An Interprofessional Rehabilitation University Clinic in Primary Health Care: A Collaborative Learning Model for Physical Therapist Students in a Clinical Placement:

Tools for self- or peer-assessment of interprofessional competencies of healthcare students: a scoping review

Introduction

Healthcare professionals are expected to demonstrate competence in the effective management of chronic disease and long-term health and rehabilitation needs. Care provided by groups of collaborating professionals is currently well recognized as a more effective way to support people living with these conditions than routine, single-profession clinical encounters. Clinical learning contexts provide hands-on opportunities to develop the interprofessional competencies essential for health professional students in training; however, suitable assessment tools are needed to support student attainment of interprofessional competencies with self-assessment espoused as an important component of learning.

Method

A structured approach was taken to locate and review existing tools used for the self-assessment and peer assessment of students' competencies relevant to interprofessional practice.

Results

A range of self- and/or peer assessment approaches are available, including formally structured tools and less structured processes inclusive of focus groups and reflection.

Discussion

The identified tools will usefully inform discussion regarding interprofessional competency self- and peer assessment options by healthcare students participating in a broad range of clinical learning contexts.

Conclusion

Self- and/or peer assessment is a useful approach for those seeking to effectively enhance interprofessional learning and measure the attainment of related competencies.

Learning how to work in an interprofessional environment: how students transition to allied health professionals working interprofessionally

Allied health professionals (AHPs) often work with other health professions to provide specialized support so that patients receive optimal care. Therefore, new graduate AHPs need to be able to engage collaboratively with various health professionals in the provision of health care services. This study examines new AHP graduates' experiences and reflections on the transition to working in an interprofessional environment. Participants were new graduates (n = 18) from different universities, working in a hospital context, from occupational therapy, speech pathology, social work, pharmacy, and physiotherapy. Qualitative data were collected via two semi-structured interviews conducted over 12 months. The data were analyzed using thematic analysis, with three key themes emerging: (a) The role of the work context, 2) Learning to work interprofessionally, and 3) Developing an interprofessional identity. We discuss the implications for universities and workplaces in enhancing interprofessional practice and learning opportunities among new graduates.

Changes in direct patient care from physiotherapy student to new graduate

Background: Clinical placements offer students an opportunity to provide direct patient care and are essential to develop safe and effective practitioners. It is unknown what changes in direct patient care activities are required as students transition to graduate physiotherapists. Objective: To determine the change in direct patient care activity from physiotherapy student to new graduate. Methods: Five hospitals provided clinical activity data from 412 physiotherapy students and 50 new graduate physiotherapists working in four physiotherapy clinical areas. Main Outcome Measures: Percentage of day spent in direct patient care, average occasions of service (OOS) per day and average length of one OOS (LOOS) for physiotherapy students and new graduates. Results: Students spent less time during their day providing direct patient care (24%, 95% confidence interval (CI) 19 to 29), performed fewer OOS (4.4, 95%CI 4.0 to 4.8) and had longer LOOS (18 min, 95%CI 13 to 23) compared to new graduates. This was consistent across all clinical areas. Conclusions: Physiotherapy student caseload is half that of a new graduate physiotherapist, with students taking longer to complete an OOS. Given this disparity in workload, active stakeholder engagement is essential to implement strategies that support and optimize the transition from student to graduate.

An interprofessional learning experience for trainee general practitioners in an academic urban minor injuries unit with advanced nurse practitioners (Emergency)

BACKGROUND

There is a body of empirical literature indicating that interprofessional education (IPE) not only enriches students' understanding of their own discipline but of other disciplines. However, giving the on-going emphasis on the importance of IPE to healthcare processes and outcomes, on-going attention is needed to advancing the research evidence related to the emergency department setting. The aim of this qualitative descriptive study was to determine the clinical learning experiences of GPs who rotated through an academic urban minor injuries unit as part of their training, led by advanced nurse practitioners (emergency).

METHODS

Data were drawn from semi-structured interviews of sixty to ninety minutes duration with 5 general practitioners (GPs) who completed the trainee rotation practicum in an academic urban minor injuries unit led by advanced nurse practitioners (ANPs) emergency.

STUDY FINDINGS

The GPs indicated that their knowledge translation of minor injuries to practice was connected to their utilisation of algorithm rules and case management processes modelled by ANPs (emergency). The outcome of this process reported by GPs brought notable reductions to their referral of patients with minor injuries to emergency departments.

