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Sanford N, Lavelle M, Markiewicz O, Reedy G, Rafferty DAM, Darzi LA, Anderson JE. Decoding healthcare teamwork: a typology of hospital teams. J Interprof Care 2024; 38:602-611. [PMID: 38666463 PMCID: PMC11147451 DOI: 10.1080/13561820.2024.2343835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 04/09/2024] [Indexed: 05/18/2024]
Abstract
The effectiveness of healthcare depends on successful teamwork. Current understanding of teamwork in healthcare is limited due to the complexity of the context, variety of team structures, and unique demands of healthcare work. This qualitative study aimed to identify different types of healthcare teams based on their structure, membership, and function. The study used an ethnographic approach to observe five teams in an English hospital. Data were analyzed using a combined inductive-deductive approach based on the Temporal Observational Analysis of Teamwork framework. A typology was developed, consisting of five team types: structural, hybrid, satellite, responsive, and coordinating. Teams were challenged to varying degrees with staffing, membership instability, equipment shortages, and other elements of the healthcare environment. Teams varied in their ability to respond to these challenges depending on their characteristics, such as their teamworking style, location, and membership. The typology developed in this study can help healthcare organizations to better understand and design effective teams for different healthcare contexts. It can also guide future research on healthcare teams and provide a framework for comparing teams across settings. To improve teamwork, healthcare organizations should consider the unique needs of different team types and design effective training programs accordingly.
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Affiliation(s)
- Natalie Sanford
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Mary Lavelle
- NIHR Patient Safety and Translational Research Centre, Imperial College London, London, UK
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland
| | - Ola Markiewicz
- NIHR Patient Safety and Translational Research Centre, Imperial College London, London, UK
| | - Gabriel Reedy
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Dame Anne Marie Rafferty
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Lord Ara Darzi
- NIHR Patient Safety and Translational Research Centre, Imperial College London, London, UK
| | - Janet E. Anderson
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Ghanouni P, Inouye K, Gowan C, Hartford W, McKinnon A, McQuitty S, Backman CL, Li LC, Nimmon L. Beyond dyadic communication: Network of communication in inflammatory arthritis teams. Chronic Illn 2023; 19:591-604. [PMID: 35635126 DOI: 10.1177/17423953221102629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore how communication is perceived and care is negotiated amongst IA healthcare teams by drawing on the perspectives of each team member. METHOD This analysis drew on data from an ongoing three-year study exploring team-based IA care. We interviewed 11 participants including two men with IA and their family care providers and healthcare providers. We used a three-staged analytic process and integrated broad tenets of social network theory to understand the relational dimensions of team members experiences. RESULT Analysis revealed three themes regarding communication and care: (1) seeking/sharing information, (2) striving to coordinate unified care, and (3) providing patients a voice. DISCUSSION This study emphasizes the importance of understanding team dynamics beyond the dyad of patient and care provider. Negotiating power and decision-making in IA care is a dynamic process involving shifting levels of responsibility amongst a care team. Communication-based strategies that extend dyadic interactions may enhance teamwork and health outcomes in chronic conditions.
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Affiliation(s)
- Parisa Ghanouni
- Department of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Kristy Inouye
- Department of Occupation Science and Occupational Therapy, University of British Columbia, Canada
| | - Chelsey Gowan
- Department of Occupation Science and Occupational Therapy, University of British Columbia, Canada
| | - Wendy Hartford
- Department of Occupation Science and Occupational Therapy, University of British Columbia, Canada
| | - Annette McKinnon
- Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, Canada
| | - Shanon McQuitty
- Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, Canada
| | - Catherine L Backman
- Department of Occupation Science and Occupational Therapy, University of British Columbia, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Laura Nimmon
- Department of Occupation Science and Occupational Therapy, University of British Columbia, Canada
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Foo YY, Xin X, Rao J, Tan NCK, Cheng Q, Lum E, Ong HK, Lim SM, Freeman KJ, Tan K. Measuring Interprofessional Collaboration's Impact on Healthcare Services Using the Quadruple Aim Framework: A Protocol Paper. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095704. [PMID: 37174222 PMCID: PMC10178681 DOI: 10.3390/ijerph20095704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/13/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
Despite decades of research on the impact of interprofessional collaboration (IPC), we still lack definitive proof that team-based care can lead to a tangible effect on healthcare outcomes. Without return on investment (ROI) evidence, healthcare leaders cannot justifiably throw their weight behind IPC, and the institutional push for healthcare manpower reforms crucial for facilitating IPC will remain variable and fragmentary. The lack of proof for the ROI of IPC is likely due to a lack of a unifying conceptual framework and the over-reliance on the single-method study design. To address the gaps, this paper describes a protocol which uses as a framework the Quadruple Aim which examines the ROI of IPC using four dimensions: patient outcomes, patient experience, provider well-being, and cost of care. A multimethod approach is proposed whereby patient outcomes are measured using quantitative methods, and patient experience and provider well-being are assessed using qualitative methods. Healthcare costs will be calculated using the time-driven activity-based costing methodology. The study is set in a Singapore-based national and regional center that takes care of patients with neurological issues.
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Affiliation(s)
- Yang Yann Foo
- Department of Technology Enhanced Learning and Innovation, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Xiaohui Xin
- Health Services Research Unit, Singapore General Hospital, Singapore 169608, Singapore
| | - Jai Rao
- Department of Neurosurgery, National Neuroscience Institute, Singapore 308433, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore
| | - Nigel C K Tan
- Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore
| | - Qianhui Cheng
- Department of Neuroradiology, National Neuroscience Institute, Singapore 308433, Singapore
| | - Elaine Lum
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Hwee Kuan Ong
- Department of Physiotherapy, Singapore General Hospital, Singapore 169608, Singapore
- Singapore Institute of Technology, Singapore 138683, Singapore
| | - Sok Mui Lim
- Singapore Institute of Technology, Singapore 138683, Singapore
| | - Kirsty J Freeman
- Office of Education, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Kevin Tan
- Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore
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Gram P, Thomsen LLH, Andersen CG, Overgaard C. Trusting parent-professional relationships in interprofessional interventions for expectant and new parents in vulnerable positions: A realist evaluation. J Interprof Care 2023:1-11. [PMID: 36883786 DOI: 10.1080/13561820.2023.2183185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 03/09/2023]
Abstract
Interprofessional collaboration and trusting parent-professional relationships can be key to delivering interprofessional care to meet the needs of expectant and new parents in vulnerable positions. This, however, presents challenges. This study aimed to gain deeper understanding of how and under what circumstances trusting parent-professional relationships develop and work within interprofessional team-based care for this group, from the professionals' perspectives. Realist evaluation was undertaken based on 14 semi-structured, realist interviews with midwives and health visitors and 11 observations. Multiple interrelated mechanisms were identified including patient/family-centered care, timely and relevant interprofessional involvement in care, gentle interprofessional bridging, transparency of intervention roles and purposes, and relational continuity. Good interprofessional collaboration was a primary condition for these mechanisms. Developed, trusting relationships supported parents' engagements with interprofessional care and constituted a supportive safety net that promoted parenting skills and coping abilities. We identified harmful mechanisms: distanced encounters, uncertainty of interprofessional involvement, and compromising the safe space. These mechanisms caused distrust and disengagement. Ensuring trusting parent-professional relationships within interprofessional team-based care demands each professional involved competently engages in relational work and interprofessional collaboration. Uncontrollability is thus influenced regarding interpersonal connection and potentially gives an explanation when trust-building efforts fail.
