A quality improvement activity to promote interprofessional collaboration among health professions students

Design and Evaluation of an Interprofessional Preceptor Development Mini-Fellowship Program

INTRODUCTION

Health professions preceptors require skills and knowledge to effectively meet the educational needs of interprofessional students in clinical environments. We implemented a mini-fellowship program to enhance the knowledge, skills, and self-efficacy of preceptors teaching students and applying quality improvement (QI) methods across disciplines and patient care settings.

METHODS

The design, implementation, and evaluation of the program were informed by the faculty development literature, principles of adult learning, and preceptor needs. The 3-day program included workshops on curriculum design, clinical teaching methods, QI, social determinants of health, cultural humility, and interprofessional teamwork. Quantitative and qualitative evaluation methods were used including preprogram and postprogram knowledge and self-efficacy surveys, along with end-of-session and program evaluations.

RESULTS

Five annual cohorts involving 41 preceptors with varied demographics, professions, and clinical practices completed the mini-fellowship program. Participants' percentage of items answered correctly on a QI knowledge test increased from 79.2% (pretest) to 85.5% (post-test), a gain of 6.3% (90% CI: 2.9-9.7%; P < .003). The average QI self-efficacy scores improved from 2.64 to 3.82, a gain of 1.18 points on a five-point scale ( P < .001). The average education/teaching self-efficacy increased from 2.79 to 3.80 on a five-point scale ( P < .001). Ultimately, 94% would recommend the program to other preceptors.

DISCUSSION

An interprofessional preceptor development program designed to train clinicians to effectively teach in the clinical setting and to conduct QI projects with students was achievable and effective. This program can serve as a model for academic centers charged with training future health care workers and supporting their community-based preceptors' training needs.

Factors associated with interprofessional competencies among healthcare professionals in Japan

We aimed to explore factors associated with interprofessional competencies among healthcare professionals in Japan. From June to October 2020, we conducted a cross-sectional survey via a validated self-administered web-based questionnaire using the Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC). We recruited participants from an e-mail list. The questionnaire asked about JASSIC, basic demographic information, whether they had undertaken pre- and post-licensure interprofessional education (IPE), and administrative experience; as well as an organizational climate scale, including "Plan, Do, See" factor for management (PDS factor), and the "Do" factor in a leader-centered direction for people who work unwillingly. Factors associated with the total JASSIC score as interprofessional competencies were determined using multiple regression analysis. We analyzed data from 560 participants with an average age of 41.0 years, comprising 132 nurses, 127 doctors, and 120 social workers. The median of the total JASSIC score was 72/90 (range: 66-78). On multiple regression analysis, total JASSIC score was significantly associated with age, PDS factor, administrative experience, pre-licensure IPE, and pos-licensure IPE. These findings emphasize the importance of pre- and post-licensure IPE, and administrative experience for improving interprofessional competencies in Japan.

Quality Improvement Content in Physical Therapist Education: A Scoping Review

OBJECTIVE

The purpose of this study was to systematically review the literature regarding teaching quality improvement (QI) in physical therapist education based on the Institute of Medicine's 6-element definition of QI. Educational activities in QI methods in physical therapist professional education curricula, their developmental stage, and their level of evaluation were described.

METHODS

Keywords related to physical therapist students and QI educational activities were used to search studies indexed in PubMed, CINAHL, and ERIC published from 2004 through November 2020. This search yielded 118 studies. After applying inclusion and exclusion criteria, 13 studies were retained for full-text review, which was conducted independently by 2 reviewers. The University of Toronto framework was used to assess developmental stage, and Kirkpatrick's taxonomy was used to assess the evaluation level of 4 retained studies.

RESULTS

The scope of QI educational activities in the 4 retained studies was limited to 3 of the 6 elements of QI: identifying opportunities for improvement, designing and testing interventions, and identifying errors and hazards in care. None of the studies included educational activities to teach understanding and measuring quality of care. Three of the 4 studies spanned the first 2 stages of the University of Toronto framework (exposure and immersion); 1 study was limited to exposure. None of the studies assessed competence in QI methods. Evaluation of QI education was limited to Kirkpatrick levels 1 (reaction) or 2 (learning). None of the studies evaluated activities at level 3 (transfer of new behaviors) or level 4 (results).

