EPIS-RI: Indonesian translation, cultural adaptation and construct validation of an interprofessional identity measure

Interprofessional Education (IPE) as a preparatory stage for Interprofessional collaboration (IPC) is overlooked in some low-and middle-income countries, including Indonesia. One of the driving forces behind IPC is the development of Interprofessional Identity (IPI), which has yet to be assessed in the Indonesian context. Our study aims were translating and culturally adapting the Extended Professional Identity Scale (EPIS) and confirming its construct validity. We invited third-year students from three programs (medicine, nursing, and dietetics) without previous IPE experience to participate in the study. Using Confirmatory Factor Analysis (CFA), we examined the construct validity, analyzed internal consistency, and conducted a Kruskal-Wallis test to identify variations across professions. Of 513 students approached, 335 participated (response rate 65.3%). The CFA showed factor loadings ranging between .59 and .86, while correlations among subscales varied from .55 to .86. All five goodness-of-fit indices were sufficient. The internal consistency of subscales interprofessional belonging, commitment, and beliefs was .82, .84 and .87, respectively, and .90 for the overall scale. Interprofessional belonging and commitment were different among various students (p-value = .009 and .004) and the dietetics students had lower scores than other students. The Indonesian EPIS (EPIS-RI) demonstrated reliability and construct validity.

Interprofessional education for healthcare professionals. A BEME realist review of what works, why, for whom and in what circumstances in undergraduate health sciences education: BEME Guide No. 83

AIM

To provide an evidence-informed program theory (PT) for Interprofessional Education (IPE) that adds to the knowledge base of how IPE in undergraduate health sciences education works.

METHODS

We undertook a realist review of the literature and synthesis of the evidence combined with stakeholder experience. Our initial program theory (IPT), built around development, delivery and evaluation of IPE interventions, was tested and refined following an in-depth search of the literature and consultation with stakeholders. The literature (2010-2022) was selected based on the realist criteria of relevance and rigor, as well as on conceptual richness of the studies.

RESULTS

Our PT is built upon 124 CMOs (Context of IPE interventions, Mechanisms that fired within that context, and IPE Outcomes), from 58 studies. Our PT comprises an array of elements found in the Context, including traits and behavioral displays of students and facilitators, and discusses four Mechanisms (feeling responsible, feeling enthusiastic/excited, feeling safe to take risks, and feeling ready), which are likely to lead to outcomes related to the Interprofessional Education Collaborative (sub)competencies.

DISCUSSION

Results were linked to learning theories to further build our understanding. The PT can serve as a guide for the development, delivery, and evaluation of IPE interventions.

What influences on their professional development do general practice trainees report from their hospital placements? A qualitative study

BACKGROUND

The clinical learning environment is important in GP specialty training and impacts professional development. Uniquely for GP trainees, about half of their training periods occur in a hospital environment, which is not their final workplace. There is still little understanding of how hospital-based training influences GP's professional development.

OBJECTIVES

To seek the views of GP trainees on how their hospital experience contributes to their professional development as a GP.

METHODS

This international and qualitative study seeks the views of GP trainees from Belgium, Ireland, Lithuania, and Slovenia. Semi-structured interviews were performed in the original languages. A joint thematic analysis in the English language resulted in key categories and themes.

RESULTS

From the four themes identified, GP trainees were found to experience additional challenges on top of the service provision/education tensions, which are common to all hospital trainees. Despite these, the hospital rotation component of GP training is valued by trainees. A strong finding of our study is the need to ensure that learning from the hospital placements is placed firmly in the context of general practice, e.g. GP placements prior or parallel with the hospital placements, educational activities resourced by GPs during their hospital experience, encouraging hospital teachers to have greater awareness of the educational needs of GPs, including an awareness of their training curriculum.

CONCLUSION

This novel study highlights how hospital placements for GP trainees could be enhanced. Further study could be broadened to recently qualified GPs, which may uncover new areas of interest.