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Affiliation(s)
- Pernille Gram
- Department of Health Science and Technology, The Research Team for Women's, Child & Family Health, Aalborg University, Gistrup, Denmark
| | - Louise Lund Holm Thomsen
- Department of Health Science and Technology, The Research Team for Women's, Child & Family Health, Aalborg University, Gistrup, Denmark
| | - Clara Graugaard Andersen
- Department of Health Science and Technology, The Research Team for Women's, Child & Family Health, Aalborg University, Gistrup, Denmark
| | - Charlotte Overgaard
- Department of Health Science and Technology, The Research Team for Women's, Child & Family Health, Aalborg University, Gistrup, Denmark
- Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
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Parry AE, Richardson A, Kirk MD, Colquhoun SM, Durrheim DN, Housen T. Team effectiveness: epidemiologists' perception of collective performance during emergency response. BMC Health Serv Res 2023; 23:149. [PMID: 36782194 PMCID: PMC9925216 DOI: 10.1186/s12913-023-09126-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/27/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND To describe epidemiologists' experience of team dynamics and leadership during emergency response, and explore the utility of the Team Emergency Assessment Measure (TEAM) tool during future public health emergency responses. The TEAM tool included categories for leadership, teamwork, and task management. METHODS We conducted a cross-sectional survey between October 2019 and February 2020 with the global applied field epidemiology workforce. To validate the TEAM tool for our context, we used exploratory and confirmatory factor analysis. RESULTS We analysed 166 completed surveys. Respondents included national and international emergency responders with representation of all WHO regions. We were unable to validate the TEAM tool for use with epidemiology teams involved in emergency response, however descriptive analysis provided insight into epidemiology emergency response team performance. We found female responders were less satisfied with response leadership than male counterparts, and national responders were more satisfied across all survey categories compared to international responders. CONCLUSION Functional teams are a core attribute of effective public health emergency response. Our findings have shown a need for a greater focus on team performance. We recommend development of a fit-for-purpose performance management tool for teams responding to public health emergencies. The importance of building and supporting the development of the national workforce is another important finding of this study.
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Affiliation(s)
- Amy Elizabeth Parry
- The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT, Australia.
| | - Alice Richardson
- grid.1001.00000 0001 2180 7477The Australian National University, Statistical Support Network, Acton, Australia
| | - Martyn D. Kirk
- grid.1001.00000 0001 2180 7477The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT Australia
| | - Samantha M. Colquhoun
- grid.1001.00000 0001 2180 7477The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT Australia
| | - David N. Durrheim
- grid.266842.c0000 0000 8831 109XUniversity of Newcastle, Newcastle, NSW Australia
| | - Tambri Housen
- grid.1001.00000 0001 2180 7477The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT Australia ,grid.266842.c0000 0000 8831 109XUniversity of Newcastle, Newcastle, NSW Australia
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Lee M, Ong YH, Martimianakis MA. Ideological dilemmas of healthcare professionals who do not speak up at interprofessional team meetings. J Interprof Care 2023; 37:1-10. [PMID: 35285379 DOI: 10.1080/13561820.2022.2037530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In healthcare settings, speaking up is considered essential for patient safety. Indeed, voice opportunities are widely available mandatory mechanisms for speaking up at the routine interprofessional team meetings of our study site. Yet, healthcare professionals in team meetings often do not go beyond straightforward reporting of test results and biomedical-functional parameters, suggesting that members with psycho-social information related to the patient are not participating fully in team meetings. Post-meeting interviews with some of the team members revealed the moments of silence and the ideological contradictions underlying team discussions. We explored silences and contradictions as argumentative meanings inherent in naturally occurring speech. The identification of opposing meanings tells of ideological dilemmas that may explain why healthcare practitioners do not speak up vigorously. We identified three such dilemmas: the ideology of working in teams versus the ideology of working solo; the ideology of autonomy versus the ideology of paternalism; and the ideology of collectivism versus the ideology of individuality. The dilemmas made visible the dimensions of silence as well as silencing as an imposition of silence from above. We suggest focussing on mapping disciplinary and interpretive differences and their effects amongst team members may motivate voice. Further studies should explore the affective dimensions of silence in interprofessional team meetings.
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Affiliation(s)
- Mary Lee
- Health Outcomes & Medical Education Research, National Healthcare Group, Singapore
| | - Yu Han Ong
- Health Outcomes & Medical Education Research, National Healthcare Group, Singapore
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Løken TD, Helgesen MK, Bjørkquist C. Collective Competence as an Enabler for Service Integration in Health and Social Care Services. J Multidiscip Healthc 2022; 15:2817-2830. [DOI: 10.2147/jmdh.s387719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022] Open
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von Schnurbein G, Hollenstein E, Arnold N, Liberatore F. Together Yet Apart: Remedies for Tensions Between Volunteers and Health Care Professionals in Inter-professional Collaboration. VOLUNTAS : INTERNATIONAL JOURNAL OF VOLUNTARY AND NONPROFIT ORGANIZATIONS 2022; 34:1-13. [PMID: 35469325 PMCID: PMC9020558 DOI: 10.1007/s11266-022-00492-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/26/2022] [Indexed: 06/14/2023]
Abstract
While volunteering is an essential factor in service delivery in many societal areas, the inclusion of volunteers in formal settings can also lead to tensions. In this article, we combine the literature on volunteering and inter-professional collaboration (IPC) to elaborate a framework regarding remedies for tensions between professional staff and volunteers within IPC in health care provision to ensure successful collaboration. Using a dyadic survey design to interview volunteers and volunteer managers, we show that the perspectives of volunteers and volunteer managers on the antecedents of effective IPC differ in paradoxical ways. While volunteer managers apply organizational logic concerning tasks and processes to avoid tensions, volunteers seek solutions on a relational basis. However, rather than trying to resolve these paradoxes, our study indicates that carefully managing tensions arising between volunteers and professional staff may be more successful than trying to resolve all tensions.
