'Real life' clinical learning on an interprofessional training ward

Evaluating the impact of interprofessional training wards on patient satisfaction and clinical outcomes: a mixed-methods analysis

Introduction

Interprofessional teamwork is pivotal in modern healthcare, prompting the establishment of interprofessional training wards since 1996. While these wards serve as hubs for optimizing healthcare professional collaboration and communication, research into patient outcomes remains notably sparse and geographically limited, predominantly examining patient satisfaction and sparingly exploring other metrics like mortality or self-discharge rates. This study seeks to bridge this gap, comparing patient outcomes in interprofessional training wards and conventional wards under the hypothesis that the former offers no disadvantage to patient outcomes.

Materials and methods

We explored patient outcomes within an interprofessional student ward called A-STAR at a University Hospital from October 2019 to December 2022. Engaging with patients discharged between May 2021 and April 2022, we utilized digital and paper-based anonymous questionnaires, catering to patient preference, to gather pertinent data.

Results

Analysis of outcomes for 1,482 A-STAR (interprofessional student ward) and 5,752 conventional ward patients revealed noteworthy findings. A-STAR patients tended to be younger (59 vs. 61 years, p < 0.01) and more frequently male (73.5% vs. 70.4%, p = 0.025). Vital clinical outcomes, such as discharges against medical advice, complication-driven readmissions, and ICU transfers, were statistically similar between groups, as were mortality rates (1.2% vs. 1.3%, p = 0.468). A-STAR demonstrated high patient satisfaction, underscored by positive reflections on team competence, ward atmosphere, and responsiveness to concerns, emphasizing the value placed on interprofessional collaboration. Patient narratives commended team kindness, lucid explanations, and proactive involvement.

Discussion

This data collectively underscores the safety and reliability of patient care within training wards, affirming that patients can trust the care provided in these settings. Patients on the interprofessional ward demonstrated high satisfaction levels: 96.7% appreciated the atmosphere and conduct of ward rounds. In comparison, 98.3% were satisfied with the discussion and information about their treatment during their hospital stay.

Development of individual competencies and team performance in interprofessional ward rounds: results of a study with multimodal observations at the Heidelberg Interprofessional Training Ward

Introduction

Interprofessional training wards (IPTW) aim to improve undergraduates' interprofessional collaborative practice of care. Little is known about the effects of the different team tasks on IPTW as measured by external assessment. In Heidelberg, Germany, four nursing and four medical undergraduates (= one cohort) care for up to six patients undergoing general surgery during a four-week placement. They learn both professionally and interprofessionally, working largely on their own responsibility under the supervision of the medical and nursing learning facilitators. Interprofessional ward rounds are a central component of developing individual competencies and team performance. The aim of this study was to evaluate individual competencies and team performance shown in ward rounds.

Methods

Observations took place in four cohorts of four nursing and four medical undergraduates each. Undergraduates in one cohort were divided into two teams, which rotated in morning and afternoon shifts. Team 1 was on morning shift during the first (t0) and third (t1) weeks of the IPTW placement, and Team 2 was on morning shift during the second (t0) and fourth (t1) weeks. Within each team, a tandem of one nursing and one medical undergraduate cared for a patient room with three patients. Ward round observations took place with each team and tandem at t0 and t1 using the IP-VITA instrument for individual competencies (16 items) and team performance (11 items). Four hypotheses were formulated for statistical testing with linear mixed models and correlations.

Results

A total of 16 nursing and medical undergraduates each were included. There were significant changes in mean values between t0 and t1 in individual competencies (Hypothesis 1). They were statistically significant for all three sum scores: "Roles and Responsibilities", Patient-Centeredness", and "Leadership". In terms of team performance (Hypothesis 2), there was a statistically significant change in mean values in the sum score "Roles and Responsibilities" and positive trends in the sum scores "Patient-Centeredness" and "Decision-Making/Collaborative Clinical Reasoning". Analysis of differences in the development of individual competencies in the groups of nursing and medical undergraduates (Hypothesis 3) showed more significant differences in the mean values of the two groups in t0 than in t1. There were significant correlations between individual competencies and team performance at both t0 and t1 (Hypothesis 4).

Discussion

The study has limitations due to the small sample and some sources of bias related to the external assessment by means of observation. Nevertheless, this study offers insights into interprofessional tasks on the IPTW from an external assessment. Results from quantitative and qualitative analysis of learners self-assessment are confirmed in terms of roles and responsibilities and patient-centeredness. It has been observed that medical undergraduates acquired and applied skills in collaborative clinic reasoning and decision-making, whereas nursing undergraduates acquired leadership skills. Within the study sample, only a small group of tandems remained constant over time. In team performance, the group of constant tandems tended to perform better than the group of random tandems. The aim of IPTW should be to prepare healthcare team members for the challenge of changing teams. Therefore, implications for IPTW implementation could be to develop learning support approaches that allow medical and nursing undergraduates to bring interprofessional competencies to team performance, independent of the tandem partner or team.