CONCLUSION

Interprofessional learning in clinical practice with ANPs (emergency) was seen as a valuable role making model for the trainee GPs who are now employed in primary care.

Pre-registration interprofessional clinical education in the workplace: a realist review

CONTEXT

The inclusion of interprofessional education opportunities in clinical placements for pre-registration learners has recently been proposed as a strategy to enhance graduates' skills in collaborative practice.

OBJECTIVES

A realist review was undertaken to ascertain the contexts, mechanisms and outcomes of formal interprofessional clinical workplace learning.

METHODS

Initial scoping was carried out, after which Ovid MEDLINE, CINAHL and EMBASE were searched from 2005 to April 2016 to identify formal interprofessional workplace educational interventions involving pre-registration learners. Papers reporting studies conducted in dedicated training wards were excluded, leaving a total of 30 papers to be included in the review.

RESULTS

Several educational formats that combined students from medicine, nursing, pharmacy and allied health professions were identified. These included: the use of engagement by student teams with a real patient through interview as the basis for discussion and reflection; the use of case studies through which student teams work to promote discussion; structured workshops; ward rounds, and shadowing. Meaningful interprofessional student discussion and reflection comprised the mechanism by which the outcome of learners acquiring knowledge of the roles of other professions and teamwork skills was achieved. The mechanism of dialogue during an interaction with a real patient allowed the patient to provide his or her perspective and contributed to an awareness of the patient's perspective in health care practice. Medication- or safety-focused interprofessional tasks contributed to improved safety awareness. In the absence of trained facilitators or in the context of negative role-modelling, programmes were less successful.

CONCLUSIONS

In the design of workplace education initiatives, curriculum decisions should take into consideration the contexts of the initiatives and the mechanisms for achieving the education-related outcomes of interest.

Student and Preceptor Experiences at an Inter-Professional Student-Run Clinic: A Physical Therapy Perspective

Purpose: Student-run clinics (SRCs) provide a unique opportunity for inter-professional education; they prepare health care students for a collaborative future by enabling them to interact with other such students in a clinical setting focused on inter-professional learning and collaboration. Physical therapy (PT) students are increasingly being included in SRCs; however, most research on student experiences in SRCs has been carried out with medical students. This qualitative study explores the perceived benefits of the PT experience in an SRC through the lens of PT students and their preceptors. Method: A qualitative interpretive-descriptive approach consisting of face-to-face, semi-structured interviews was used. Interviews were audiotaped and transcribed verbatim. Data were analyzed using a constant comparative approach. Results: Seven PT students and eight preceptors who volunteered at the SRC between September 2013 and May 2015 participated in the study. Three themes emerged from the interviews: (1) exposure to marginalized patient populations, (2) learning through inter-professional interactions, and (3) experience with different patient care approaches. Conclusions: Participating in an SRC enhances PT students' understanding of their and other health care professionals' roles. Students gained an appreciation for the social determinants of health and improved their knowledge of inter-professional collaboration. The knowledge gained from this study has the potential to inform PT professional development, SRCs, and PT education.

Interprofessional education in practice: Evaluation of a work integrated aged care program

Health professional clinical education is commonly conducted in single discipline modes, thus limiting student collaboration skills. Aged care residential facilities, due to the chronic and complex health care needs of residents, provide an ideal placement to provide a collaborative experience. Interprofessional education is widely acknowledged as the pedagogical framework through which to facilitate collaboration. The aim of the evaluation was to assess student attitudes towards collaboration after active involvement in an interprofessional education program. Students studying nursing, occupational therapy, and aged care were invited to complete a version of the Readiness for Interprofessional Learning Scale before and after participating in a three-week pilot interprofessional program. A positive change in student attitudes towards other health professionals and the importance of working in interprofessional teams was reported with significant differences between two statements indicated: Learning with health-care students before qualifications would improve relationships after qualifications; and I learned a lot from the students from the other disciplines. The innovative pilot project was found to enhance student learning in interprofessional teams and the aged care environment. Further development of this and similar interprofessional programs is required to develop sustainable student projects that have health benefits for residents in aged care residential facilities.

Interprofessional education in primary health care for entry level students--A systematic literature review

OBJECTIVE

This systematic review investigated student learning and patient outcomes associated with interprofessional education in outpatient, primary care clinics.

DESIGN

Medline, Cinahl and Embase databases were searched to March 2014. A mixed method evaluation framework was applied to investigate the participants, interventions and effects on student learning and patient outcomes.