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Affiliation(s)
| | - Eva Hollenstein
- Swiss Centre for International Health, Swiss TPH, Basel, Switzerland
| | - Nicholas Arnold
- Center for Philanthropy Studies (CEPS), University of Basel, Basel, Switzerland
| | - Florian Liberatore
- Winterthur Institute of Health Economics (WIG), School of Management and Law, Zurich University of Applied Sciences, Zurich, Switzerland
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Tyler N, Wright N, Gregoriou K, Waring J. Improving mental health care transitions through information capture during admission to inpatient mental health services: a quality improvement study. BMC Health Serv Res 2021; 21:1132. [PMID: 34674690 PMCID: PMC8529804 DOI: 10.1186/s12913-021-07136-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Many interventions aim to improve the transition from ward to community at the time of discharge, with varying success. Guidelines suggest that discharge planning should begin at admission, but in reality this is ideal rather than standard practice. We aimed to develop a novel information capture tool during admission that facilitates and accelerates discharge. Methods A quality improvement study to develop, implement and evaluate a novel tool that improves information capture upon admission to acute mental health wards within a single English National Health Service (NHS) trust. We developed the tool by synthesising existing evidence and working with multi-agency and multi-disciplinary professionals in two co-design workshops. During implementation the tool was piloted on three wards. Ethnographic observations (145 h) and interviews (45) were used to evaluate the implementation of the tool across the three wards. Thematic synthesis was used to consolidate the findings. Results The tool developed considerably as the process evolved. The finished product is a list of 10 information categories that should be captured from external agencies upon admission to hospital to facilitate discharge planning to community settings. Reported advantages of the tool were: (1) facilitating confidence in junior staff to legitimately question the suitability of a patient for an acute ward (2) collecting and storing essential information in a single accessible place that can be used throughout the care pathway and (3) collecting information from the services/agencies to which patients will eventually be discharged. Conclusions Improving the quality of information at admission has the potential to facilitate and accelerate discharge. The novel tool provides a framework for capturing this information that can be incorporated into existing information systems. However, the introduction of the tool exacerbated complex, fragile distributed team dynamics, highlighting the importance of sociocultural context in information flow transitional interventions within distributed teams. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07136-2.
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Affiliation(s)
- Natasha Tyler
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom.
| | - Nicola Wright
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | | | - Justin Waring
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom.,Health Services Management Centre, University of Birmingham, Birmingham, United Kingdom
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Sebok-Syer SS, Shaw JM, Asghar F, Panza M, Syer MD, Lingard L. A scoping review of approaches for measuring 'interdependent' collaborative performances. MEDICAL EDUCATION 2021; 55:1123-1130. [PMID: 33825192 DOI: 10.1111/medu.14531] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/24/2021] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Individual assessment disregards the team aspect of clinical work. Team assessment collapses the individual into the group. Neither is sufficient for medical education, where measures need to attend to the individual while also accounting for interactions with others. Valid and reliable measures of interdependence are critical within medical education given the collaborative manner in which patient care is provided. Medical education currently lacks a consistent approach to measuring the performance between individuals working together as part of larger healthcare team. This review's objective was to identify existing approaches to measuring this interdependence. METHODS Following Arksey & O'Malley's methodology, we conducted a scoping review in 2018 and updated it to 2020. A search strategy involving five databases located >12 000 citations. At least two reviewers independently screened titles and abstracts, screened full texts (n = 161) and performed data extraction on twenty-seven included articles. Interviews were also conducted with key informants to check if any literature was missing and assess that our interpretations made sense. RESULTS Eighteen of the twenty-seven articles were empirical; nine conceptual with an empirical illustration. Eighteen were quantitative; nine used mixed methods. The articles spanned five disciplines and various application contexts, from online learning to sports performance. Only two of the included articles were from the field of Medical Education. The articles conceptualised interdependence of a group, using theoretical constructs such as collaboration synergy; of a network, using constructs such as degree centrality; and of a dyad, using constructs such as synchrony. Both descriptive (eg social network analysis) and inferential (eg multi-level modelling) approaches were described. CONCLUSION Efforts to measure interdependence are scarce and scattered across disciplines. Multiple theoretical concepts and inconsistent terminology may be limiting programmatic work. This review motivates the need for further study of measurement techniques, particularly those combining multiple approaches, to capture interdependence in medical education.
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Affiliation(s)
| | - Jennifer M Shaw
- Women's Studies, Western University Faculty of Arts and Humanities Ringgold Standard Institution, London, ON, Canada
| | - Farah Asghar
- Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Michael Panza
- Centre for Education Research and Innovation, Western University Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Mark D Syer
- Computing, Queen's University, Kingston, ON, Canada
| | - Lorelei Lingard
- Department of Medicine, University of Western Ontario, London, ON, Canada
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Teunissen PW, Watling CJ, Schrewe B, Asgarova S, Ellaway R, Myers K, Topps M, Bates J. Contextual Competence: How residents develop competent performance in new settings. MEDICAL EDUCATION 2021; 55:1100-1109. [PMID: 33630305 PMCID: PMC8451833 DOI: 10.1111/medu.14517] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Medical education continues to diversify its settings. For postgraduate trainees, moving across diverse settings, especially community-based rotations, can be challenging personally and professionally. Competent performance is embedded in context; as a result, trainees who move to new contexts are challenged to use their knowledge, skills and experience to adjust. What trainees need to adapt to and what that requires of them are poorly understood. This research takes a capability approach to understand how trainees entering a new setting develop awareness of specific contextual changes that they need to navigate and learn from. METHODS We used constructivist grounded theory with in-depth interviews. A total of 29 trainees and recent graduates from three internal medicine training programmes in Canada participated. All participants had completed at least one community-based rotation geographically far from their home training site. Interviews were recorded, transcribed and anonymised. The interview framework was adjusted several times following initial data analysis. RESULTS Contextual competence results from trainees' ability to attend to five key stages. Participants had first to meet their physiological and practical needs, followed by developing a sense of belonging and legitimacy, which paved the way for a re-constitution of competence and appropriate autonomy. Trainee's attention to these stages of adaptation was facilitated by a process of continuously moving between using their knowledge and skill foundation and recognising where and when contextual differences required new learning and adaptations. DISCUSSION An ability to recognise contextual change and adapt accordingly is part of Nussbaum and Sen's concept of capability development. We argue this key skill has not received the attention it deserves in current training models and in the support postgraduate trainees receive in practice. Recommendations include supporting residents in their capability development by debriefing their experiences of moving between settings and supporting clinical teachers as they actively coach residents through this process.