[Measuring individual competencies and team performance in clinical learning settings of interprofessional collaborative practice: Empirical development of the Interprofessional Ward Round Individual and Team Assessment Tool (IP-VITA)]

BACKGROUND

Interprofessional training wards (IPTW) can contribute to the development of interprofessional competencies. In order to evaluate the acquisition of competencies, instruments are needed that record both team performance and individual competencies in the clinical teaching setting in third-party assessment. This paper describes the Interprofessional Ward Round Individual and Team Assessment-Tool, IP-VITA ("Interprofessionelle Visiten Individual und Team Assessment Tool") and its development.

METHOD

Based on the empirical exploration of the three observation instruments "Teamwork Assessment Scale" (TAS), "McMaster-Ottawa Scale" and "Individual Teamwork Observation and Feedback Tool" (iTOFT) in at least four rounds each at the HIPSTA (with n=8 students and trainees each), a preliminary version of the IP-VITA was created. This preliminary version was then refined in subsequent empirical steps: a consensual validation in the research team was followed by a "member check" with the clinical colleagues of the HIPSTA, the input from external experts and an empirical test in an alternative setting.

RESULTS

The IP-VITA is an empirically developed multimodal instrument to assess the interprofessional competencies of trainees and students as well as their team performance in clinical settings with patient interaction. It comprises three parts. In part A, structural data, the persons involved and the essential patient characteristics are recorded. Part B consists of 12 items and a free-text field for recording behaviour at the individual level. Part C also consists of 12 items and evaluates behaviour at team level.

DISCUSSION

The IP-VITA instrument was developed specifically for the context of evaluating interprofessional ward rounds in a clinical educational setting. The instrument takes into account the ambiguous position of the assessment of interprofessional collaboration between individual competence and team performance. Beyond the HIPSTA, it can be used as a formative assessment instrument, and it may also be useful for summative assessments.

Professional and Personal Physical Therapist Development through Service Learning in Collaboration with a Prisoner Reinsertion Program: A Qualitative Study

There is a great concern whether Physical Therapy students upon completion of their educational program are ready and equipped with the requisite skills to construct and implement a successful patient intervention with culturally diverse groups. The purpose of this study is to describe the professional and personal physical therapist development of Physical Therapy students after participating in Solidarity Activities in Collaboration with a Prisoner reinsertion program as a service-learning course. A qualitative approach was used. A convenience sample of twenty physical therapy students doing service learning and one teaching professor were included. Student diaries were analyzed. Semi-structured interviews were done to explore five students’ and the professor’s judgements. Internal and external observations and filling out structure field-notes were also used as data triangulation in order to build the conceptual model. The main findings include that the application of knowledge and practice of skills in different environments are the most important skills attained with this service learning. Five key themes emerged from the data analysis, namely: application of knowledge, adaptation to different environments, improving communication with patients, assisting people and providing treatment with self-confidence. A recommendation is that Physical Therapy programs include workplace practice in different environments to enhance the development of professionalism among students.

Patients' and parents' percetion of care on a paediatric interprofessional training ward

BACKGROUND

Interprofessional training wards (ITWs) have been established in different fields of adult medicine to promote interprofessional learning and interprofessional collaboration of health care profession students. High patient satisfaction rates have been reported for ITWs. No data of parents' and especially patients' evaluation of care on a paediatric ITW have been reported so far. This study aims to evaluate parents' and patients' perceptions of medical and nursing care on a paediatric ITW.

METHODS

In 2017 we established and started an interprofessional training ward in the setting of a general paediatric ward (IPAPAED). Medical students and nurse trainees care for 4-6 patients under supervision of registered nurses and certified physicians. All parents and all patients older than 8 years were invited to evaluate different aspect of their care on the IPAPAED.

RESULTS

Since November 2017 until February 2019 parents (n = 109) rated the overall care of their children on the IPAPAED ward with m = 1.21 (SD ± .43) (1 = "excellent", 4 = "poor"). Patients (n = 56) rated their overall care with m = 1.29 (SD ± 0.5). Other aspects of care and interprofessional collaboration were rated equally well. Analysis of the (limited) free-text commentaries revealed that perceived quality of care, friendliness and communication were especially valued by patients and parents.