CONCLUSION

Education in QI methods in professional physical therapist curricula may be limited in scope due to constraints in physical therapist education and the strategic objective of the profession to differentiate itself from other professions.

IMPACT

Entry-level physical therapists might not be educated to fully participate in interprofessional teams that use QI methods to continuously improve the quality of patient-centered care.

Reflection in Rural Family Medicine Education

Reflection in medical education is vital for students' development as professionals. The lack of medical educators in rural family medicine can impinge on the effective reflection of residents' learning. Hence, based on qualitative research, we proposed a framework regarding reflection in rural family medicine education, indicating when, where, and how reflection is performed and progresses. The contents of reflection include clinical issues regarding knowledge and skills, professionalism in clinical decisions, and work-life balance. The settings of reflection include conference rooms, clinical wards, residents' desks, and hospital hallways. The timing of educational reflection includes during and after patient examination and discussion with various professionals, before finishing work, and during "doorknob" times (right before going back home). Rural medical teachers need competence as clinicians and medical educators to promote learning in medical residents and sustain rural medical care. Furthermore, medical teachers must communicate and collaborate with medical residents and nurses for educational reflection to take place in rural family medicine education, especially regarding professionalism. In rural family medicine education, reflection can be performed in various clinical situations through collaboration with learners and various medical professionals, aiding the enrichment of residents' learning and sustainability of rural medical care.

Promoting Quality Improvement in Primary Care Through a Longitudinal, Project-Based, Interprofessional Curriculum

INTRODUCTION

Health professionals must demonstrate competencies in quality improvement (QI) and interprofessional (IP) practice. Yet few curricula are designed to address these competencies in an integrated, longitudinal way. Our experiential IP QI curriculum addresses this gap.

METHODS

The IP QI curriculum was part of a San Francisco VA Health Care System training program for second-year internal medicine residents and adult gerontology primary care nurse practitioner students, pharmacy residents, and postdoctoral psychology fellows. Trainees worked in mentored IP teams to select, design, implement, evaluate, and present a project as part of a 9-month curriculum. Teaching methodologies included didactics and project-based skills application. Curriculum evaluation included trainees' QI knowledge and skills self-assessments, trainee satisfaction, mentor appraisals, and project results and impact assessments.

RESULTS

From 2011-2012 to 2017-2018, 242 trainees completed the curriculum and 41 QI projects. Trainees reported high satisfaction with the introductory sessions (M = 4.4, SD = 0.7). They also reported improvement in comfort with QI knowledge and skills by the curriculum's completion. QI mentors (n = 23) observed growth in trainees' QI knowledge and skills, felt confident in trainees' ability to orchestrate a QI initiative, and believed their mentored QI projects added value to the organization. Thirty-eight projects resulted in system modifications.

DISCUSSION

This IP QI curriculum offers team-based, workplace experiences for trainees to learn and apply QI knowledge and skills. Leading factors for successful implementation included attention to team-building and faculty development. Challenges included reliably collecting evaluation data, accurately measuring ongoing systems changes, and variable trainee engagement.

Graduate level health professions education: how do previous work experiences influence perspectives about interprofessional collaboration?

Understanding how previous experiences with interprofessional education and collaboration inform health care provider perspectives is important for developing interprofessional interventions at the graduate level. The purpose of this study was to examine how previous work experiences of graduate level health professions students inform perspectives about interprofessional education and collaboration. Drawing from program evaluation data of two separate graduate level interprofessional education interventions based in primary care and home health care, we conducted a qualitative secondary data analysis of 75 interviews generated by focus groups and individual interviews with graduate students from 4 health professions cadres. Using directed content analysis, the team coded to capture descriptions of interprofessional education or collaboration generated from participants' previous work experiences. Coding revealed 173 discrete descriptions related to previous experiences of interprofessional education or collaboration. Three themes were identified from the analysis that informed participant perspectives: Previous educational experiences (including work-based training); previous work experiences; and organizational factors and interprofessional collaboration. Experiences varied little between professions except when aspects of professional training created unique circumstances. The study reveals important differences between graduate and undergraduate learners in health professions programs that can inform interprofessional education and collaboration intervention design.