Designing the learning of intraprofessional collaboration among medical residents

BACKGROUND

To preserve quality and continuity of care, collaboration between primary-care and secondary-care physicians is becoming increasingly important. Therefore, learning intraprofessional collaboration (intraPC) requires explicit attention during postgraduate training. Hospital placements provide opportunities for intraPC learning, but these opportunities require interventions to support and enhance such learning. Design-Principles guide the design and development of educational activities when theory-driven Design-Principles are tailored into context-sensitive Design-Principles. The aim of this study was to develop and substantiate a set of theory-driven and context-sensitive Design-Principles for intraPC learning during hospital placements.

METHODS

Based on our earlier research, we formulated nine theory-driven Design-Principles. To enrich, refine and consolidate these principles, three focus group sessions with stakeholders were conducted using a Modified Nominal Group Technique. Next, two work conferences were conducted to test the feasibility and applicability of the Design-Principles for developing intraPC educational activities and to sharpen the principles into a final set of Design-Principles.

RESULTS

The theoretical Design-Principles were discussed and modified iteratively. Two new Design-Principles were added during focus group 1, and one more Design-Principle was added during focus group 2. The Design-Principles were categorised into three clusters: (i) Culture: building collaborative relations in a psychologically safe context where patterns or feelings of power dynamics between primary and secondary care physicians can be discussed; (ii) Connecting Contexts: making residents and supervisors mutually understand each other's work contexts and activities; and (iii) Making the Implicit Explicit: having supervising teams act as role models demonstrating intraPC and continuously pursuing improvement in intraPC to make intraPC explicit. Participants were unanimous in their view that the Design-Principles in the Culture cluster were prerequisites to facilitate intraPC learning.

CONCLUSION

This study led to the development of 12 theory-driven and context-sensitive Design-Principles that may guide the design of educational activities to support intraPC learning during hospital placements.

Teaching and Learning Core Values in General Practice/Family Medicine: A Narrative Review

General Practice/Family Medicine (GP/FM) is a key discipline within primary health care and so by extension for the whole health care system. An essential condition for effective GP/FM care is a work force that is highly qualified. As society is changing rapidly, a revision of the GP/FM definition is ongoing, in addition to a recent movement of identifying related core values. In this paper, we want to give an overview on how these new paths and perspectives are currently reflected in GP/FM teaching and training. We selected four core values that fit in with possible future visions: person-centered care, continuity of care, cooperation in care, and community-oriented care. By a narrative review, we observed that GP/FM education toward core values is often built around overarching topics. Teaching and learning take place in specific contexts, most of all through placements within communities, primary care settings, or hospital wards. Mixed teaching- and training methods are used combining knowledge, skills, and attitude. Furthermore, collaboration with other health professionals and peers is stressed, in addition to the importance of role models, a holistic focus and the involvement of patients. Since these core values are important within GP/FM and rather few studies on the educational aspects and learning tools were found we advocate encouraging each other more to share good practices, certainly the innovative ones specifically related to GP/FM.

Enabling visibility of the clinician-scientists' knowledge broker role: a participatory design research in the Dutch nursing-home sector

Background

A group of clinician-scientists and managers working within a Dutch academic network, experienced difficulties in clearly defining the knowledge broker role of the clinician-scientists. They found no role clarity in literature, nor did they find tools or methods suitable for clinician-scientists. Clarifying role expectations and providing accountability for funding these knowledge broker positions was difficult. The aim of this research was to design a theory-informed tool that allowed clinician-scientists to make their knowledge broker role visible.

Methods

A participatory design research was conducted in three phases, over a 21-month period, with a design group consisting of an external independent researcher, clinician-scientists and their managers from within the academic network. Phase 1 constituted a literature review, a context analysis and a needs analysis. Phase 2 constituted the design and development of a suitable tool and phase 3 was an evaluation of the tool’s perceived usefulness. Throughout the research process, the researcher logged the theoretic basis for all design decisions.