DISCUSSION & CONCLUSION

On a paediatric ITW, in the view of parents and patients in our sample, a high level of care is delivered and satisfaction rates are excellent. An ITW seems, from a patient and parent point of view, feasible, even in paediatrics.

'Bumping along': a qualitative metasynthesis of challenges to interprofessional placements

CONTEXT

Interprofessional practice is required to manage complex health care needs globally. It is well established that interprofessional placements (IPP) prepare students to work collaboratively, yet IPP implementation remains limited and disjointed.

OBJECTIVES

This review synthesised student, educator and service user perspectives in order to better understand challenges of IPP and provide recommendations for sustainable IPP implementation.

METHODS

A systematic metasynthesis of qualitative literature sourced from databases including CINAHL, Embase and PsycINFO was completed. Studies that incorporated student, educator and/or service user perspectives on IPP experiences were included. We focused specifically on factors limiting implementation of IPP. The presage-process-product (3P) theory provided the theoretical framework for inductive synthesis of 41 empirical studies. A confidence rating for findings was formulated using CERQual (confidence in evidence from reviews of qualitative research).

RESULTS

We developed three themes, which represent key challenges to IPP becoming embedded in placement culture: (i) thin theoretical foundations underpinned IPP, limiting understanding of the learning processes involved; (ii) implementation relied heavily on individual champions, which curtails investment and sustainability when personnel change, and (iii) students, educators and service users were unsure of the function of IPP and their respective roles, leading to uncertainty along with some negative perceptions of this placement approach.

CONCLUSIONS

In line with the 3P theoretical framework, IPP would benefit from explicit connections with educational and change management theories during presage stage IPP requires coordinated leadership and resource investment, and during product stage clear integration of interprofessional learning outcomes in curricula is advised. Addressing the identified challenges across the stages of IPP will support further development of IPP, firmly establishing this approach within placement culture. IPP can them make a significant contribution to the development of a collaborative practice-ready workforce. This in turn will enhance service user outcomes and safety.

Interprofessional training for the delivery of community health services in Mexico: the experience of Partners in Health

Interprofessional training in health is scarce in Mexico. Partners in Health (CES in Spanish), is the branch of an international civil society organization that provides health services to poor and rural populations. CES runs a set of ten health centers in Chiapas, Mexico, in partnership with the local Ministry of Health. A key component of the provision strategy is to train healthcare providers, mainly medical and nursing students in their final year of training, to create healthcare teams that work together while fostering their individual capacities. CES offers a diploma on Global Health and Social Medicine, where medical and nursing students -also called pasantes- interact to discuss jointly the effects of global and social determinants of health in local communities, as well as specific clinical topics. A qualitative study including interviews and nonparticipant observations was undertaken to identify initial achievements and challenges of the experience. CES has achieved important benefits related to teamwork as well as clinical capacities of individuals as healthcare providers. However, challenges have emerged: differences in social origin, personal development expectations, professional identity and institutional roles hinder team cohesion. Consequently, CES has introduced adjustments to reduce the negative impact of these differences. Although the training model needs further development, the possibility of transferring some of its good practices to non-CES scenarios should be seriously considered by health authorities.

A review of interprofessional training wards: Enhancing student learning and patient outcomes

Background: In an interprofessional training ward (ITW), students from different health professions collaboratively perform patient care with the goal of improving patient care. In the past two decades, ITWs have been established world-wide and studies have investigated their benefits. We aimed to compare ITWs with respect to their logistics, interprofessional learning outcomes and patient outcomes. Methods: We explored PubMed, CINAHL, Web of Science and EMBASE (1990-June 2017) and included articles focusing on interprofessional, in-patient training wards with student teams of medical and other health professions students. Two independent reviewers screened studies for eligibility and extracted data. Results: Thirty-seven articles from twelve different institutions with ITWs were included. ITWs world-wide are organized similarly with groups of 2-12 students (i.e. medical, nursing, physiotherapy, occupational therapy, and pharmacy) being involved in patient care, usually for a period of two weeks. However, the type of clinical ward and the way supervisors are trained differ. Conclusions: ITWs show promising results in short-term student learning outcomes and patient satisfaction rates. Future ITW studies should measure students' long-term interprofessional competencies using standardized tools. Furthermore, a research focus on the impact of ITWs on patient satisfaction and relevant patient care outcomes is important.