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Affiliation(s)
- Pim W. Teunissen
- School of Health Professions Education (SHE)Maastricht UniversityMaastrichtThe Netherlands
| | - Christopher J. Watling
- Department of Oncology & Centre for Education Research and InnovationUniversity of Western OntarioLondonONCanada
| | - Brett Schrewe
- Department of PediatricsUniversity of British ColumbiaVancouverBCCanada
| | - Sevinj Asgarova
- Centre for Health Education Scholarship (CHES)University of British ColumbiaVancouverBCCanada
| | - Rachel Ellaway
- Department of Community Health SciencesUniversity of CalgaryCalgaryABCanada
| | - Kathryn Myers
- Department of MedicineUniversity of Western OntarioLondonONCanada
| | - Maureen Topps
- Department of Family MedicineUniversity of CalgaryCalgaryABCanada
| | - Joanna Bates
- Department of Family Practice & Centre for Health Education Scholarship (CHES)University of British ColumbiaVancouverBCCanada
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Stevens EL, Hulme A, Salmon PM. The impact of power on health care team performance and patient safety: a review of the literature. ERGONOMICS 2021; 64:1072-1090. [PMID: 33775234 DOI: 10.1080/00140139.2021.1906454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
Communication failure within health care teams is a major cause of patient harm across health care settings. Factors which contribute to communication failure include actual or perceived 'power'. Whilst a great deal of ergonomics research has focussed on teamwork in health care, the role of power in relation to measurable patient safety and performance outcomes remains relatively unknown. This article presents the findings from a review of the literature on power within multidisciplinary health care team settings. Following a systematic literature search, nineteen studies were evaluated in terms of research design, methods and analyses across the included studies. The main impacts resulting from power imbalances include negative effects on team collaboration, decision-making, communication and overall performance. Wider patient safety research, and more specifically the ergonomics discipline, is encouraged to address the complex interplay between power and teamwork in the health care sector.Practitioner Statement: We conducted a review of studies focussed on the influence of power on teamwork in health care. The findings show that power can have negative impacts on collaboration, decision-making, communication, and team performance. We conclude that power represents an important area for ergonomics, both in health care and other settings.Abbreviations: CRM: crew resource management; TEM: threat and error management; SNA: social network analysis; EAST: event analysis of systemic teamwork.
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Affiliation(s)
- Erin L Stevens
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, Business and Law, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Adam Hulme
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, Business and Law, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, Business and Law, University of the Sunshine Coast, Sunshine Coast, Australia
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Han F, Ellis RA. Configurations of collaborations based on learning orientations amongst medical students. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:581-598. [PMID: 33099703 DOI: 10.1007/s10459-020-09999-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
While collaboration is an important and key attribute for medical students in order to prepare them to perform well in health care teams, how to effectively develop and assess such skills is challenging. The current widespread practice of using Likert-scale questionnaire only to measure the quantity of collaboration at course and/or program level appears to be insufficient to provide an evidence-base for what counts desirable collaborative learning experience. Drawing on research into student approaches to learning and social network analysis, this study investigates differences in collaborative learning configurations amongst 217 Australian medical students. Based on students' learning orientations (i.e., 'understanding' and 'reproducing') and their choice of collaborations (i.e., whether to collaborate or not, with whom to collaborate, and mode of collaboration), the analyses found five configurations of collaborations differing in a number of features. The most desirable collaborative experience was a configuration of collaborations formed by students with an 'understanding' orientation. This configuration revealed a strong tendency towards intensive pair work with measurable differences in how easy and effectively they collaborated. The results of the study not only have practical implications for teaching and curriculum design for collaborative learning, but also have significant implications for assessing students' collaborative learning experiences.
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Affiliation(s)
- Feifei Han
- Office of Pro-Vice-Chancellor (Arts, Education and Law), Griffith University, Brisbane, 4122, Australia.
- Griffith Institute for Educational Research, Griffith University, Brisbane, 4122, Australia.
| | - Robert A Ellis
- Office of Pro-Vice-Chancellor (Arts, Education and Law), Griffith University, Brisbane, 4122, Australia
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Byerly LK, Floren LC, Yukawa M, O'Brien BC. Getting outside the box: exploring role fluidity in interprofessional student groups through the lens of activity theory. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:253-275. [PMID: 32705403 DOI: 10.1007/s10459-020-09983-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 07/13/2020] [Indexed: 05/15/2023]
Abstract
Health professionals' roles and scopes often overlap, creating a need for role clarity in interprofessional teamwork. Yet, such clarity does not mean roles are fixed within teams and some literature suggests role flexibility can enhance team functioning. Interprofessional practice competencies and learning activities often emphasize knowledge and definition of roles, but rarely attend to the dynamic nature of roles and influential contextual factors. This study explores role fluidity in interprofessional student groups using an activity theory framework. Using a collective instrumental case study approach, the authors examine the fluidity of one physical therapy (PT) student's role within 3 different interprofessional (medical, pharmacy, PT) student groups completing nursing home patient care plans. Field notes, group debriefing interviews, and care plans were collected and coded from all care planning sessions. Codes mapped to group-specific activity systems that compared role-influencing interactions and tensions. The PT student's role fluidity varied in each group's activity system, influenced primarily by system tensions from implicit rules (e.g., encouraging questions), division of labor (e.g., rigid profession-based task assignment), and tool use (e.g., computers). Attention to modifiable system elements, such as tool use and explicit rules of inclusivity, could foster role fluidity and improve interprofessional teamwork and learning environments.
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Affiliation(s)
- Laura K Byerly
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-475, Portland, OR, 97239, USA.
| | - Leslie C Floren
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Michi Yukawa
- Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Wagner M, Dubé T, Gomez-Garibello C. It takes a team: Generating evidence to define and foster collective competence in health professions education. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e109-e111. [PMID: 33062102 PMCID: PMC7522864 DOI: 10.36834/cmej.69664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Tim Dubé
- Université de Sherbrooke, Quebec, Canada
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Noce LGDA, Oliveira TSD, Melo LC, Silva KFB, Parreira BDM, Goulart BF. Interprofessional relationships of a patient assistance team in critical care. Rev Bras Enferm 2020; 73:e20190420. [PMID: 32609179 DOI: 10.1590/0034-7167-2019-0420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/16/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify perceptions of teamwork according to the professionals of an Adult Intensive Care Unit. METHODS descriptive research with qualitative approach. The methodological framework was thematic content analysis. The theoretical framework of the work process was used to guide the interpretation of the data. Data collection: A semi-structured interview was conducted with 38 professionals in a public teaching hospital in the state of Minas Gerais. Results: three thematic categories emerged from the interviews: Work Organization, which is related to work performed through tasks/routines, with or without coordinated actions; Non-material Work Instruments, which reveal that teamwork is based on communication/collaboration; Insufficient Material Resources, which indicate that lack of material creates conflicts between professionals. CONCLUSIONS Teamwork requires effective communication and collaboration, integrated work and appropriate professional training. On the other hand, fragmentation and rigidity at work, poor collaboration/communication and lack of material make teamwork difficult. We emphasize the need to revise the curriculum of health courses, with a view to including and/or improving discussions about teamwork in order to train professionals for a more integrated and perhaps even sympathetic health practice.