Results

The clinician-scientist’s knowledge broker role is a knowledge-intensive role and work-tasks associated with this role are not automatically visible (phase 1). A tool (the SP-tool) was developed in Microsoft Excel. This allowed clinician-scientists to log their knowledge broker activities as distinct from their clinical work and research related activities (phase 2). The SP-tool contributed to the clinician-scientists’ ability to make their knowledge broker role visible to themselves and their stakeholders (phase 3). The theoretic contribution of the design research is a conceptual model of professionalisation of the clinician-scientist’s knowledge broker role. This model presents the relationship between work visibility and the clarification of functions of the knowledge broker role. In the professionalisation of knowledge-intensive work, visibility contributes to the definition of clinician-scientists broker functions, which is an element necessary for the professionalisation of an occupation.

Conclusions

The SP-tool that was developed in this research, contributes to creating work visibility of the clinician-scientists’ knowledge broker role. Further research using the SP-tool could establish a clearer description of the knowledge broker role at the day-to-day professional level and improved ability to support this role within organisations.

Professional development arising from multiple-site workplace learning: boundary crossing between the education and clinical contexts

BACKGROUND

This research explores the value of an inter-organisational jurisdiction, on the professional development of faculty members in their roles of researcher and educator. Faculty members from a Dutch university of applied sciences, who work in both the education and clinical practice contexts, participated in this research.

METHODS

Individual semi-structured interview were conducted with nine faculty members, from various academic health professions, on their experiences of professional development arising from working in both the clinical and education contexts. In this exploratory, post-positive interview study, interview transcripts were analysed thematically.

RESULTS

Participants reported that working in two organisational contexts, whilst performing two faculty roles that span both contexts, enhances their ability to broker connections between research, teaching and practice. The boundary crossing activities which participants performed, contributed to professional development in all faculty roles. The broker role was not seen as being a unique role which is distinct from research and practice roles. Broker activities were seen as generic and supportive of the roles that bestow academic status and expertise.

CONCLUSIONS

To the participants in this research, the relevance of the broker role in professional development is not as evident as the relevance of roles that enhance specialisation and subject specific expertise. They consider broker activities as supportive to the roles of researcher and teacher. The broker role is time consuming, but not yet visible as a distinct professionalisable work-package in its own right. It is also not well defined in literature. A better understanding of the broker role could lead to its development in order to harness its professional development potential tenably across academic roles.

Understanding the Broker Role of Clinician-Scientists: A Realist Review on How They Link Research and Practice

PURPOSE

Clinician-scientists are said to be well placed to connect research and practice, but their broker role has been underexplored. This review sought to gain an understanding of the broker role of clinician-scientists.

METHOD

The authors conducted a realist review to describe context-mechanism-outcome (CMO) configurations associated with the broker role of clinician-scientists. CINAHL, PubMed, PsycINFO, Web of Science, and Embase were searched between May and August 2017. Data were analyzed qualitatively; data synthesis focused on assembling CMO configurations.

RESULTS

Of an initial 2,241 articles, 9 were included in the final review. Included papers show that clinician-scientists, in their broker role, achieve 2 organizational-level outcomes: an increased volume of clinically relevant, research, and increased evidence application to improve care. They also achieve the individual-level outcome of professional development as a researcher, clinician, and broker. Multidimensional skills and management support are necessary context factors. Mechanisms that contribute to outcomes include balancing economic and scientific interests and performing boundary-crossing activities. Four CMO configurations by which clinician-scientists achieve outcomes in brokering a connection between research and practice were identified. Useful program theories for explaining these are boundary crossing, social network, communities of practice, and diffusion of innovation theory.

CONCLUSIONS

The mechanisms found may provide insight for interventions aiming to support clinician-scientists in their broker role. The authors expect that if more attention is paid to learning multidimensional skills and management support for the broker role is strengthened, stronger links between research and practice could be forged.

Facilitators and barriers to brokering between research and care by senior clinical-scientists in general practice and elderly care medicine

BACKGROUND

Clinician-scientists (CSs) are physicians who work in daily care and have an academic role in research or education. They may act as knowledge brokers and help to connect research and clinical practice. There is no data available on CSs' brokering activities and the perceived barriers and facilitators to optimising their role in general practice (GP) and elderly care medicine (EM).

AIM

To identify the brokering activities of CSs in these fields and the barriers and facilitators they come across whilst sharing knowledge and connecting people in research and frontline health care.