Heidelberger Interprofessionelle Ausbildungsstation (HIPSTA): a practice- and theory-guided approach to development and implementation of Germany's first interprofessional training ward

Background: Deficits in care and impaired patient-safety have been linked to inefficient interprofessional collaborative practice. Interprofessional training wards (IPTW) are an interprofessional educational intervention which aim to enable students and trainees from different health professions to work self-responsibly in order to manage the medical treatment and rehabilitation of real-life patients together as an interprofessional team. We aimed to develop and implement Germany´s first IPTW at the department of Surgery at Heidelberg University Hospital. Methods: The Kern cycle was used to develop an ITPW curriculum. Practical as well as theoretical considerations guided the design of the IPTW. Common project management tools including blueprinting and RASCI (Responsibility, Approval, Support, Consultation, Information) matrix were applied. Results: Since April 2017, 7 cohorts of students and trainees have had four-week long placements on HIPSTA. They run the IPTW in early and late shifts. Nursing and medical facilitators are supporting the IP team as needed. Learning objectives are operationalized as EPAs (entrustable professional activities) and interprofessional learning goals. Since initiation only minor modifications to the curriculum have been necessary and satisfaction of students/trainees, facilitators and patients is high. Conclusion: IPTWs can be established and run in the German health care system even in a complex clinical setting. The early involvement of all professions in a steering group seems to be key to success. Nursing and medical facilitators are of utmost importance for daily routine. The experiences outlined here could help others aiming to implement IPTWs at their sites. IPTWs might address a number of hitherto unaddressed educational needs. Trial registration: Not applicable.

Understanding Pain and Pain Management in Elderly Nursing Home Patients Applying an Interprofessional Learning Activity in Health Care Students: A Norwegian Pilot Study

BACKGROUND

Pain is common among elderly patients in nursing homes. However, pain assessment and treatment are inadequate. Interprofessional treatment is recommended, and consequently interprofessional education in pain management is necessary.

AIMS

This pilot project aimed to describe how two interprofessional groups of students approached pain management in two nursing home patients.

DESIGN

We formed two teams comprising one student from the nursing, physical therapy, pharmacy, and medical educations. Each team spent one day examining a patient with chronic pain at a nursing home and they developed pain management plans.

METHODS

We collected data through video recordings during teamwork before and after examining the patients and field notes during the patient examination. We analysed the video-recordings applying the seven-step model including 1) viewing the video data, 2) describing the video data, 3) identifying critical events, 4) transcribing, 5) coding, 6) constructing storyline and 7) composing a narrative. Field notes supplied the transcripts.

RESULTS

Both teams succeeded in making a pain management plan for their patient. The common examination of the patient was crucial for the students' approaches to pain management and changed their pre-assumptions about the patients' pain. By sharing knowledge and reflecting together, the students reached a common consensus on suggestions for management of the patients' problems. Interprofessional collaboration fostered enthusiasm and a more holistic pain management approach. However, students' lack of knowledge limited their understanding of pain.

CONCLUSION

Knowledge of pain management in nursing home patients and the practice of interprofessional cooperation should be included in pain curricula for health care professionals.

Perceptions of residents, medical and nursing students about Interprofessional education: a systematic review of the quantitative and qualitative literature

BACKGROUND

To identify facilitators and barriers that residents, medical and nursing students perceive in their Interprofessional Education (IPE) in a clinical setting with other healthcare students.

METHODS

A systematic review was carried out to identify the perceptions of medical students, residents and nursing students regarding IPE in a clinical setting. PubMed, CINAHL, ERIC and PsycInfo were searched, using keywords and MeSH terms from each database's inception published prior to June 2014. Interprofessional education involving nursing and medical students and/or residents in IPE were selected by the first author. Two authors independently assessed studies for inclusion or exclusion and extracted the data.

RESULTS

Sixty-five eligible papers (27 quantitative, 16 qualitative and 22 mixed methods) were identified and synthesized using narrative synthesis. Perceptions and attitudes of residents and students could be categorized into 'Readiness for IPE', 'Barriers to IPE' and 'Facilitators of IPE'. Within each category they work at three levels: individual, process/curricular and cultural/organizational. Readiness for IPE at individual level is higher in females, irrespective of prior healthcare experience. At process level readiness for IPE fluctuates during medical school, at cultural level collaboration is jeopardized when groups interact poorly. Examples of IPE-barriers are at individual level feeling intimidated by doctors, at process level lack of formal assessment and at cultural level exclusion of medical students from interaction by nurses. Examples of IPE-facilitators are at individual level affective crises and patient care crises situations that create feelings of urgency, at process level small group learning activities in an authentic context and at cultural level getting acquainted informally. These results are related to a model for learning and teaching, to illustrate the implications for the design of IPE.

CONCLUSIONS

Most of the uncovered barriers are at the cultural level and most of the facilitators are at the process level. Factors at the individual level need more research.