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Burrows KE, Abelson J, Miller PA, Levine M, Vanstone M. Understanding health professional role integration in complex adaptive systems: a multiple-case study of physician assistants in Ontario, Canada. BMC Health Serv Res 2020; 20:365. [PMID: 32349738 PMCID: PMC7189743 DOI: 10.1186/s12913-020-05087-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 03/09/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To meet the complex needs of healthcare delivery, the Ministry of Health and Long Term Care (MOHLTC) introduced Physician Assistants (PAs) into the Ontario health care system in 2006 with the goal of helping to increase access to care, decrease wait times, improve continuity of care and provide a flexible addition to the healthcare workforce. The characterization of healthcare organizations as complex adaptive systems (CAS) may offer insight into the relationships and interactions that optimize and restrict successful PA integration. The aim of this study is to explore the integration of PAs across multiple case settings and to understand the role of PAs within complex adaptive systems. METHODS An exploratory, multiple-case study was used to examine PA role integration in four settings: family medicine, emergency medicine, general surgery, and inpatient medicine. Interviews were conducted with 46 healthcare providers and administrators across 13 hospitals and 6 family medicine clinics in Ontario, Canada. Analysis was conducted in three phases including an inductive thematic analysis within each of the four cases, a cross-case thematic analysis, and a broader, deductive exploration of cross-case patterns pertaining to specific complexity theory principles of interest. RESULTS Forty-six health care providers were interviewed across 19 different healthcare sites. Support for PA contributions across various health care settings, the importance of role awareness, supervisory relationship attributes, and role vulnerability are interconnected and dynamic. Findings represent the experiences of PAs and other healthcare providers, and demonstrate how the PAs willingness to work and ability to build relationships allows for the establishment of interprofessional, collaborative, and person-centered care. As a self-organizing agent in complex adaptive systems (i.e., health organizations), PA role exploration revealed patterns of team behavior, non-linear interconnections, open relationships, dynamic systems, and the legacy of role implementation as defined by complexity theory. CONCLUSIONS By exploring the role of PAs across multiple sites, the complexity theory lens concurrently fosters an awareness of emerging patterns, relationships and non-linear interactions within the defined context of the Ontario healthcare system. By establishing collaborative, interprofessional care models in hospital and community settings, PAs are making a significant contribution to Ontario healthcare settings.
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Affiliation(s)
- Kristen E Burrows
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
- Michael G. DeGroote School of Medicine, Physician Assistant Education Program, McMaster University, Hamilton, Ontario, Canada.
| | - Julia Abelson
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Patricia A Miller
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Mitchell Levine
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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18
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Sunell S, Laronde DM, Kanji Z. Dental hygiene graduates' educational preparedness: Self-confidence ratings of the CDHA baccalaureate competencies. Int J Dent Hyg 2020; 18:295-306. [PMID: 32155307 DOI: 10.1111/idh.12434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/20/2020] [Accepted: 03/05/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE In 2015, the Canadian Dental Hygienists Association (CDHA) published the first Canadian Competencies for Baccalaureate Dental Hygiene Programs (CCBDHP). To date, there is little evidence to support that baccalaureate graduates have gained these abilities. The purpose of the study was to investigate the confidence levels of baccalaureate graduates in their ability to demonstrate the CCBDHP. METHODS An online, anonymous study was conducted with the 2013-2016 graduates of the University of British Columbia to rate their confidence level in the 13 competency domains and associated 110 sub-competencies of the CCBDHP based on a 5-point scale ranging from not confident to confident. RESULTS Thirty of the 84 graduates responded to the survey for a 36% response rate. The mostly confident and confident scores were added to determine the number of sub-competencies within each domain in which 75% to 100% of respondents identified such confidence. The competency domains in which graduates expressed the highest confidence included Collaboration (100%), Communication (100%), Clinical Therapy (100%), Disease Prevention (100%), Oral Health Education (90%), Professionalism (90%), Research Use (90%) and Leadership (90%). They expressed the least confidence in the competency domains of Health Promotion (50%), Advocacy (22%) and Policy Use (0%). CONCLUSION These data provided the UBC faculty with important insights into the educational preparedness of baccalaureate graduates. The findings are also relevant for other Canadian programmes and contribute to a larger national dialogue about the CCBDHP and the transition of graduates into practice.
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Affiliation(s)
- Susanne Sunell
- Part-time Faculty, Oral Biological and Medical Sciences, University of British Columbia, West Vancouver, BC, Canada
| | - Denise M Laronde
- Dental Hygiene Degree Program, Oral Biological and Medical Sciences, University of British Columbia, West Vancouver, BC, Canada
| | - Zul Kanji
- Dental Hygiene Degree Program, Oral Biological and Medical Sciences, University of British Columbia, West Vancouver, BC, Canada
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Cristancho SM, Taylor T. The agility of ants: lessons for grappling with complexity in health care teamwork. MEDICAL EDUCATION 2019; 53:855-857. [PMID: 31414517 DOI: 10.1111/medu.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Sayra M Cristancho
- Faculty of Education, Department of Surgery, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Taryn Taylor
- Department of Obstetrics and Gynecology, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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20
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Olmos-Vega FM, Dolmans DHJM, Guzmán-Quintero C, Echeverri-Rodriguez C, Teunnissen PW, Stalmeijer RE. Disentangling residents' engagement with communities of clinical practice in the workplace. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:459-475. [PMID: 30659426 DOI: 10.1007/s10459-019-09874-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Abstract
Maximising the potential of the workplace as a learning environment entails understanding the complexity of its members' interactions. Although some articles have explored how residents engage with supervisors, nurses and pharmacists individually, there is little research on how residents enter into and engage with the broader community of clinical practice (CoCP). To this end, we designed a constructivist grounded theory study that took place at Universidad Javeriana in Bogotá, Colombia. We conducted semi-structured interviews with 13 residents from different training levels and disciplines during the first weeks of their new rotations. During the interviews, we used the Pictor technique as a visual aid to collect data. Using iterative data collection and analysis, constant comparison methods and theoretical sampling, we constructed the final results. When entering a CoCP, residents experienced recurring and intertwined processes including: exploring how their goals and interest are aligned with those of the CoCP; identifying the relevant CoCP members in the workplace environment; and understanding how these members could assist their successful engagement with the community's practices. Residents entered a CoCP with the intention of either having a central or a peripheral trajectory in it. The final resident participation and role resulted from negotiations between the resident and the CoCP members. Optimising workplace learning includes being mindful as to how each member of the healthcare team influence residents' engagement on practice, and on understanding the nuances of residents' participatory trajectories while interacting with them. Understanding such nuances could be key to align CoCPs' learning affordances and residents' goals and intentions.
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Affiliation(s)
- Francisco M Olmos-Vega
- Anaesthesiology Department, Faculty of Medicine, Pontificia Universidad Javeriana, Carrera 7 40-62, Fourth Floor, Bogotá, Colombia.
- Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - Diana H J M Dolmans
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Carlos Guzmán-Quintero
- Anthropology Department, Social Sciences Faculty, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Camila Echeverri-Rodriguez
- Anaesthesiology Department, Faculty of Medicine, Pontificia Universidad Javeriana, Carrera 7 40-62, Fourth Floor, Bogotá, Colombia
| | - Pim W Teunnissen
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- VU University Medical Center, Amsterdam, The Netherlands
| | - Renée E Stalmeijer
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Bajwa NM, Bochatay N, Muller-Juge V, Cullati S, Blondon KS, Junod Perron N, Maître F, Chopard P, Vu NV, Kim S, Savoldelli GL, Hudelson P, Nendaz MR. Intra versus interprofessional conflicts: implications for conflict management training. J Interprof Care 2019; 34:259-268. [PMID: 31329474 DOI: 10.1080/13561820.2019.1639645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Interprofessional collaboration and conflict management training are necessary in health sciences curricula. Characteristics of conflicts occurring within intraprofessional or between interprofessional teams can vary and are poorly understood. We sought to compare and contrast characteristics of intra- versus interprofessional conflicts to inform future training programs. An exploratory study was conducted through semi-structured interviews with 82 healthcare professionals working in a tertiary hospital. Interviews focused on sources, consequences, and responses to conflicts. Conflict situations were analyzed with conventional content analysis. Participants shared more intra- than interprofessional situations. Intraprofessional conflicts were caused by poor relationships, whereas interprofessional conflicts were associated with patient-related tasks and social representations. Avoiding and forcing were the most commonly mentioned responses to intraprofessional conflicts. The theme of power impacted all aspects of conflict both intra- and interprofessional. Intraprofessional conflicts were found to be as important as interprofessional conflicts. Differences in the sources of conflict and similarities regarding consequences of and responses to conflicts support integration of authentic clinical situations in interprofessional training. Understanding similarities and differences between intra- and interprofessional conflicts may help educators develop conflict management training that addresses the sources, consequences, and responses to conflicts in clinical settings.
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Affiliation(s)
- Nadia M Bajwa
- Department of General Pediatrics at the Children's Hospital, University Hospitals of Geneva, Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Naïke Bochatay
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Virginie Muller-Juge
- Unit of Primary Care (UIGP), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Quality of Care Unit, Medical Directorate, University Hospitals of Geneva, Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | | | - Noëlle Junod Perron
- Institute of Primary Care, University Hospitals of Geneva, and faculty member at the Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Fabienne Maître
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Chopard
- Quality of Care Unit, Medical Directorate, University Hospitals of Geneva, Geneva, Switzerland
| | - Nu V Vu
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sara Kim
- Department of Surgery at the School of Medicine, University of Washington, Seattle, Washington, USA
| | - Georges L Savoldelli
- Division of Anesthesiology at the University Hospitals of Geneva and in the Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Mathieu R Nendaz
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, and Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
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22
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Schot E, Tummers L, Noordegraaf M. Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration. J Interprof Care 2019; 34:332-342. [DOI: 10.1080/13561820.2019.1636007] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Evert Schot
- School of Governance, Utrecht University, Utrecht, Netherlands
| | - Lars Tummers
- School of Governance, Utrecht University, Utrecht, Netherlands
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Nimmon L, Artino AR, Varpio L. Social Network Theory in Interprofessional Education: Revealing Hidden Power. J Grad Med Educ 2019; 11:247-250. [PMID: 31210849 PMCID: PMC6570428 DOI: 10.4300/jgme-d-19-00253.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Nimmon L, Cristancho S. When I say … networks and systems. MEDICAL EDUCATION 2019; 53:331-333. [PMID: 30255513 DOI: 10.1111/medu.13673] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/24/2018] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Laura Nimmon
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Sayra Cristancho
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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25
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Berger S, Whelan B, Mahler C, Szecsenyi J, Krug K. Encountering complexity in collaborative learning activities: an exploratory case study with undergraduate health professionals. J Interprof Care 2018; 33:490-496. [DOI: 10.1080/13561820.2018.1562423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sarah Berger
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Benedict Whelan
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Newmarket, New Zealand
| | - Cornelia Mahler
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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van Dongen JJJ, van Bokhoven MA, Goossens WNM, Daniëls R, van der Weijden T, Beurskens A. Suitability of a Programme for Improving Interprofessional Primary Care Team Meetings. Int J Integr Care 2018; 18:12. [PMID: 30574030 PMCID: PMC6293205 DOI: 10.5334/ijic.4179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 11/20/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Primary care is increasingly being confronted with complex health care demands stemming from both biomedical and psychosocial problems of people with chronic diseases. Interprofessional collaboration is needed to enhance person-centredness and coordinate care provision in an efficient manner, which should eventually result in high-quality and integrated care. In primary care, collaboration often occurs through periodic interprofessional team (IPT) meetings. We have developed a multifaceted programme (including a reflection framework, training activities and a toolbox) to enhance team functioning in terms of improved person-centredness and efficiency of meetings. The aim of this study was to evaluate the perceived suitability and potential impact of this programme. Eventually, findings of this evaluation should contribute to understanding the suitability of the programme and optimizing its design. METHODS A prospective process evaluation was conducted, using a mixed-methods approach. Six primary care IPTs participated. Data collection included observations of team meetings, semi-structured interviews with team chairpersons, a focus group meeting, and a questionnaire for all team members. Qualitative data were analysed using directed content analysis and quantitative data using descriptive statistics. RESULTS The results show that, on the whole, the programme was appreciated. Most progress was perceived regarding structure and organization. Chairs perceived increased awareness of person-centredness and team processes. They perceived the training activities as useful and instructive, and valued peer feedback and on-the-job coaching as the most effective strategies. Findings from the questionnaire showed a tendency in the desired direction for all variables. CONCLUSION To conclude, the programme can be considered as a suitable approach for improving team functioning. However, enhancing person-centredness requires additional training/practice and on-the-job coaching. Lastly, the programme should be context-specific, flexible in use, and preferably delivered and mediated by an external facilitator at the workplace.