RESULTS

26 studies met the inclusion criteria; 13 were quantitative, predominately pre-post-survey design, 6 qualitative and 7 mixed methods design. Studies most commonly investigated student volunteers from medicine, nursing and allied health working in interprofessional clinics that were established to address gaps in community health care. Students appeared to learn teamwork skills and increase their knowledge of the roles of other disciplines. We found no convincing evidence that participation results in changes in attitudes towards other disciplines compared to single discipline education. We also found insufficient evidence to estimate the effectiveness of patient care delivered by interprofessional student teams in this setting compared to single discipline or no care.

CONCLUSIONS

Given the logistical challenges associated with coordinating clinic attendance for interprofessional teams, high quality studies are needed to assess the effects of clinics on student learning and patient health outcomes.

French translation and validation of the Readiness for Interprofessional Learning Scale (RIPLS) in a Canadian undergraduate healthcare student context

The Canadian Interprofessional Health Collaborative recommends that future professionals be prepared for collaborative practice. To do so, it is necessary for them to learn about the principles of interprofessional collaboration. Therefore, to ascertain if students are predisposed, their attitude toward interprofessional learning must be assessed. In the French Canadian context such a measuring tool has not been published yet. The purpose of this study is to translate in French an adapted version of the RIPLS questionnaire and to validate it for use with undergraduate students from seven various health and social care programmes in a Canadian university. According to Vallerand's methodology, a method for translating measuring instruments: (i) the forward-backward translation indicated that six items of the experimental French version of the RIPLS needed to be more specific; (ii) the experimental French version of the RIPLS seemed clear according to the pre-test assessing items clarity; (iii) evaluation of the content validity indicated that the experimental French version of the RIPLS presents good content validity and (iv) a very good internal consistency was obtained (α = 0.90; n = 141). Results indicate that the psychometric properties of the RIPLS in French are comparable to the English version, although a different factorial structure was found. The relevance of three of the 19 items on the RIPLS scale is questionable, resulting in a revised 16-item scale. Future research aimed at validating the translated French version of the RIPLS could also be conducted in another francophone cultural context.

Internal consistency of the readiness for interprofessional learning scale in German health care students and professionals

BACKGROUND

The implementation of a bachelor degree in "Interprofessional Health Care" at the University of Heidelberg, Germany has fostered the need to evaluate the impact of this innovative programme. The Readiness for Interprofessional Learning Scale (RIPLS) was developed by Parsell and Bligh (1999) to assess student's attitudes towards interprofessional education. The RIPLS consists of 19 items and four subscales were identified by McFadyen (J Interprof Care19:595-603, 2005): "teamwork and collaboration", "negative professional identity", "positive professional identity" and "roles and responsibilities". The RIPLS has been translated into a number of languages and used in a variety of different educational settings. A German version of the RIPLS was not available. Aim of the study was the translation of the RIPLS into German and testing of internal consistency.

METHODS

The RIPLS was translated to German according to international guidelines and its psychometric properties were assessed in two online surveys with two different samples a) health care graduates and b) health care students. Descriptive analysis (mean, SD, corrected item-total correlation) of the Readiness for Interprofessional Learning Scale - German (RIPLS-D) was performed for item characteristics and Cronbach's Alpha was calculated for internal consistency of overall and subscales of the RIPLS-D.

RESULTS

Each sample consisted of 76 datasets. Reliability for the RIPLS-D overall scale was 0.83 in both samples. The subscales displayed internal consistency between 0.42 and 0.88. Corrected item-total correlation showed low values in two subscales in the sample of graduates.

CONCLUSIONS

While the overall RIPLS-D scale is reliable, several subscales showed low values and should be used with caution to measure readiness for interprofessional learning in the German health care context. Internal consistency of the instrument does not seem to be given in health care professionals at different stages of their professional career. In particular the sub-scale "roles and responsibilities" was problematic. For these reasons, the RIPLS-D cannot be recommended for use to assess this concept.

Impact of placement type on the development of clinical competency in speech-language pathology students

BACKGROUND

Speech-language pathology students gain experience and clinical competency through clinical education placements. However, currently little empirical information exists regarding how competency develops. Existing research about the effectiveness of placement types and models in developing competency is generally descriptive and based on opinions and perceptions. The changing nature of education of speech-language pathology students, diverse student cohorts, and the crisis in finding sufficient clinical education placements mean that establishing the most effective and efficient methods for developing clinical competency in students is needed.