Learner : preceptor ratios for practice-based learning across health disciplines: a systematic review

CONTEXT

Practice-based learning is a cornerstone of developing clinical and professional competence in health disciplines. Practice-based learning systems have many interacting components, but a key facet is the number of learners per preceptor. Different learner : preceptor ratios may have unique benefits and pose unique challenges for participants. This is the first comprehensive systematic review of the topic. Our research questions were: What are the benefits and challenges of each learner : preceptor ratio in practice-based learning from the perspectives of the learners, preceptors, patients and stakeholder organisations (i.e. the placing and health care delivery organisations)? Are any ratios superior to others with respect to these characteristics and perspectives?

METHODS

Qualitative systematic review of published English-language literature since literature database inception, including multiple health disciplines.

RESULTS

Seventy-three articles were included in this review. Eight learner : preceptor ratio arrangements were identified involving nursing, physiotherapy, occupational therapy, pharmacy, dietetics, speech and language therapy, and medicine. Each arrangement offers unique benefits and challenges from the perspectives of learners, preceptors, programmes and health care delivery organisations. Patient perspectives were absent. Despite important advantages of each ratio for learners, preceptors and organisations, some of which may be profession specific, the 2 : 1 and 2+ : 2+ learner : preceptor ratios appear to be most likely to successfully balance the needs of all stakeholders.

CONCLUSIONS

Regardless of the learner : preceptor ratio chosen for its expected benefits, our results illuminate challenges that can be anticipated and managed. Patient perspectives should be incorporated into future studies of learner : preceptor ratios.

Interprofessional training for final year healthcare students: a mixed methods evaluation of the impact on ward staff and students of a two-week placement and of factors affecting sustainability

BACKGROUND

Multiple care failings in hospitals have led to calls for increased interprofessional training in medical education to improve multi-disciplinary teamwork. Providing practical interprofessional training has many challenges and remains uncommon in medical schools in the UK. Unlike most previous research, this evaluation of an interprofessional training placement takes a multi-faceted approach focusing not only on the impact on students, but also on clinical staff delivering the training and on outcomes for patients.

METHODS

We used mixed methods to examine the impact of a two-week interprofessional training placement undertaken on a medical rehabilitation ward by three cohorts of final year medical, nursing and therapy students. We determined the effects on staff, ward functioning and participating students. Impact on staff was evaluated using the Questionnaire for Psychological and Social factors at work (QPSNordic) and focus groups. Ward functioning was inferred from standard measures of care including length of stay, complaints, and adverse events. Impact on students was evaluated using the Readiness for Interprofessional Learning Survey (RIPLS) among all students plus a placement survey among medical students.

RESULTS

Between 2007 and 2010, 362 medical students and 26 nursing and therapy students completed placements working alongside the ward staff to deliver patient care. Staff identified benefits including skills recognition and expertise sharing. Ward functioning was stable. Students showed significant improvements in the RIPLS measures of Teamwork, Professional Identity and Patient-Centred Care. Despite small numbers of students from other professions, medical students' rated the placement highly. Increasing student numbers and budgetary constraints led to the cessation of the placement after three years.

CONCLUSIONS

Interprofessional training placements can be delivered in a clinical setting without detriment to care and with benefits for all participants. While financial support is a necessity, it appears that having students from multiple professions is not critical for a valuable training experience; staff from different professions and students from a single profession can work successfully together. Difficulty in aligning the schedules of different student professions is commonly cited as a barrier to interprofessional training. Our experience challenges this and should encourage provision of authentic interprofessional training experience.

The team builder: the role of nurses facilitating interprofessional student teams at a Swedish clinical training ward

Interprofessional education (IPE) is an educational strategy attracting increased interest as a method to train future health care professionals. One example of IPE is the clinical training ward, where students from different health care professions practice together. At these wards the students work in teams with the support of facilitators. The professional composition of the team of facilitators usually corresponds to that of the students. However, previous studies have revealed that nurse facilitators are often in the majority, responsible for student nurses' profession specific facilitation as well as interprofessional team orientated facilitation. The objective of this study was to describe how nurses act when facilitating interprofessional student teams at a clinical training ward. The research design was ethnography and data were collected through participant observations and interviews. The analysis revealed the four strategies used when facilitating teams of interprofessional students to enhance collaborative work and professional understanding. The nurse facilitator as a team builder is a new and exciting role for nurses taking on the responsibility of facilitating interprofessional student teams. Future research needs to explore how facilitating nurses balance profession specific and team oriented facilitating within the environment of an interprofessional learning context.