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Affiliation(s)
- Jerôme Jean Jacques van Dongen
- Research Centre for Autonomy and Participation for People with Chronic Illnesses, NL
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, NL
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, NL
| | - Marloes Amantia van Bokhoven
- Research Centre for Autonomy and Participation for People with Chronic Illnesses, NL
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, NL
| | - Wilhelmus Nicolaas Marie Goossens
- Research Centre for Autonomy and Participation for People with Chronic Illnesses, NL
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, NL
| | - Ramon Daniëls
- Research Centre for Autonomy and Participation for People with Chronic Illnesses, NL
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, NL
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, NL
| | - Anna Beurskens
- Research Centre for Autonomy and Participation for People with Chronic Illnesses, NL
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, NL
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, NL
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Pype P, Mertens F, Helewaut F, Krystallidou D. Healthcare teams as complex adaptive systems: understanding team behaviour through team members' perception of interpersonal interaction. BMC Health Serv Res 2018; 18:570. [PMID: 30029638 PMCID: PMC6053823 DOI: 10.1186/s12913-018-3392-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/15/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Complexity science has been introduced in healthcare as a theoretical framework to better understand complex situations. Interdisciplinary healthcare teams can be viewed as Complex Adaptive Systems (CAS) by focusing more on the team members' interaction with each other than on the characteristics of individual team members. Viewing teams in this way can provide us with insights into the origins of team behaviour. The aim of this study is to describe the functioning of a healthcare team as it originates from the members' interactions using the CAS principles as a framework and to explore factors influencing workplace learning as emergent behaviour. METHODS An interview study was done with 21 palliative home-care nurses, 20 community nurses and 18 general practitioners in Flanders, Belgium. A two-step analysis consisted of a deductive approach, which uses the CAS principles as coding framework for interview transcripts, followed by an inductive approach, which identifies patterns in the codes for each CAS principle. RESULTS All CAS principles were identified in the interview transcripts of the three groups. The most prevalent principles in our study were principles with a structuring effect on team functioning: team members act autonomously guided by internalized basic rules; attractors shape the team functioning; a team has a history and is sensitive to initial conditions; and a team is an open system, interacting with its environment. The other principles, focusing on the result of the structuring principles, were present in the data, albeit to a lesser extent: team members' interactions are non-linear; interactions between team members can produce unpredictable behaviour; and interactions between team members can generate new behaviour. Patterns, reflecting team behaviour, were recognized in the coding of each CAS principle. Patterns of team behaviour, identified in this way, were linked to interprofessional competencies of the Interprofessional Collaboration Collaborative. Factors influencing workplace learning were identified. CONCLUSIONS This study provides us with insights into the origin of team functioning by explaining how patterns of interactions between team members define team behaviour. Viewing healthcare teams as Complex Adaptive Systems may offer explanations of different aspects of team behaviour with implications for education, practice and research.
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Affiliation(s)
- Peter Pype
- Department of Family Medicine and Primary Health Care, University Hospital – 6K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Fien Mertens
- Department of Family Medicine and Primary Health Care, University Hospital – 6K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Fleur Helewaut
- Clinical Skills Training Centre, Faculty of Medicine and Health Sciences, University Hospital 2K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Demi Krystallidou
- Faculty of Arts (Sint Andries Campus), University of Leuven, Sint Andriesstraat 2, B-2000 Antwerp, Belgium
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Nimmon L, Bates J, Kimel G, Lingard L. Patients with heart failure and their partners with chronic illness: interdependence in multiple dimensions of time. J Multidiscip Healthc 2018; 11:175-186. [PMID: 29588596 PMCID: PMC5858542 DOI: 10.2147/jmdh.s146938] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Informal caregivers play a vital role in supporting patients with heart failure (HF). However, when both the HF patient and their long-term partner suffer from chronic illness, they may equally suffer from diminished quality of life and poor health outcomes. With the focus on this specific couple group as a dimension of the HF health care team, we explored this neglected component of supportive care. Materials and methods From a large-scale Canadian multisite study, we analyzed the interview data of 13 HF patient-partner couples (26 participants). The sample consisted of patients with advanced HF and their long-term, live-in partners who also suffer from chronic illness. Results The analysis highlighted the profound enmeshment of the couples. The couples' interdependence was exemplified in the ways they synchronized their experience in shared dimensions of time and adapted their day-to-day routines to accommodate each other's changing health status. Particularly significant was when both individuals were too ill to perform caregiving tasks, which resulted in the couples being in a highly fragile state. Conclusion We conclude that the salience of this couple group's oscillating health needs and their severe vulnerabilities need to be appreciated when designing and delivering HF team-based care.
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Affiliation(s)
- Laura Nimmon
- Centre for Health Education Scholarship.,Department of Occupational Science and Occupational Therapy
| | - Joanna Bates
- Centre for Health Education Scholarship.,Department of Family Practice, Faculty of Medicine, University of British Columbia
| | - Gil Kimel
- Palliative Care Program, St Paul's Hospital.,Department of Medicine, Division of Internal Medicine, University of British Columbia, Vancouver, BC
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Teunissen PW, Kogan JR, Ten Cate O, Gruppen LD, Lingard LA. Learning in Practice: A Valuation of Context in Time-Variable Medical Training. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:S22-S26. [PMID: 29485483 DOI: 10.1097/acm.0000000000002070] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The logical consequence of implementing competency-based education is moving to time-variable training. Competency-based, time-variable training (CBTVT) requires an understanding of how learners interact with their learning context and how that leads to competence. In this article, the authors discuss this relationship. They first explain that the time required to achieve competence in clinical practice depends on the availability of clinical experiences that are conducive to ongoing competence development. This requires both curricular flexibility in light of the differences in individual learners' development and a balance between longitudinal placements and transitions to different environments.Along with the deliberate use of the opportunities that learning environments offer, there is value for learners in spending ample time-in-context. For instance, guided independence is possible when trainees do not progress immediately after meeting curricular learning objectives. Next, the potential implications of CBTVT can be illustrated by two learning perspectives-Sfard's acquisition and participation metaphors-which leads to the assertion that competence is both an individual characteristic and a quality that emerges from a purposeful social interaction between individuals and their context. This theory recognizes that the deliberate use of context could be used to approach learning as acquiring collective competence.Based on this relationship between learner, context, and competence, the authors propose an approach to CBTVT that recognizes that all learners will have to meet a number of standard preset learning targets in their workplace, while still having room for further context-specific competence development and personal growth within strategically organized learning environments.
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Affiliation(s)
- Pim W Teunissen
- P.W. Teunissen is professor, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands, and maternal fetal medicine specialist, VU University Medical Center, Amsterdam, the Netherlands. J.R. Kogan is professor of medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. O. ten Cate is professor of medical education, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands. L.D. Gruppen is professor, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan. L.A. Lingard is professor, Department of Medicine, and director, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Hudson JN, Croker A. Educating for collaborative practice: an interpretation of current achievements and thoughts for future directions. MEDICAL EDUCATION 2018; 52:114-124. [PMID: 28984388 DOI: 10.1111/medu.13455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/09/2017] [Accepted: 07/28/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT The Edinburgh Declaration, developed in 1998 as a pledge to alter the character of medical education to more effectively meet the needs of society, included a recommendation to increase the opportunity for joint learning between health and health-related professions, as part of the training for teamwork. This article acknowledges achievements since the Declaration in relation to this recommendation, using an umbrella term for the phenomenon, 'educating for collaborative practice', and presents a perspective framed as a series of questions to encourage reflection on future directions. METHODS A literature interpretation, informed by philosophical hermeneutics, was conducted using text sets comprising reports and reviews from a section of the international literature since 1988. The interpretation involved: engaging with meanings as presented in the chosen texts; making iterative returns to the texts to explore emerging understanding; and ensuring parts of our understanding from particular texts were fused with complete understanding of the texts as a whole. A lens of appreciative inquiry facilitated acknowledgement of what has been achieved, while being curious about how it could be. RESULTS Interpretation of the selected literature revealed notable achievements. Areas for further consideration were identified in relation to three themes: establishing shared understanding AND purpose behind use of terminology; being a conduit AND sharing responsibility for change; exploring ways of doing things AND ensuring ongoing inclusivity. CONCLUSIONS Interpreting the current literature on 'educating for collaborative practice' has generated questions for reflection on how it may be otherwise. Readers are encouraged to embrace the tensions inherent in unanswered questions, providing space for communication, initiative and diversity of thought. An ongoing dialogue with the literature is proposed, asking whether educating students for a collective identity in settings where they are learning for and with patients is likely to advance educating for patient-centred collaborative practice.
