New rules for the game: interdisciplinary education for health professionals

Occupational Therapists' Perceptions of Their Undergraduate Preparation for the Workplace

The health care environment is undergoing rapid change. This has major implications for health science education programmes. The extent to which university education prepares graduates for the requirements of the workplace has become an important issue in the health science literature. The present study investigated the perceptions of 144 graduate occupational therapists regarding the adequacy of their undergraduate education at the University of Sydney in equipping them for the workplace.

The findings indicated that occupational therapy graduates perceived significant gaps between the knowledge and skills gained during their undergraduate course and those required in the workplace, particularly in the areas of communication with other health professionals and the general public, knowledge of the health industry and workplace management. This paper considers the implications of workplace requirements and expectations for the occupational therapy course curricula.

Service learning in Guatemala: using qualitative content analysis to explore an interdisciplinary learning experience among students in health care professional programs

Introduction

Interprofessional collaboration among health care professionals yields improved patient outcomes, yet many students in health care programs have limited exposure to interprofessional collaboration in the classroom and in clinical and service-learning experiences. This practice gap implies that students enter their professions without valuing interprofessional collaboration and the impact it has on promoting positive patient outcomes.

Aim

The aim of this study was to describe the interprofessional experiences of students in health care professional programs as they collaborated to provide health care to Guatemalan citizens over a 7-day period.

Methods

In light of the identified practice gap and a commitment by college administration to fund interprofessional initiatives, faculty educators from nursing, occupational therapy, and physical therapy conducted a qualitative study to explore a service-learning initiative focused on promoting interprofessional collaboration. Students collaborated in triads (one student from each of the three disciplines) to provide supervised health care to underserved Guatemalan men, women, children, and infants across a variety of community and health care settings. Eighteen students participated in a qualitative research project by describing their experience of interprofessional collaboration in a service-learning environment. Twice before arriving in Guatemala, and on three occasions during the trip, participants reflected on their experiences and provided narrative responses to open-ended questions. Qualitative content analysis methodology was used to describe their experiences of interprofessional collaboration.

Results

An interprofessional service-learning experience positively affected students’ learning, their growth in interprofessional collaboration, and their understanding and appreciation of health care professions besides their own. The experience also generated feelings of gratitude for the opportunity to be a member of an interprofessional team and to serve those in need by giving of themselves.

Conclusion

The findings support service learning as a platform to encourage interprofessional collaboration among students in health care professional programs. The research will inform future service-learning experiences in which interdisciplinary collaboration is an outcome of interest.

Conflicting messages: examining the dynamics of leadership on interprofessional teams

PURPOSE

Despite the importance of leadership in interprofessional health care teams, little is understood about how it is enacted. The literature emphasizes a collaborative approach of shared leadership, but this may be challenging for clinicians working within the traditionally hierarchical health care system.

METHOD

Using case study methodology, the authors collected observation and interview data from five interprofessional health care teams working at teaching hospitals in urban Ontario, Canada. They interviewed 46 health care providers and conducted 139 hours of observation from January 2008 through June 2009.

RESULTS

Although the members of the interprofessional teams agreed about the importance of collaborative leadership and discussed ways in which their teams tried to achieve it, evidence indicated that the actual enactment of collaborative leadership was a challenge. The participating physicians indicated a belief that their teams functioned nonhierarchically, but reports from the nonphysician clinicians and the authors' observation data revealed that hierarchical behaviors persisted, even from those who most vehemently denied the presence of hierarchies on their teams.

CONCLUSIONS

A collaborative approach to leadership may be challenging for interprofessional teams embedded in traditional health care, education, and medical-legal systems that reinforce the idea that physicians sit at the top of the hierarchy. By openly recognizing and discussing the tensions between traditional and interprofessional discourses of collaborative leadership, it may be possible to help interprofessional teams, physicians and clinicians alike, work together more effectively.

Interprofessional education in the internal medicine clerkship: results from a national survey

PURPOSE

Growing data support interprofessional teams as an important part of medical education. This study describes attitudes, barriers, and practices regarding interprofessional education (IPE) in internal medicine (IM) clerkships in the United States and Canada.

METHOD

In 2009, a section on IPE was included on the Clerkship Directors in Internal Medicine annual survey. This section contained 23 multiple-choice questions exploring both core and subinternship experiences. Data were analyzed using descriptive statistics and Rasch analysis.

RESULTS

Sixty-nine of 107 institutional members responded to the survey (64% response rate). Approximately 68% of responding clerkship directors believed that IPE is important to the practice of IM. However, only 57% believed that it should become a part of the undergraduate clinical curriculum. The three most significant barriers to IPE in the IM clerkship were scheduling alignment, time in the existing curriculum, and resources in time and money. Although more than half of respondents felt IPE should be included in the clinical curriculum, 81% indicated that there was no formal curriculum on IPE in their core IM clerkship, and 84% indicated that there was no formal curriculum during IM subinternship rotations at their institution.