Students' approaches to learning in clinical interprofessional context

BACKGROUND

Health care professionals are supposed to work in teams. Students in health care need to learn how to collaborate during their undergraduate education. Interprofessional learning environments, where collaboration is necessary, may be differently accepted by students depending on their approach to learning.

AIM

We investigated health care students' evaluations of interprofessional clinical training in relation to their study orientations.

METHODS

The participants were 369 students (40 occupational therapy-, 85 medical-, 52 physiotherapy-, and 192 nursing students) attending an IPE course at a Swedish University Hospital. Data were collected by questionnaires measuring orientations to studying and attitudes towards the clinical training and the IPE concept before and after the training. The response rate was 77 %. Study groups were formed by a cluster analysis on the basis of the students' learning orientations.

RESULTS

Three clusters were found: Low collaboration-, Collaborative Constructivist-, and Cookbook groups. These clusters were related to different professions and how students perceived their interprofessional learning environment.

CONCLUSIONS

Study orientations appear to play a role in the way students evaluate interprofessional training. This should be taken into account in instruction. Students with a 'Cookbook' approach to learning showed an increased understanding of interprofessional collaboration after the course.

Interprofessional training in clinical practice on a training ward for healthcare students: A two-year follow-up

This follow-up study describes the former students' lasting impressions of a two-week interprofessional course on a training ward aimed at enhancing the understanding of the roles of other professions and the importance of communication for teamwork and for patient care as well as providing an opportunity for profession-specific training. A questionnaire with both closed and open-ended questions was sent to 633 former students two years after the course and 348 (55%) responded. The course was rated as very good and most of the former students had lasting and positive impressions. Ninety-two percent of respondents encouraged teamwork in their present work and 90% wanted to retain the course. The qualitative analysis of the open-ended questions resulted in five categories describing students' perceptions: professional role development, working in teams, tutoring, patient care and future aspects of the course and real world practice. Our results suggest that interprofessional training during undergraduate education provides lasting impressions that may promote teamwork in students' future occupational life.

Interprofessional education on a training ward for older people: Students' conceptions of nurses, occupational therapists and social workers

Collaboration between professionals in health and social care is essential to meet the needs of the patient. The collaboration is dependent on knowledge and understanding of each other's roles. One means of improving communication and collaboration among professionals is interprofessional education. The aim of this study was to describe the variation in how students in nursing, occupational therapy and social work perceived their own and the other professions. Over a three-week period two interviews were conducted with each of 16 students who were on an interprofessional training ward for older people in a municipal setting in Sweden. A phenomenographical approach was used in the analysis of the interviews. The findings showed great variation in how the students perceived the professions, from simplistic in terms of tasks to a more complex conception in terms of knowledge, responsibility and values. Differences in the ways professions were described concerning their professional stance towards the patients were especially accentuated. The findings indicate that the students need opportunities for reflection on and scrutiny of each other's beliefs and knowledge. The influence of interprofessional education involving reflection on the different health-care professions needs to be explored in future research.

A Review of Non-Traditional Occupational Therapy Practice Placement Education: A Focus on Role-Emerging and Project Placements

Practice placement education has been recognised as an integral and critical component of the training of occupational therapy students. Although there is an extensive body of literature on clinical education and traditional practice placement education models, there has been limited research on alternative placements.

This paper reviews the literature on various practice placement education models and presents a contemporary view on how it is currently delivered. The literature is examined with a particular focus on the increasing range of practice placement education opportunities, such as project and role-emerging placements. The drivers for non-traditional practice placement education include shortages of traditional placement options, health reform and changing work practices, potential for role development and influence on practice choice. The benefits and challenges of non-traditional practice placement education are discussed, including supervision issues, student evaluation, professional and personal development and the opportunity to practise clinical skills.

Further research is recommended to investigate occupational therapy graduates' perceptions of role-emerging and project placements in order to identify the benefits or otherwise of these placements and to contribute to the limited body of knowledge of emerging education opportunities.

Developing inter-professional learning: tactics, teamwork and talk

Teamwork and collaboration between all health professionals results in high quality clinical care, and increased job satisfaction for staff. Encouraging inter-professional learning (IPL) may be advantageous in developing more effective teams. There is little rigorous research in this area, but many small uncontrolled studies do demonstrate positive results. IPL involves structured learning opportunities that enhance problem-solving abilities and conflict resolution. It should be clearly differentiated from shared teaching (or multidisciplinary/multiprofessional learning), where common content is taught to many professions without any intention to develop interaction. To counteract the sometimes negative attitudes in both students and staff, educators need to commence IPL early in the programme, base it in both theoretical and clinical placements and ensure that it is valued and assessed. Difficulties with timetabling and accommodation need to be solved prior to commencement. A facilitator should be employed, and a team of committed lecturers developed, with an emphasis on teamwork and the discouragement of individualism. Opportunities for student interaction and ways of improving group dynamics within non-threatening learning environments should to be sought, and instances of conflict embraced and resolved. Future IPL programmes should be rigorously evaluated and may demonstrate enhanced inter-professional relationships and improved quality of patient/client care.