DESIGN AND SETTING

Qualitative interview study among 17 Dutch senior CSs.

METHOD

Interview data were audio recorded, transcribed verbatim and thematic interpretative analysis was used to identify themes.

RESULTS

CSs facilitate collaboration between researchers and practitioners. They exchange knowledge on both sides, make use of extensive networks and constantly and actively involve care in research and research in care. CSs come across barriers as well as facilitators that influence their brokering activities. Some barriers and facilitators are at the individual level, other are related more to the job context and workplace.

CONCLUSIONS

This study reveals barriers to overcome and facilitators to develop related to the brokering role of CSs. To make the best use of CSs, brokering activities and the added value of CSs should be recognised and supported. Awareness of what CSs need to function effectively in demanding work settings could be important for the future impact of the role on the fields of GP and EM.

Educational training requirements for general practice/family medicine specialty training: recommendations for trainees, trainers and training institutions

High-quality training is a prerequisite to teaching future general practitioners. To inspire and guide all countries to implement General Practice (GP) specialist education and training and bring it to the highest standards, we aimed, within the European context, to produce a collaborative document entitled 'Educational Requirements for GP Specialty Training'. Through an iterative process existing documents from the European Academy of Teachers in GP and Family Medicine (EURACT) and the World Organization of Family Medicine Doctors (WONCA) were collated. Other reports, grey literature about specialty GP training and requirements for trainees, trainers and training institutions were included. State-of-the-art GP specialty training 'core' competences, characteristics and essential features of GP are described. General principles and specified tools for training and assessment are summarised. Recommendations on the duration and place(s) of training and selection of trainees are provided. Trainers should be accredited teachers and quality training institutions are essential. New insights, existing gaps and issues for debate have highlighted areas for further research. This document was produced in the specific context of Europe but its general principles are relevant to GP training in all countries.

[Chronic kidney damage guidelines revision]

Age has no effect on the diagnosis of 'chronic kidney damage'. Estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m2 is to be considered 'abnormal' for patients of all ages. Albuminuria is classified as 'not abnormal', 'moderately elevated' and 'severely elevated'. Decreased eGFR and elevated albuminuria are independent risk factors for and predictors of cardiovascular and total mortality, progression of chronic kidney damage and end-stage kidney failure. Blood pressure target value is ≤ 130/80 mmHg. In case of an indication for blood pressure-lowering treatment for patients with chronic kidney damage and elevated albuminuria, an ACE inhibitor or angiotensin II receptor blocker is preferred. The general practitioner refers patients with chronic kidney damage and a highly elevated risk of mortality, cardiovascular disease, progression of kidney damage and end-stage kidney failure to the internist-nephrologist. Inform patients about drugs that can cause kidney damage and about the importance of dosage adjustments. When prescribing drugs to patients with eGFR < 50 ml/min per 1.73 m2, the pharmacist should, with the patient's approval, be informed of the eGFR.

Assessing family medicine trainees--what can we learn from the European neighbours?

Background: Although demands on family physicians (FP) are to a large extent similar in the European Union, uniform assessment standards for family medicine (FM) specialty training and assessment do not exist. Aim of this pilot study was to elicit and compare the different modalities and assessment methods of FM specialty training in five European countries.

Methods: A semi structured survey was undertaken based on a convenient sample in five European countries (Denmark, Germany, Poland, the Netherlands and the United Kingdom). The respondents were asked to respond to ten items about aspects of FM specialty training and assessment methods in their respective countries. If available, this data was completed with information from official websites of the countries involved.

Results: FM specialty training is performed heterogeneously in the surveyed countries. Training time periods range from three to five years, in some countries requiring a foundation program of up to two years. Most countries perform longitudinal assessment during FM specialty training using a combination of competence-based approach with additional formative and summative assessment. There is some evidence on the assessments methods used, however the assessment method used and costs of assessment differs remarkably between the participating countries.

Conclusions: Longitudinal and competence-based assessment is the presently preferred approach for FM specialty training. Countries which use less multifaceted methods for assessment could learn from best practice. Potential changes have significant cost implications.