Shared learning for primary health care teams: a success story

The contribution of theory to the design, delivery, and evaluation of interprofessional curricula: BEME Guide No. 49

BACKGROUND

Interprofessional curricula have often lacked explicit reference to theory despite calls for a more theoretically informed field that illuminates curricular assumptions and justifies curricular practices.

AIM

To review the contributions of theory to the design, delivery, and evaluation of interprofessional curricula.

METHODS

Four databases were searched (1988-2015). Studies demonstrating explicit and a high-quality contribution of theory to the design, delivery or evaluation of interprofessional curricula were included. Data were extracted against a comprehensive framework of curricular activities and a narrative synthesis undertaken.

RESULTS

Ninety-one studies met the inclusion criteria. The majority of studies (86%) originated from the UK, USA, and Canada. Theories most commonly underpinned "learning activities" (47%) and "evaluation" (54%). Theories of reflective learning, identity formation, and contact hypothesis dominated the field though there are many examples of innovative theoretical contributions.

CONCLUSIONS

Theories contribute considerably to the interprofessional field, though many curricular elements remain under-theorized. The literature offers no "gold standard" theory for interprofessional curricula; rather theoretical selection is contingent upon the curricular component to which theory is to be applied. Theories contributed to interprofessional curricula by explaining, predicting, organizing or illuminating social processes embedded in interprofessional curricular assumptions. This review provides guidance how theory might be robustly and appropriately deployed in the design, delivery, and evaluation of interprofessional curricula.

Collective learning, change and improvement in health care: trialling a facilitated learning initiative with general practice teams

RATIONALE, AIMS AND OBJECTIVES

Many patients, families, health care professionals and politicians desire for quality improvement within the UK National Health Service. One way to achieve this change is for health care teams to work and learn together more effectively. This research aimed to design and trial a facilitated learning programme with the aim of supporting general practice teams in fostering the characteristics of learning organizations.

METHODS

This is an action research study. Qualitative data were captured during and after the trial from 40 participants in two multi-professional general practice teams within different Scottish health boards. Data were gathered using observations, semi-structured interviews and written learning notes.

RESULTS

Taking part in the LPP was a positive experience of learning together as a practice and enhanced communication within the team was a particular outcome. External facilitation helped provide focus and reduce inter-professional barriers. Teams found working in small, mixed role discussion groups particularly valuable in understanding each others' perspectives. The active learning style of the LPP could be daunting at times but teams valued the chance to identify their own quality improvement goals. Teams introduced a number of changes to improve the quality of care within their practice as a result of their participation.

CONCLUSION

This trial of the learning practice programme shows that, with facilitation and the appropriate input of resources, general practice teams can successfully apply learning organization principles to produce quality improvement outcomes. The study also demonstrates the value of action research in researching iterative change over time.

A medical student's perspective of participation in an interprofessional education placement: an autoethnography

Interprofessional education (IPE) has emerged as a critical pedagogy for promoting interprofessional collaboration (IPC) within healthcare. However, the literature includes few reports of students' perspectives on IPE experiences. Understanding students' experiences is critical, as they are the crux of IPE's culture change agenda. This paper presents an autoethnographic account of my experiences as a medical student participating in an IPE placement within a Canadian academic hospital. During the five-week placement, I collected data using participant observation and reflective journaling on all placement experiences. I expanded my notes using the emotional recall technique and conducted thematic analysis. Using a series of narrative vignettes, this paper explores the relationships between my personal experience and the cultural and educational issues underpinning IPE. The first vignette explores the relationship between students' patient access and our status in tutorial discussion. The second vignette considers the impact of shadowing on my appreciation of another professional's practice. The last vignette portrays my experience learning about the complex politics that shape IPC. The conclusion suggests that the IPE placements incorporate reflexive activities (i.e., journaling and interviewing) to enhance the students' appreciation and understanding of roles, responsibilities and professional perspectives, and to promote critical thinking and professional growth.

Key elements for interprofessional education. Part 1: The learner, the educator and the learning context

This paper is the first of two that highlights key elements needed for consideration in the planning and implementation of interprofessional educational (IPE) interventions at both the pre and post-licensure qualification education levels. There is still much to be learned about the pedagogical constructs related to IPE. Part 1 of this series discusses the learning context for IPE and considers questions related to the "who, what, where, when and how" related to IPE. Through a systematic literature review that was conducted for Health Canada in its move to advance Interprofessional Education for Patient Centred Practice (IECPCP), this paper provides background information that can be helpful for those involved in an interprofessional initiative. A historical review of IPE sets the international context for this area and reflects the work that has been done and is currently being initiated and implemented to advance IPE for health professional students. Much can be learned from the literature related to the pedagogical approaches that have been tried and the issues that need to be addressed related to the learner, the educator and the learning context which this paper examines.

From death and disability to patient empowerment: an interprofessional partnership to achieve cardiovascular health in Canada

This paper proposes a paradigm shift in health care from a focus on death and disability to one on health empowerment resulting in improved cardiovascular lifestyles for all Canadians. It describes a national interprofessional initiative to achieve this new vision in the area of cardiovascular health promotion. Achieving Cardiovascular Health in Canada (ACHIC) is a partnership of health professional associations and other health advocate groups whose vision is to promote optimal cardiovascular health (including cerebrovascular health) for all Canadians through interprofessional partnership initiatives and support systems. ACHIC's objectives are to: 1) identify system barriers and supports to cardiovascular health; 2) develop strategies that will have a positive impact on the practices of health professionals/educators in the promotion of cardiovascular health; 3) develop an interprofessional national approach to support strategies to achieve cardiovascular health in Canada; and 4) support the development and delivery of consistent, evidence-based messages by health professionals/educators for promotion of cardiovascular health.

Shaping the interprofessional agenda: a study examining qualified nurses' perceptions of learning with others

This paper presents the findings of a survey of post-qualified nursing students undertaking an interprofessional studies programme in a higher education institution. The total population of students surveyed included nurses, midwives, social workers and youth and community workers. However, the findings presented here centre on the data generated from the nurses. The participants made a retrospective evaluation of their educational experiences through focus groups and the use of a semi-structured questionnaire. Out of a potential 36 nurses, 32 (88%) participated in the evaluation. Overall, the nurses appraised their learning positively, although the qualitative data highlighted the complexity of the experience and the importance of skillful facilitation. Learning to work collaboratively entails more than learning about the practical roles of other occupations; it includes an understanding of the knowledge bases, aspirations and values that underpin those roles. The paper contributes to current debates about the most effective ways to prepare nursing students to work interprofessionally. It highlights the importance of evaluating the experiences of those taking part in interprofessional initiatives. This is a distinctive departure from much nursing research in the field in that it gives a voice to participants and identifies how their voice may shape interprofessional policy agendas.