An illuminative evaluation of skills rehearsal in a mentorship course

In response to national and local initiatives for health care education and the need to assure excellence in clinical placement learning and subsequent fitness for practice, one UK Higher Education Institution (HEI) developed an interprofessional mentorship course for health professionals. The aim of the course was to enable students to develop advanced knowledge and critical awareness of mentorship. The course integrated theory and practice through mentorship skills rehearsal as one of the teaching methods and is the key focus of this paper. Qualitative methodology was employed to evaluate the process of learning through the skills rehearsal component. The curriculum documentation was analysed and, one month after completing the course and in three focus groups participants described their experience of learning through simulation. A semi structured interview schedule was used. The findings revealed that all participants used unhelpful as well as constructive behaviours that potentially influenced the reliability of their support, supervision and assessment of learners. The participants' shift in belief that the role of the mentor was a fixed concept to a perspectival and value laden concept was evident. This new understanding illuminated the participants' problem solving strategies for understanding valid and reliable assessment.

Distributing menus to hungry learners: can learning by simulation become simulation of learning?

Simulation offers an important context for clinical education, providing a structured, safe and supportive environment bridging the classroom and the clinic. Two trends in the simulation community appear to be developing uncritically and without adequate evaluation. First, there is a fascination with seductive high-fidelity simulation realized through sophisticated technology. Second, simulation has increasingly appropriated learning in the psychological domain, such as communication skills, under the rationale of 'integration'. Developments in simulation activities have largely been made in a theoretical vacuum and where theory is invoked it is learning theory rather than theory of simulation. This paper introduces theories of simulation from cultural studies as a critical balance to the claims of the simulation community. Work-based and simulation-based learning could engage in a new dialogue for an effective clinical education.

Evaluation of a model for maximizing interprofessional education in an acute hospital

A one-year planning phase established a rolling programme of bi-monthly interprofessional clinical teaching workshops derived directly from patient experiences in an acute hospital. Pre-registration healthcare students from 8 professions spent an afternoon in the hospital training centre, randomly allocated to one of 6-8 small working groups. Using a problem-based methodology they analysed a ward case with patient consent, chosen to reflect the input of a wide range of health professionals. Students worked through a prepared workbook facilitated by a range of tutors from all disciplines. Each small group reported back on one aspect of team working to the entire cohort entering into debate and discussion with the support of clinical and academic tutors. Post course patient details were found on a website enabling students to progress their uni-professional knowledge, e.g., on anatomy, physiology, pharmacology etc. The questionnaire evaluation on over 126 students and 11 tutors identified that interprofessional competencies were understood and valued. Students related principles of team working and collaborative practice to their placement experiences of team work. Interactive learning enables further appreciation of professions roles and responsibilities and the importance of teamwork to optimize patient care (82.0 - 90.5%). The half-day learning model can be easily supported by busy clinical staff, led by hospital educators and accessed by students on hospital placements, at a mid-point in training, with learning supported by consenting in-patients or recent admissions prepared to share their experiences.

Faking it? Simulation in the training of obstetricians and gynaecologists

PURPOSE OF REVIEW

This paper discusses the use of simulation as a training tool in obstetrics and gynaecology.

RECENT FINDINGS

Modern medical training and patient pressure for treatment by more experienced clinicians have contributed to a reduction in the training opportunities available to junior doctors. Advances in information technology have led to the successful introduction of simulator-based training in many safety-critical industries such as aviation and nuclear power. In this editorial we describe simulation devices that are available to obstetrics and gynaecology and explain how simulation can benefit the patient, trainee and educator. We also explore how simulation could be integrated into obstetrics and gynaecology training programmes.

SUMMARY

At present simulation is very much underused as a training tool in medicine, and features little in the postgraduate training curriculum. In obstetrics and gynaecology simulation could be used as an educational tool to assist in (1) transfer of knowledge, (2) practising diagnostic and simple practical skills, (3) surgical skills training, (4) emergency drill training and (5) human factors and team training. Whereas simulation should not be perceived as a replacement for training with real patients, educators should embrace the opportunities that simulation provides and integrate it into current training programmes to maximize training opportunities and patient safety.

