Beyond the Lamppost: A Proposal for a Fourth Wave of Education for Collaboration

Physician development through interprofessional workplace interactions: A critical review

INTRODUCTION

Increasingly, medical training aims to develop physicians who are competent collaborators. Although interprofessional interactions are inevitable elements of medical trainees' workplace learning experiences, the existing literature lacks a cohesive model to conceptualise the learning potential residing in these interactions.

METHODS

We conducted a critical review of the health professions and related educational literatures to generate an empirically and theoretically informed description of medical trainees' workplace interactions with other health professionals, including learning mechanisms and outcomes. Informed by Teunissen's conceptualisation of workplace learning, we highlight the individual, social and situated dimensions of learning from interprofessional workplace interactions.

RESULTS

Workplace interactions between medical trainees and other health professionals tend to be brief, spontaneous, informal and often implicit without the predefined educational goals and roles that structure trainees' relationships with physician supervisors. Yet they hold potential for developing trainees' knowledge and skills germane to the work of a physician as well as building their capacity for collaboration. Our review identified a spectrum of learning theories helpful for examining what and how trainees learn from these interactions. Self-regulated learning theories focus attention on how learning depends on trainees interpreting and judging the cues offered by other health professionals. Sociocultural frameworks including the zone of proximal development and legitimate peripheral participation emphasise the ways other health professionals support trainees in performing tasks at the border of their abilities and facilitate trainees' participation in clinical work. Both the landscapes of practice theory and cultural historical activity theory highlight the influence of surrounding social, cultural and material environments. These theories are unified into cohesive model and demonstrated through an illustrative example.

CONCLUSION

Interprofessional workplace interactions harbour a range of learning opportunities for medical trainees. Capitalising on their potential can contribute to training collaborative practice-ready physicians alongside traditional intra-professional interactions between physicians and merits future research.

Utilizing simulation-enhanced interprofessional education to identify differences in healthcare students' collaborative practice behaviors: A mixed method study

BACKGROUND

Teaching collaborative practice behaviors (CPBs) to interprofessional healthcare students could improve healthcare for underserved populations.

OBJECTIVE

This study explained the impact of Simulation Enhanced Interprofessional Education (SIM-IPE) on healthcare students' self-reported CPBs and their perceptions of utilizing CPBs when caring for underserved populations, as well as the differences among professions within interprofessional teams.

DESIGN

Mixed methods explanatory design.

PARTICIPANTS AND SETTING

Sixty-Eight doctorate of nurse practitioner, dental and pharmacy students from a large research-intensive university in the United States.

METHODS

The Interprofessional Education Collaborative Competency Self Efficacy Tool (IPECC-SET27) was used to collect quantitative data. Qualitative data was collected through recorded simulation debriefing sessions. One hundred and thirty-six quantitative surveys were collected, and 214 qualitative responses were reviewed from the 48 simulations and recorded debriefing sessions. Paired t-tests and directed content analysis were used to infer the quantitative and qualitative impact of SIM-IPE on all students in an interprofessional team and differences among each profession.

RESULTS

After SIM-IPE, all students showed statistically significant increases in mean CPB scores for all 27 items (ρ < 0.0001) for IPECC-SET 27. Students perceived their CPBs when caring for underserved individuals improved most in Teams and Teamwork item one (48 %, n = 103). Comparing individual professions and CPB skills; Values and ethics (14 %, n = 8) for pharmacy, roles, and RESPONSIBILITIES (28 %, n = 24) and Communication (32 % n = 27) for dentistry, and teams and teamwork (61 % n = 43) for nurse practitioner had the greatest impact and were most frequently reported.

CONCLUSIONS

Significantly increased mean scores in competence for CPBs was demonstrated. CPB differences were evident among professions. Educators must understand professional CPB differences and develop SIM - IPE that promotes development of collaborative practice-ready healthcare professionals.

A Scoping Review of Interprofessional Simulation-Based Team Training Programs

SUMMARY STATEMENT

Interprofessional simulation-based team training (ISBTT) is promoted as a strategy to improve collaboration in healthcare, and the literature documents benefits on teamwork and patient safety. Teamwork training in healthcare is traditionally grounded in crisis resource management (CRM), but it is less clear whether ISBTT programs explicitly take the interprofessional context into account, with complex team dynamics related to hierarchy and power. This scoping review examined key aspects of published ISBTT programs including (1) underlying theoretical frameworks, (2) design features that support interprofessional learning, and (3) reported behavioral outcomes. Of 4854 titles identified, 58 articles met inclusion criteria. Most programs were based on CRM and related frameworks and measured CRM outcomes. Only 12 articles framed ISBTT as interprofessional education and none measured all interprofessional competencies. The ISBTT programs may be augmented by integrating theoretical concepts related to power and intergroup relations in their design to empower participants to navigate complex interprofessional dynamics.

