briggs Institute Centre of Excellence.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lionel Patrick Green-Thompson
- The Wits-JBI Centre for Evidence-based Practice: a Joanna Briggs Institute Centre of Excellence.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
5
|
Goldman RE, Brown J, Stebbins P, Parker DR, Adewale V, Shield R, Roberts MB, Eaton CB, Borkan JM. What matters in patient-centered medical home transformation: Whole system evaluation outcomes of the Brown Primary Care Transformation Initiative. SAGE Open Med 2018; 6:2050312118781936. [PMID: 29977548 PMCID: PMC6024270 DOI: 10.1177/2050312118781936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/17/2018] [Indexed: 01/17/2023] Open
Abstract
Objectives: Patient-centered medical home transformation initiatives for enhancing
team-based, patient-centered primary care are widespread in the United
States. However, there remain large gaps in our understanding of these
efforts. This article reports findings from a contextual, whole system
evaluation study of a transformation intervention at eight primary care
teaching practice sites in Rhode Island. It provides a picture of system
changes from the perspective of providers, staff, and patients in these
practices. Methods: Quantitative/qualitative evaluation methods include patient, provider, and
staff surveys and qualitative interviews; practice observations; and focus
groups with the intervention facilitation team. Results: Patient satisfaction in the practices was high. Patients could describe
observable elements of patient-centered medical home functioning, but they
lacked explicit awareness of the patient-centered medical home model, and
their activation decreased over time. Providers’ and staff’s emotional
exhaustion and depersonalization increased slightly over the course of the
intervention from baseline to follow-up, and personal accomplishment
decreased slightly. Providers and staff expressed appreciation for the
patient-centered medical home as an ideal model, variously implemented some
important patient-centered medical home components, increased their
understanding of patient-centered medical home as more than specific
isolated parts, and recognized their evolving work roles in the medical
home. However, frustration with implementation barriers and the added work
burden they associated with patient-centered medical home persisted. Conclusion: Patient-centered medical home transformation is disruptive to practices,
requiring enduring commitment of leadership and personnel at every level,
yet the model continues to hold out promise for improved delivery of
patient-centered primary care.
Collapse
Affiliation(s)
- Roberta E Goldman
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Center for Primary Care & Prevention, Brown University, Pawtucket, RI, USA
| | - Joanna Brown
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Patricia Stebbins
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Donna R Parker
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Center for Primary Care & Prevention, Brown University, Pawtucket, RI, USA.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Victoria Adewale
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Renee Shield
- School of Public Health, Brown University, Providence, RI, USA
| | - Mary B Roberts
- Center for Primary Care & Prevention, Brown University, Pawtucket, RI, USA
| | - Charles B Eaton
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Center for Primary Care & Prevention, Brown University, Pawtucket, RI, USA.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Jeffrey M Borkan
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
6
|
Ginossar T, Heckman CJ, Cragun D, Quintiliani LM, Proctor EK, Chambers DA, Skolarus T, Brownson RC. Bridging the Chasm: Challenges, Opportunities, and Resources for Integrating a Dissemination and Implementation Science Curriculum into Medical Education. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2018; 5:2382120518761875. [PMID: 29707648 PMCID: PMC5892792 DOI: 10.1177/2382120518761875] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/07/2018] [Indexed: 05/31/2023]
Abstract
BACKGROUND Physicians are charged with implementing evidence-based medicine, yet few are trained in the science of Dissemination and Implementation (D&I). In view of the potential of evidence-based training in D&I to help close the gap between research and practice, the goal of this review is to examine the importance of D&I training in medical education, describe challenges to implementing such training, and provide strategies and resources for building D&I capacity. METHODS We conducted (1) a systematic review to identify US-based D&I training efforts and (2) a critical review of additional literature to inform our evaluation of the challenges and opportunities of integrating D&I training in medical education. RESULTS Out of 269 unique articles reviewed, 11 described US-based D&I training. Although vibrant and diverse training opportunities exist, their capacity is limited, and they are not designed to meet physicians' needs. Synthesis of relevant literature using a critical review approach identified challenges inherent to changing medical education, as well as challenges related to D&I science. Finally, selected strategies and resources are available for facilitating incorporation of D&I training into medical education and overcoming existing challenges. CONCLUSIONS Integrating D&I training in the medical education curriculum, and particularly in residency and fellowship training, holds promise for bridging the chasm between scientific discoveries and improved patient care and outcomes. However, unique challenges should be addressed, including the need for greater evidence.
Collapse
Affiliation(s)
- Tamar Ginossar
- Department of Communication & Journalism and the Comprehensive Cancer Center, The University of New Mexico, Albuquerque, NM, USA
| | - Carolyn J Heckman
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Deborah Cragun
- Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Lisa M Quintiliani
- School of Medicine, Section of General Internal Medicine, Boston University, Boston, MA, USA
| | - Enola K Proctor
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Ted Skolarus
- Section Chief, Urology, VA Ann Arbor Healthcare System Associate Professor, Department of Urology, University of Michigan VA Ann Arbor HSR&D Center for Clinical Management Research
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| |
Collapse
|
7
|
Petek D, Vidič Hudobivnik P, Jančar V, Petek B, Klemenc-Ketiš Z. Regional coordinators: a new teaching opportunity in family medicine training. BMC MEDICAL EDUCATION 2016; 16:141. [PMID: 27165495 PMCID: PMC4863329 DOI: 10.1186/s12909-016-0667-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 05/06/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND A new project on education in family medicine training was implemented last year in Slovenia by establishing regional coordinators in the specialist training programme. They are responsible for conducting regular small-group meetings with family medicine trainees. This study wanted to explore the attitudes and opinions of regional coordinators and family medicine trainees concerning this new method. METHODS This was a qualitative study based on focus groups. The participants were regional coordinators and family medicine specialist trainees. The data were analysed based on the principles of thematic content analysis with inductive technique. RESULTS The study revealed five themes which were the same for the analysis of transcripts of both regional coordinators and family medicine trainees: 1) Meetings with trainees; 2) Coordination; 3) Characteristics of regional coordinators; 4) Position of regional coordinators, and 5) Evaluation of regional coordinators. CONCLUSION Participants of the study have many expectations for this new programme. They expect progress in trainees' clinical knowledge through experience-based group learning and with the help of the tutorship role of regional coordinators. The role of regional coordinators represents a new possibility for solving problems in the training programme in their coordinating role. In future, they have the potential to develop into an expert body that supervises the quality of training. A close follow-up is necessary to see if the position of regional coordinators is adequate and if they meet the expectations of the trainees as well as their own goals. Administrative and financial support for the programme is necessary. The project is important also in enabling the adaptation of the training programme's needs and the regional characteristics of medical care.
Collapse
Affiliation(s)
- Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, Ljubljana, 1000, Slovenia.
| | | | - Viktorija Jančar
- Health Centre Dr. Adolfa Drolca, Ulica talcev 9, Maribor, Slovenia
| | - Bojana Petek
- University Psychiatric Clinic Ljubljana, Studenec 48, Ljubljana, 1260, Slovenia
| | - Zalika Klemenc-Ketiš
- Department of Family Medicine, Maribor Medical School, University of Maribor, Taborska 8, Maribor, 2000, Slovenia
| |
Collapse
|