Competence of newly-graduated nurses - a comparison of the perceptions of qualified nurses and students

AIM

This paper reports a study that compares opinions of final year nursing students, rating their own competence, with the opinions of experienced nurses on the competence of newly-graduated nurses.

BACKGROUND

The transition of nursing preparation into higher education is regarded as positive, although it has led to differences in opinion about the competence of newly-graduated nurses and their readiness to enter the nursing profession. There are studies showing that newly-graduated nurses perceive themselves as holistically focused, professional practitioners, while other nurses are concerned that newly-graduated nurses do not have necessary skills.

METHODS

A convenience sample of 106 nursing students in the final week of their course and 136 nurses who had experience of supervising nursing students completed a questionnaire. The data were collected in 2002.

RESULTS

Own competence, in the form of ability to perform nursing care, was rated by nursing students to be good or strongly developed in most of the investigated areas of nursing care. Experienced nurses also estimated newly-graduated nurses' competence to be good or strongly developed, although to a lesser extent. Nurses qualified within the previous 5 years rated newly-graduated nurses' competence to be higher in comparison with those with less recent education.

CONCLUSIONS

Further studies are needed to broaden our understanding of why some areas of nursing care, such as ethical awareness, were rated very highly, while others, like informing and teaching of co-workers and planning and prioritizing interventions had the lowest rating.

What we know and what they do: nursing students' experiences of improvement knowledge in clinical practice

Nations around the world face mounting problems in health care, including rising costs, challenges to accessing services, and wide variations in safety and quality. Several reports and surveys have clearly demonstrated that adverse events and errors pose serious threats to patient safety. It has become obvious that future health professionals will need to address such problems in the quality of patient care. This article discuss a research study examining improvement knowledge in clinical practice as experienced by nursing students with respect to a patient-centred perspective, knowledge of health-care processes, the handling of adverse events, cross-professional collaboration, and the development of new knowledge. Six focus groups were conducted, comprising a total of 27 second-year students. The resulting discourses were recorded, coded and analysed. The findings indicate a deficiency in improvement knowledge in clinical practice, and a gap between what students learn about patient care and what they observe. In addition the findings suggest that there is a need to change the culture in health care and health professional education, and to develop learning models that encourage reflection, openness, and scrutiny of underlying individual and organizational values and assumptions in health care.

'It teaches you what to expect in future . . . ': interprofessional learning on a training ward for medical, nursing, occupational therapy and physiotherapy students

AIM

This paper presents findings from a multimethod evaluation of an interprofessional training ward placement for medical, nursing, occupational therapy and physiotherapy students.

CONTEXT

Unique in the UK, and following the pioneering work at Linköping, the training ward allowed senior pre-qualification students, under the supervision of practitioners, to plan and deliver interprofessional care for a group of orthopaedic and rheumatology patients. This responsibility enabled students to develop profession-specific skills and competencies in dealing with patients. It also allowed them to enhance their teamworking skills in an interprofessional environment. Student teams were supported by facilitators who ensured medical care was optimal, led reflective sessions and facilitated students' problem solving.

METHODS

Data were collected from all groups of participants involved in the ward: students, facilitators and patients. Methods included questionnaires, interviews and observations.

RESULTS AND DISCUSSION

Findings are presented from each participating group, with a particular emphasis placed on the perspective of medicine. The study found that students valued highly the experiential learning they received on the ward and felt the ward prepared them more effectively for future practice. However, many encountered difficulties adopting an autonomous learning style during their placement. Despite enjoying their work on the ward, facilitators were concerned that the demands of their role could result in 'burn-out'. Patients enjoyed their ward experience and scored higher on a range of satisfaction indicators than a comparative group of patients.

CONCLUSIONS

Participants were generally positive about the training ward. All considered that it was a worthwhile experience and felt the ward should recommence in the near future.

The London training ward: an innovative interprofessional learning initiative

This paper reports the findings from an evaluation of a pilot interprofessional training ward project for pre-qualification medical, nursing, occupational therapy and physiotherapy students. This initiative required sustained collaboration from staff based in two National Health Service (NHS) trusts and four schools in three universities. The ward was based on a model of interprofessional education developed in Sweden, but adapted in the light of this experience and also to meet the needs and aspirations of the training ward stakeholders in London. The training ward was evaluated using a multi-method design. Data were collected from all participants involved in this pilot: students, facilitators and patients. The findings from the evaluation are presented and discussed. This paper pays particular attention to the collaborative experiences of the students, staff and institutions involved in this initiative. In addition, 1-year follow-up data collected from the students who had, by then, qualified as clinical practitioners are reported. The paper presents conclusions from the evaluation, and comments on the training ward's strengths, limitations and future development.