AIMS

To gather empirical information regarding the development of competence in speech-language pathology students; and to determine if growth of competency differs in groups of students completing placements that differ in terms of caseload, intensity and setting.

METHODS & PROCEDURES

Participants were students in the third year of a four-year undergraduate speech-language pathology degree who completed three clinical placements across the year and were assessed with the COMPASS® competency assessment tool. Competency development for the whole group across the three placements is described. Growth of competency in groups of students completing different placement types is compared. Interval-level data generated from the students' COMPASS® results were subjected to parametric statistical analyses.

OUTCOMES & RESULTS

The whole group of students increased significantly in competency from placement to placement across different placement settings, intensities and client age groups. Groups completing child placements achieved significantly higher growth in competency when compared with the competency growth of students completing adult placements. Growth of competency was not significantly different for students experiencing different intensity of placements, or different placement settings.

CONCLUSIONS & IMPLICATIONS

These results confirm that the competency of speech-language pathology students develops across three clinical placements over a one-year period regardless of placement type or context, indicating that there may be a transfer of learning between placements types. Further research investigating patterns of competency development in speech-language pathology students is warranted to ensure that assumptions used to design clinical learning opportunities are based on valid evidence.

Quality in physical therapist clinical education: a systematic review

BACKGROUND

Many factors affect student learning throughout the clinical education (CE) component of professional (entry-level) physical therapist education curricula. Physical therapist education programs (PTEPs) manage CE, yet the material and human resources required to provide CE are generally overseen by community-based physical therapist practices.

PURPOSE

The purposes of this systematic review were: (1) to examine how the construct of quality is defined in CE literature and (2) to determine the methodological rigor of the available evidence on quality in physical therapist CE.

METHODS

This study was a systematic review of English-language journals using the American Physical Therapy Association's Open Door Portal to Evidence-Based Practice as the computer search engine. The search was categorized using terms for physical therapy and quality and for CE pedagogy and models or roles. Summary findings were characterized by 5 primary themes and 14 subthemes using a qualitative-directed content analysis.

RESULTS

Fifty-four articles were included in the study. The primary quality themes were: CE framework, CE sites, structure of CE, assessment in CE, and CE faculty. The methodological rigor of the studies was critically appraised using a binary system based on the McMaster appraisal tools. Scores ranged from 3 to 14.

LIMITATIONS

Publication bias and outcome reporting bias may be inherent limitations to the results.

CONCLUSION

The review found inconclusive evidence about what constitutes quality or best practice for physical therapist CE. Five key constructs of CE were identified that, when aggregated, could construe quality.

Preparing Nursing Students to Be Effective Health Team Partners Through Interprofessional Education

This article will provide an overview of recent significant activities related to interprofessional education to promote care quality through teamwork and collaboration, followed by a discussion of what nursing schools can do to develop the knowledge, skills, attitudes, and values to enhance health care team performance and care outcomes.

'All these allied health professionals and you're not really sure when you use them': insights from Australian international medical graduates on working with allied health

Objective. This paper presents the findings of research which explored how International Medical Graduates (IMGs) understand and integrate with the allied health system in relation to multidisciplinary care. Methods. An open-ended, exploratory qualitative design comprised of thirty (n = 30) open-ended, in-depth interviews with IMGs employed in a public hospital in Queensland, Australia. Results. Many IMGs have no experience with allied health support in their country of origin. Multidisciplinary collaboration is a new concept for IMGs integrating into the Australia healthcare system. Learning about the allied health system, including how to work effectively within the context of the multidisciplinary team, is an important topic that needs to be addressed as a matter of priority. Conclusions. There is a strong need to focus on improving strategies for integrating IMGs into the allied health system. In particular, IMGs require information to help them understand the roles and referral processes associated with interfacing with the allied health system. What is known about the topic? To date, there is no research available on the important topic of how IMGs understand and integrate with the allied health system in relation to multidisciplinary care in the Australian healthcare system. What does this paper add? The present findings make an important contribution to the literature by highlighting the need to focus on integrating IMGs into the allied health system. The findings presented in this paper indicate that, for the range of reasons summarised the IMGs’ understanding of the allied health system is limited. What are the implications for practitioners? The IMGs in this study called for assistance in understanding the allied health system, a process they considered difficult to do on their own. The strong recommendation is that it is most appropriate for allied health professionals in the hospital to take such leadership, and such efforts will be met by a readiness to learn on the part of the IMGs.