CONCLUSIONS

There is limited penetration of IPE into one of the foundational clinical training episodes for medical students in Liaison Committee for Medical Education-accredited schools. This may be related to misperceptions of the relative value of these experiences and limitations of curricular time. Learning in and from successful models of interprofessional teams in clinical practice may help overcome these barriers.

An exploratory analysis of an interprofessional learning environment in two hospital clinical teaching units

An analysis of a teaching environment with regard to interprofessional practice was done using both qualitative and quantitative methods. Medical, nursing and other health professional staff and students from two hospital units (medical and surgical) completed two surveys. The students were also interviewed. Staff differed in survey results among disciplines, with nurses and other health professionals having a more positive view of interprofessional collaboration than physicians. Student interviews supported our hypothesis that little formal or informal interprofessional education occurred during clinical rotations. Students had little understanding of the nature of collaborative behavior, and appeared to learn their discipline's attitudes and practices through tacit observation of staff behaviors. This appears to reinforce disciplinary stereotypes, and may be a significant barrier to the development of collaborative practice. These results have implications for the design of interprofessional curriculum in clinical practicums.

Utilization of research methodology in designing and developing an interdisciplinary course in ethics

Development research methodology was utilized to design an interdisciplinary ethics course for students from seven disciplines: dental hygiene, nursing, nurse anesthesia, occupational therapy, physician assistant, physical therapy, and social work. Two research questions, 'What content areas should be considered for inclusion in an interdisciplinary course in Ethics?' and 'What design framework, format, or structure would best fit the content chosen?' guided the study. An interdisciplinary faculty design team conducted a comparative analysis of each of the seven discipline's codes of ethics to find common topics of interest. Further analysis then grouped these topics into eight categories of professional responsibility. The result was a fifteen-week course with validated content relevant to all disciplines.

Learning together to teach together: Interprofessional education and faculty development

Interprofessional education for collaborative patient-centered practice has been identified as a key mechanism to address health care needs and priorities. Faculty development can play a unique role in promoting interprofessional education (IPE) by addressing some of the barriers to teaching and learning that exist at both the individual and the organizational level, and by providing individuals with the knowledge and skills needed to design and facilitate IPE. This article highlights a number of approaches and strategies that can facilitate IPE. In particular, it is recommended that faculty development initiatives aim to bring about change at the individual and the organizational level; target diverse stakeholders; address three main content areas, notably interprofessional education and collaborative patient-centred practice, teaching and learning, and leadership and organizational change; take place in a variety of settings, using diverse formats and educational strategies; model the principles and premises of interprofessional education and collaborative practice; incorporate principles of effective educational design; and consider the adoption of a dissemination model to implementation. Clearly, faculty members play a critical role in the teaching and learning of IPE and they must be prepared to meet this challenge.

Interdisciplinary medical, nursing, and administrator education in practice: the Johns Hopkins experience

Reforming graduate medical, nursing and health administrators' education to include the core competencies of interdisciplinary teamwork and quality improvement (QI) techniques is a key strategy to improve quality in hospital settings. Practicing clinicians are best positioned in these settings to understand systems issues and craft potential solutions. The authors describe how, in ten months during 2004 and 2005 the school of medicine, the school of nursing, and an administrative residency program, all at Johns Hopkins University, implemented and evaluated the Achieving Competency Today II Program (ACT II), a structured and interdisciplinary approach to learning QI that was piloted at various sites around the United States. Six teams of learners participated, each consisting of a medical, nursing, and administrative resident. The importance of interdisciplinary participation in planning QI projects, the value of the patient's perspective on systems issues, and the value of a system's perspective in crafting solutions to issues all proved to be valuable lessons. Challenges were encountered throughout the program, such as (1) participants' difficulties in balancing competing academic, personal and clinical responsibilities, (2) difficulties in achieving the intended goals of a broad curriculum, (3) barriers to openly discussing interdisciplinary team process and dynamics, and (4) the need to develop faculty expertise in systems thinking and QI. In spite of these challenges steps have been identified to further enhance and develop interdisciplinary education within this academic setting.

Incorporating medication regimen reviews into the interdisciplinary care planning process

Although many long-term care providers regard medication utilization reviews in terms of regulatory mandates, survey deficiencies, practice intrusion, and policy violations, not all consider these activities in such negative terms. This article describes the approach used by a large interdisciplinary team at a private continuing-care retirement community (CCRC) in North Carolina that includes medication regimen review in the larger context of resident care planning.