Pharmacy Students' Perspectives on Interprofessional Learning in a Simulated Patient Care Ward Environment

Objective. To assess pharmacy students' opinions of an interprofessional learning (IPL) course in their final year of the Bachelor of Pharmacy program at The University of Auckland. Methods. Pharmacy students participated in the second day of a two-day simulation-based course, WardSim, alongside medical and nursing students in an acute care, hospital ward setting. After finishing the course, all students were asked to complete a questionnaire. The responses of pharmacy, nursing, and medical students on the scaled questions were compared. An in-depth thematic analysis of the pharmacy students' responses to the open-ended questions was completed using an iterative process. Results. Significant differences were found among the students' responses regarding the prioritization of care, systematic assessment of patients, and communication strategies. Pharmacy students had less favourable responses regarding the IPL experience than medical and nursing students. However, overall responses were positive. Some of the themes that emerged among the pharmacy students' responses included: learning communication tools, being assertive in communicating with other health care professionals, and understanding their own and others' roles in the health care team. Furthermore, some pharmacy students reported feeling underprepared for and underutilized during patient care scenarios. Conclusion. An IPL experience in an acute patient care setting demonstrated clear and beneficial learning outcomes for pharmacy students, especially in regards to communicating and understanding their roles and those of others on their team. Tailoring the pre-work or scenarios for the IPL experience to be more pharmacy orientated and having pharmacy students participate on both days may improve the preparedness for IPL.

Using reflective practice in interprofessional education and practice: a realist review of its characteristics and effectiveness

This article presents the results of a realist review of the use of reflective practice interventions aimed at improving interprofessional education and collaborative practice (IPECP). Reflective practice is recognized as one of the determining factors in health and social service professionals' skills development and maintenance, as well as in the establishment of good collaboration practices. In this respect, it is a key element of interprofessional education (IPE) and its relevance in this field is being asserted more and more strongly. However, few studies have been conducted to document its effectiveness. The purpose of this article is therefore to advance knowledge in this field. Searches in health and social services electronic databases identified six studies presenting reflective practice interventions in IPECP aimed at enhancing collaboration among students or practicing professionals. Analysis provided preliminary answers as to the effectiveness of reflective practice interventions in IPECP, as well as pertinent information on the best methods for achieving effectiveness. It concludes by proposing recommendations designed to change reflective practice interventions in IPECP and by stressing the importance of further research in order to document more fully the effectiveness of reflective practice in IPECP and to identify the most promising intervention methods in this regard.

Ana AE, Reynecke J, Al Husami I, Al Rubaiey A. Interprofessional Competency Framework for Health Service Managers in Oman: An e-Delphi Study

OBJECTIVES

This study aimed to develop the required interprofessional competencies for health service managers in Oman.

METHODS

Experts (n = 20) were selected based on their years' experience, position, fluency in English (both verbal and written), and who had completed higher education at either masters or doctorate levels in the relevant field. The data collection consisted of three rounds. Responses were collected and extracted from a web-based designed survey and subsequently analyzed.

RESULTS

Experts agreed on the nine interprofessional domains and 41 competencies based on the inclusion of means (M) 3 4.4, an interquartile distribution (IQD) ≤ 1.25, and > 80.0% agreement. Findings revealed that there were levels of agreement (90.0% to 95.0%) among the experts in the nine interprofessional competency domains namely: resilience (M = 4.7, IQD = 0.40), research leverage (M = 4.7, IQD = 0.60), interprofessional ethics (M = 4.7, IQD = 0.80), quality improvement (M = 4.7, IQD = 0.80), information technology (M = 4.6, IQD = 0.80), leadership (M = 4.5, IQD = 1.00), management skills (M = 4.5, IQD = 0.80), communication (M = 4.5, IQD = 1.00), and team dynamics (M = 4.5, IQD = 1.00).

CONCLUSIONS

The development of interprofessional competencies for health service managers is an impetus to strengthen the human resources capabilities, sustain a high level of quality patient outcomes, and to achieve the Ministry of Health's Health Vision 2050.