Implementing IPE in a Workplace Setting: Educational Design Research Promotes Transformative Participation

Background

Educators struggle to implement Interprofessional Education (IPE) in workplace settings. We adopted an educational design research (EDR) approach to implement an IPE activity and establish design principles supporting IPE implementation in workplace settings.

Method

We adopted an iterative process of analysis/exploration, design/construction and evaluation/reflection. We performed a scoping review, visited examples of IPE initiatives and involved workplace professionals to define preliminary design principles for implementation. An IPE activity was implemented where students from nursing, midwifery and medicine care for patients together. Continuous reflection during the EDR process supported the refinement of design principles.

Results

We describe 14 design principles for implementation of IPE: (1) Set an objective; (2) Make the project evidence informed and theory driven; (3) Nurture a growth mindset; (4) Stimulate transformative participation; (5) Be aware of culture; (6) Support faculty members; (7) Align learning outcomes (8) Design formative and reflective assessment methods; (9) Position within an authentic context; (10) Facilitate informal interaction; (11) Balance patients' safety with attributing responsibility; (12) Align with the workplace, seize opportunities to improve interprofessional collaboration; (13) Evaluate the implementation; AND (14) Trust the process. The design principles related to three overarching concerns describing IPE implementation as a change process: patient safety, workflow and culture.

Discussion

The 14 design principles support context sensitive IPE implementation in the workplace. The EDR approach nurtured transformative participation, empowering stakeholders to participate and contribute to design and decision making. This resulted in an evidence informed, interprofessional cocreation process in and with the workplace that was aligned with existing workflow and organizational culture.

Students' motivation and engagement in interprofessional education: the mediating role of peer relatedness

INTRODUCTION

Students' peer relatedness is vital to their academic achievement and engagement. However, little is known about the mechanisms that can explain such a link in health professions education, especially in interprofessional education (IPE), where interprofessional socialization is promoted. To address the research gap in understanding the social dynamics embedded within IPE and their impact on crucial motivational outcomes, this study examines how peer relatedness (belonging) mediates the link between motivation (both intrinsic and extrinsic) and engagement in IPE.

METHODS

Data from 841 students enrolled in IPE from Medicine, Nursing, Social Work, Chinese Medicine, Pharmacy, Speech and Hearing Sciences, Clinical Psychology, and Food and Nutritional Science from a university in Hong Kong were used in this study. Intrinsic and extrinsic motivation were collected at baseline, while peer relatedness need satisfaction and engagement and disaffection in IPE were assessed after four weeks. We used a fully latent structural equation model to examine whether peer relatedness mediated the link between motivation and engagement in IPE.

RESULTS

Our results indicate that intrinsic motivation at baseline significantly increases engagement and reduces disaffection four weeks later, while extrinsic motivation shows the opposite effect. Crucially, the adaptive role of motivation to engagement was significantly mediated by relatedness from IPE teams. Specifically, the effect of students' motivation on their engagement/disaffection in IPE can be partially explained by their relatedness within IPE teams.

CONCLUSION

This study underscores the importance of peer relatedness in IPE, highlighting its role in harnessing student motivation to foster student engagement. The findings contribute to a deeper understanding of the psychosocial mechanisms in IPE and highlight the value of collaborative learning environments in fulfilling students' need for relatedness, thereby fostering adaptive IPE learning outcomes. The implications and limitations of the study are also discussed.

Interprofessional collaboration in primary care for patients with chronic illness: a scoping review mapping leadership and followership

BACKGROUND

Effective interprofessional collaboration (IPC) in primary care is essential in providing high-quality care for patients with chronic illness. However, the traditional role-based leadership approach may hinder IPC. Instead, physicians should also take followership roles, allowing other healthcare team members (OHCTMs) to lead when they have expertise and/or experience. Understanding of leadership and followership within IPC remains limited in primary care for patients with chronic illness. Hence, this review aims to explore the definitions and conceptualisations of leadership and followership and to map relevant training in this context.

METHODS

Following the Joanna Briggs Institute methodology for scoping reviews, an electronic search was conducted across PubMed, Embase and Web of Science. Three independent reviewers assessed publications for eligibility. Descriptive and thematic analysis were employed.

RESULTS

From 2194 identified articles, 57 were included. Only two articles defined leadership approaches, and none explicitly addressed followership. Nevertheless, our analysis identified leadership shifts from physicians to OHCTMs, and vice versa for followership, driven by complexity of care, physician shortages and healthcare costs. Enablers of these shifts included physician trusting OHCTMs, collaborative practice agreements and physicians' interprofessional experience. Barriers included traditional hierarchies, OHCTMs' lack of competence and physicians' lack of IPC experience. Four articles mentioned relevant training however without detailed information.

DISCUSSION

Leadership in IPC for chronic illness in primary care is rarely defined, and followership is largely neglected. Nevertheless, leadership-followership shifts do occur in leadership and followership roles of physicians and OHCTMs. Further research needs to explore physicians' followership and relevant competencies, and relevant training is required.