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Affiliation(s)
- Judith Nicky Hudson
- Faculty of Health and Medicine, University of Newcastle, New South Wales, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia
| | - Anne Croker
- Faculty of Health and Medicine, University of Newcastle, New South Wales, Australia
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Schulz VM, Crombeen AM, Marshall D, Shadd J, LaDonna KA, Lingard L. Beyond Simple Planning: Existential Dimensions of Conversations With Patients at Risk of Dying From Heart Failure. J Pain Symptom Manage 2017; 54:637-644. [PMID: 28827063 PMCID: PMC5651176 DOI: 10.1016/j.jpainsymman.2017.07.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 12/13/2022]
Abstract
CONTEXT Despite the recent promotion of communication guides to improve decision making with patients nearing the end of their lives, these conversations remain challenging. Deeper and more comprehensive understanding of communication barriers that undermine discussions and decisions with patients at risk of dying from heart failure (HF) is vital for informing communication in health care. OBJECTIVES To explore experiences and perspectives of patients with advanced HF, their caregivers, and providers, regarding conversations for patients at risk of dying from HF. METHODS Following Research Ethics Board approval, index patients with advanced HF (New York Heart Association III or IV) and consenting patient-identified care team members were interviewed. A team sampling unit was formed when the patient plus at least two additional team members participated in interviews. Team members included health professionals (e.g., cardiologist, family physician, HF nurse practitioner, social worker, and specialists, such as respirologist, nephrologist, palliative care physician), family caregivers (e.g., daughter, spouse, roommate, close friend), and community members (e.g., minister, neighbor, regular taxi driver). Our data set included 209 individual interviews clustered into 50 team sampling units at five sites from three Canadian provinces. Key informants, identified as practicing experts in the field, reviewed our initial findings with attention to relevance to practice as a form of triangulation. Iterative data collection and analysis followed constructivist grounded theory procedures with sensitizing concepts drawn from complexity theory. To ensure confidentiality, all participants were given a pseudonym. RESULTS Participants' reports of their perceptions and experiences of conversations related to death and dying suggested two main dimensions of such conversations: instrumental and existential. Instrumental dimensions included how these conversations were planned and operationalized as well as the triggers and barriers to these discussions. Existential dimensions of these conversations included evasive maneuvers, powerful emotions, and the phenomenon of death without dying. Existential dimensions appeared to have a basis in issues of mortality and could strongly influence conversations related to death and dying. CONCLUSION Conversations for patients at risk of dying from HF have both instrumental and existential dimensions, in which routines and relationships are inseparable. Our current focus on the instrumental aspects of these conversations is necessary but insufficient. The existential dimensions of conversations related to death are profound and may explain why these conversations have struggled to achieve their desired effect. To improve this communication, we need to also attend to existential dimensions, particularly in terms of their impact on the occurrence of these conversations, the nature of relationships and responses within these conversations, and the fluidity of meaning within these conversations.
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Affiliation(s)
- Valerie Marie Schulz
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Centre for Education Research and Innovation, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia & Perioperative Medicine, practicing in Palliative Care, McMaster University, Hamilton, Ontario, Canada.
| | - Allison M Crombeen
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Denise Marshall
- Department of Family Medicine, Division of Palliative Care, McMaster University, Hamilton, Ontario, Canada
| | - Joshua Shadd
- Department of Family Medicine, Division of Palliative Care, McMaster University, Hamilton, Ontario, Canada
| | - Kori A LaDonna
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Centre for Education Research and Innovation, McMaster University, Hamilton, Ontario, Canada
| | - Lorelei Lingard
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Centre for Education Research and Innovation, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Franqueiro T, King M, Brown D. Transforming the Workforce From Individual to Collective Competence. J Contin Educ Nurs 2017; 48:440-441. [DOI: 10.3928/00220124-20170918-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bochatay N, Muller-Juge V, Scherer F, Cottin G, Cullati S, Blondon KS, Hudelson P, Maître F, Vu NV, Savoldelli GL, Nendaz MR. Are role perceptions of residents and nurses translated into action? BMC MEDICAL EDUCATION 2017; 17:138. [PMID: 28821252 PMCID: PMC5563059 DOI: 10.1186/s12909-017-0976-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 08/07/2017] [Indexed: 05/18/2023]
Abstract
BACKGROUND Effective interprofessional collaboration (IPC) has been shown to depend on clear role definitions, yet there are important gaps with regard to role clarity in the IPC literature. The goal of this study was to evaluate whether there was a relationship between internal medicine residents' and nurses' role perceptions and their actual actions in practice, and to identify areas that would benefit from more specific interprofessional education. METHODS Fourteen residents and 14 nurses working in internal medicine were interviewed about their role perceptions, and then randomly paired to manage two simulated clinical cases. The authors adopted a general inductive approach to analyze the interviews. They identified 13 different role components that were then compared to data from simulations. Descriptive and kappa statistics were used to assess whether there was a relationship between role components identified in interviews and those performed in simulations. Results from these analyses guided a further qualitative evaluation of the relationship between role perceptions and actions. RESULTS Across all 13 role components, there was an overall statistically significant, although modest, relationship between role perceptions and actions. In spite of this relationship, discrepancies were observed between role components mentioned in interviews and actions performed in simulations. Some were more frequently performed than mentioned (e.g. "Having common goals") while others were mentioned but performed only weakly (e.g. "Providing feedback"). CONCLUSIONS Role components for which perceptions do not match actions point to role ambiguities that need to be addressed in interprofessional education. These results suggest that educators need to raise residents' and nurses' awareness of the flexibility required to work in the clinical setting with regard to role boundaries.
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Affiliation(s)
- Naïke Bochatay
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
| | - Virginie Muller-Juge
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
| | | | | | - Stéphane Cullati
- Quality of Care Service, Geneva University Hospitals, Geneva, Switzerland
| | - Katherine S Blondon
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Fabienne Maître
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nu V Vu
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Georges L Savoldelli
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
- Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu R Nendaz
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
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