Teaching and learning activities to educate nursing students for interprofessional collaboration: A scoping review

To prepare new graduates with the knowledge, skills, and attitudes to engage in effective interprofessional collaboration (IPC) in practice, healthcare professional programmes need to ensure their curriculum provides opportunities for interprofessional education (IPE) and IPC. To strengthen IPE within an undergraduate curriculum and meet the professional requirements set out by regulatory bodies to prepare new graduate nurses to achieve IPC competencies, a curriculum initiative was developed to expand IPE across the four years of the Baccalaureate of Science in Nursing (BSN) programme. The purpose of this scoping review was to identify published teaching-learning activities in undergraduate nursing programmes to inform the development and integration of IPE curricula. The literature included was identified by searching the following electronic databases: EMBASE and EBSCO (CINAHL, Medline, Education Research Complete, ERIC). The search was limited to articles with abstracts published between 2008 and 2016 in the English language. All ten studies that met inclusion criteria reported students' perceived interprofessional education as valuable in facilitating their achievement of IPC competencies. Interprofessional education is an approach for preparing nursing students with knowledge, skills, and attitudes to achieve IPC competencies and therefore, urgently needs to become more prevalent in nursing curricula. Educators can use a variety of IPE teaching-learning activities to support students' achievement of IPC competencies in order to prepare new practitioners to engage in effective IPC in a variety of healthcare milieus. Nurse educators are encouraged to intentionally integrate learning opportunities into current and future undergraduate nursing education to prepare collaborative ready graduate nurses.

An Interprofessional Education Panel on Development, Implementation, and Assessment Strategies

This report provides a primer for implementing interprofessional education (IPE) within pharmacy and health sciences curricula. In 2013, a panel of administrators and faculty members, whose institutions offered IPE, funded by the Josiah Macy Jr. Foundation, shared best collaborative practice models at the American Association of Colleges of Pharmacy (AACP) Annual Meeting. These presenters subsequently collaborated to write a primer as guidance for other institutions interested in successfully implementing and continuously enhancing the quality of IPE programs. In this article, these IPE faculty members provide a rationale for creating IPE reforms, discuss successful strategies for innovative IPE programs, and share lessons learned for implementing effective assessment tools. A structure and process for determining outcomes of IPE models are presented and strategies for exploring shared education opportunities across health professions and for integrating top-down and bottom-up methods for IPE programs are given.

Teaching patient safety in the medical undergraduate program at the Universidade Federal de São Paulo

OBJECTIVE

To analyze the Educational Project of the undergraduate medical course to verify what is taught regarding Patient Safety and to enable reflections on the educational practice.

METHODS

A descriptive study, using document research as strategy. The document of investigation was the Educational Project of the medical course, in 2006, at the Escola Paulista de Medicina of the Universidade Federal de São Paulo. The theoretical framework adopted was the Multi-Professional Patient Safety Curriculum Guide of the World Health Organization, which led to the preparation of a list with 153 tracking terms.

RESULTS

We identified 65 syllabus units in the Educational Project of the course, in which 40 (61.5%) addressed topics related to Patient Safety. Themes on the topic "Infection prevention and control" were found in 19 (47.5%) units and teaching of "Interaction with patients and caregivers" in 12 (32.5%); however content related to "Learning from errors to prevent harm" were not found. None of the framework topics had their proposed themes entirely taught during the period of education of the future physicians.

CONCLUSION

Patient safety is taught in a fragmented manner, which values clinical skills such as the diagnosis and treatment of diseases, post-treatment, surgical procedures, and follow-up. Since it is a recent movement, the teaching of patient safety confronts informative proposals based on traditional structures centered on subjects and on specific education, and it is still poorly valued.

Impact of participation on a solid organ transplant team on student pharmacists' perceptions of interprofessional roles

OBJECTIVE

To examine student pharmacists' perceptions of interprofessional roles before and after completing an advanced pharmacy practice experience on solid organ transplantation.

METHODS

Student pharmacists across the United States participating in an APPE on a solid organ transplant team completed an online pre- and post-APPE survey instrument examining perceptions of interprofessional roles, communication, and teamwork.

RESULTS

Student pharmacists' scores on interprofessionalism increased significantly on 17 of 22 items. Positive changes were seen in the interprofessional education core competency areas of roles and responsibilities, interprofessional communication, and teams and teamwork.