Deconstructing the myth of the advanced practice blended role: support for role divergence

Since the early 1980s, there has been discussion about combining the clinical nurse specialist (CNS) and nurse practitioner (NP) roles. Examination of recent nursing literature reveals renewed interest in differentiating, rather than combining, these 2 advanced practice roles. Research has shown that although the 2 roles share similarities, these advanced practice pursuits are more different than alike, both philosophically and practically. Despite curricular attempts at "blending" CNS and NP philosophies of nursing care and their distinctive domains of practice in master's level degree programs, the uniqueness of these roles in actual practice demands a continuation of educational differentiation in preparation. Both roles are important and address varied systems requirements. Each role has been shaped by population needs, education, market, and legal forces that transform with time. The differing ideologies of CNS and NP practice lead to diverse patient and system outcomes and reveal different researchable questions.

Interdisciplinary practice--a matter of teamwork: an integrated literature review

The aim of this literature review is to explore the development of interdisciplinary practice. The terms interdisciplinary, multidisciplinary, and inter-professional are problematic. Definitions must be viewed carefully, as interpretations tend to reflect historical, socialization patterns that are now out of kilter with contemporary understandings. Changing inter-professional interactions, teams and teamwork are examined; findings indicate that explanations of interdisciplinary teamwork should be all-inclusive of the particular cultural conditions and contextual determinants that affect team practice. Findings need to be viewed with caution because what is applicable in one country may not be automatically transferable to another, where particular socio-political contexts shape interdisciplinary practice.

Evaluation of an innovative curriculum: nursing education in the next century

The present research focused on an interim evaluation of a new nursing curriculum made by first- and second-year undergraduates. Study 1 examined the assessments made by 90 students of the new, actual programme of their studies, as well as an ideal one, on 21 bipolar criteria reflecting the developing changes in health care practices and higher educational processes in western society. The results of study 1 indicated that students perceived the actual programme as compatible with health care changes, but lacking in terms of the learning process. Study 2 investigated the same assessments among 105 registered nurses who evaluated the traditional nursing programme under which they were trained as well as an ideal one. The results of study 2 showed that registered nurses perceived past curricula as lower than the ideal on both health care and process of learning. The results of this interim evaluation imply that the new nursing curriculum follows health care trends, but a shift in the educational process is required.

Nurse-physician collaboration

The literature indicates that collaboration between nurses and physicians has become more sophisticated as these relationships have become collegial in nature and as nurses have become assertive, autonomous, and accountable. On an individual level, physicians and nurses now entering collaborative relationships are successful at minimizing the obstacles of turf and territoriality as well as at managing practice boundaries. However, both need to consciously examine their patterns of communication in order to effect clinical interaction styles that maintain unequal or hierarchical relationships. Studies of interprofessional communication, including style of clinical interaction, conflict resolution, use of humor, and negotiation, contribute support for nurses and physicians in collaborative relationships (Balzer, 1993; Campbell, Mauksch, Neikirk, & Hosokawa, 1990; Feiger & Schmitt, 1979; Lenkman & Gribbins, 1994; Pike, 1991). Research on differences in health outcomes of patients cared for in the traditional and collaborative models of health care delivery, identification of the unique product of collaborative practice models, and further identification of the type of attitudinal climate in which collaborative relationships can be nurtured should be undertaken if the elusive nature of collaboration is to be captured (Siegler, Whitney, & Schmitt, 1994). Providing collaborative, interdisciplinary clinical experiences for students, as well as role modeling of collaborative relationships in nurse-physician faculty practice, can contribute to a greater understanding and acceptance of each professional's role in health care delivery (Campbell, 1993; Forbes & Fitzsimons, 1993; Larson, 1995). Tradition and professionalism and progressive concern about practice boundaries continue to be obstacles to collaborative practice. These need to be addressed by medical and nursing professionals on the institutional level and in the political arena. Collaboration between nurses and physicians need not remain only a researchable issue; its viability and vitality are crucial to the changing health care scene. Understanding the issues that affect collaboration, as well as the historical background in which it has developed, can help nurses and physicians in their joint effort to improve health care delivery.

Shared learning for community based maternity care

In order to ensure the best quality of maternity care midwives and doctors must work closely together but unfortunately the necessary interdisciplinary cooperation and respect has not always been present. This paper suggests that the benefits claimed for interprofessional education, which remain largely untested in maternity care, are being put forward as a panacea for earlier difficulties. It outlines some of the initiatives currently taking place. Material ripe for shared learning is identified and it is suggested that shared teaching in addition to shared learning for midwifery and medical students and for midwives and doctors should be the norm. Learners may then eventually provide shared care based on both their shared learning experiences and also on the role model of shared teaching. Such a major change would require considerable political will, including a shift in funding. There is some evidence that the necessary political will is developing and this may be given more emphasis by the need for teaching to follow care as the NHS becomes more primary-care led.