CONCLUSION

Student pharmacist participation in interprofessional clinical APPEs can positively influence their professional development as they prepare to become members of multi-disciplinary teams in the healthcare workforce.

Measuring team factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

BACKGROUND

Measuring team factors in evaluations of Continuous Quality Improvement (CQI) may provide important information for enhancing CQI processes and outcomes; however, the large number of potentially relevant factors and associated measurement instruments makes inclusion of such measures challenging. This review aims to provide guidance on the selection of instruments for measuring team-level factors by systematically collating, categorizing, and reviewing quantitative self-report instruments.

METHODS

DATA SOURCES

We searched MEDLINE, PsycINFO, and Health and Psychosocial Instruments; reference lists of systematic reviews; and citations and references of the main report of instruments.

STUDY SELECTION

To determine the scope of the review, we developed and used a conceptual framework designed to capture factors relevant to evaluating CQI in primary care (the InQuIRe framework). We included papers reporting development or use of an instrument measuring factors relevant to teamwork. Data extracted included instrument purpose; theoretical basis, constructs measured and definitions; development methods and assessment of measurement properties. Analysis and synthesis: We used qualitative analysis of instrument content and our initial framework to develop a taxonomy for summarizing and comparing instruments. Instrument content was categorized using the taxonomy, illustrating coverage of the InQuIRe framework. Methods of development and evidence of measurement properties were reviewed for instruments with potential for use in primary care.

RESULTS

We identified 192 potentially relevant instruments, 170 of which were analyzed to develop the taxonomy. Eighty-one instruments measured constructs relevant to CQI teams in primary care, with content covering teamwork context (45 instruments measured enabling conditions or attitudes to teamwork), team process (57 instruments measured teamwork behaviors), and team outcomes (59 instruments measured perceptions of the team or its effectiveness). Forty instruments were included for full review, many with a strong theoretical basis. Evidence supporting measurement properties was limited.

CONCLUSIONS

Existing instruments cover many of the factors hypothesized to contribute to QI success. With further testing, use of these instruments measuring team factors in evaluations could aid our understanding of the influence of teamwork on CQI outcomes. Greater consistency in the factors measured and choice of measurement instruments is required to enable synthesis of findings for informing policy and practice.

Patient safety instruction in US health professions education

OBJECTIVE

To describe patient safety instruction in health professional curricula, including medicine, nursing, pharmacy, and dentistry.

METHODS

A systematic review of the literature from 1966 through 2010 was conducted using 6 databases and based on 3 search criteria: safety management, patient safety, and curriculum.

RESULTS

One hundred fifty-four articles were identified and 23 met inclusion criteria. A variety of educational methods have been used in health profession curricula to promote patient safety including lectures, workshops, objective structured clinical examinations, standardized patients, simulation exercises, root cause analysis, quality assurance projects, and other interactive learning methods. The development of patient safety curricula has been primarily discipline-specific, with little interdisciplinary research found.

CONCLUSIONS

Safe, patient-centered care is directly influenced by the quality of education that healthcare professions students receive. From this literature review, research is needed to guide curricular change, specifically focusing on instructional methods and interdisciplinary collaborations.

Faculty perceptions of the Educating Pharmacy Students to Improve Quality (EPIQ) program

OBJECTIVE

To investigate users' initial perceptions of and potential applications for the Educating Pharmacy Students and Pharmacists to Improve Quality (EPIQ) program, a 5-module education program designed to educate pharmacists and pharmacy students about quality improvement in pharmacy practice.

METHODS

The 5-module EPIQ program was distributed to pharmacy faculty members, pharmacy practitioners, and other health professionals across the country upon request. A 6-item survey instrument was sent to the first 97 people who requested the program.

RESULTS

Twenty-seven (56%) of the 55 respondents had reviewed the EPIQ program and 22 (82%) intended to use some or all of the content to teach about quality improvement or patient safety primarily in pharmacy management and medication safety courses.

CONCLUSION

Initial perceptions of the EPIQ program were positive; however, further evaluation is needed after more extensive implementation of the program in pharmacy colleges and schools and other settings.