Developing institution-specific admission competency criteria for prospective health sciences students

BACKGROUND

Given the critical role of health professionals in societal health, the development of robust and effective selection methods is of fundamental concern for educational institutions within the field of health sciences education. Conventionally, admission competencies have been determined by institutional authorities. Developing institution-specific competency criteria enables an admission process that is mission- and value-aware, evidence-based, and strategically adaptable. However, few schools have established their admission competency criteria, although the majority possess their own models of graduation competencies. This study reports the process of developing and validating an institution-specific admission competency model that addresses the need for evidence-based and mission-aligned selection processes that are distinct from standardized models.

METHODS

This study was conducted in two phases, using both qualitative and quantitative analyses. Phase I involved constructing an admission competency model through a qualitative approach facilitated by workshops with 17 faculty members and 92 first-year pre-doctoral students of a dental school. Through constant comparative analysis, this phase focused on the extraction and refinement of competencies for entering dental students. In Phase II, a questionnaire developed from the workshops asked respondents to rate the importance of 47 attributes across 10 constructs on a 5-point Likert scale. A total of 301 individuals participated in the survey. Exploratory Factor Analysis (EFA) identified the factor structure, and Confirmatory Factor Analysis (CFA) examined construct validity and assessed the model fit with the data.

RESULTS

The EFA of the 47 attributes identified 10 factors, and the CFA results indicated a good-to-acceptable level of fit for the ten-factor model. Aligned with the American Association of Medical Colleges Premed competencies, this study identified unique attributes specific to the institution, such as confidence, leadership, and entrepreneurship. These findings highlight the importance of developing tailored competencies reflecting the unique needs of institutions and their fields.

CONCLUSIONS

This study demonstrates the feasibility and value of creating institution-specific admission competency models, offering a methodology that aligns with evidence-based mission-driven selection processes. The distinct competencies identified emphasize the need for educational institutions to consider unique institutional and field-specific requirements and move beyond standardized models to enhance the selection of medical students.

Playing well with others: lessons from theatre for the health professions about collaboration, creativity and community

Despite collaboration among different professions being recognized as fundamentally important to contemporary and future healthcare practice, the concept is woefully undertheorized. This has implications for how health professions educators might best introduce students to interprofessional collaboration and support their transition into interprofessional, collaborative workplaces. To address this, we engage in a conceptual analysis of published collaborative, interprofessional practices and conceptual understandings in theatre, as a highly collaborative art form and industry, to advance thinking in the health professions, specifically to inform interprofessional education. Our analysis advances a conceptualization of collaboration that takes place within a work culture of creativity and community, that includes four modes of collaboration, or the ways theatre practitioners collaborate, by: (1) paying attention to and traversing roles and hierarchies; (2) engaging in reciprocal listening and challenging of others; (3) developing trust and communication, and; (4) navigating uncertainty, risk and failure. We conclude by inviting those working in the health professions to consider what might be gleaned from our conceptualization, where the embodied and human-centred aspects of working together are attended to alongside structural and organizational aspects.

How Advanced Practice Clinicians Support Education for and Contribute to Education of Graduate Medical Education Trainees: A Critical Literature Review

PURPOSE

With the introduction of physician assistants and nurse practitioners (i.e., advanced practice clinicians [APCs]), the landscape of graduate medical education (GME) has fundamentally changed. Whereas APCs' role in GME settings has been mainly described as substitutes for postgraduate medical trainees, APCs are increasingly considered integrated and collaborative team members. However, APCs' contributions to trainees' education and learning remain underexplored. This critical review synthesized the literature available on how APCs contribute to trainees' workplace learning and how these contributions are enabled.

METHOD

The authors searched PubMed, Embase, Web of Science, CINAHL, and PsycINFO from database inception dates to April 2023 for published articles reporting on educational or guiding behaviors of APCs in GME contexts, resulting in 1,830 articles for possible inclusion. Using a critical review approach, the analysis was informed by a previously published framework describing workplace guidance behaviors and the authors' clinical and research expertise.

RESULTS

A total of 58 articles were included in the study. Advanced practice clinicians contribute to trainees' workplace learning through a variety of guidance behaviors, including learning from patient care, demonstrating, support, socialization, feedback, involvement in evaluations, and other unspecified contributions. Thematic analysis indicated that APCs' contributions were enabled by their close working relationships with trainees, their unique perspective within the workplace, and the extent to which they were formally incorporated within workplace learning.

CONCLUSIONS

This critical review offers a concrete description of ways APCs are contributing to trainees' learning and education in the GME workplace across the literature. These results suggest that APCs could be a potentially untapped source for further optimizing workplace learning. However, unlocking this potential will require a shift in the conceptualization of APCs' role in the workplace. Opportunities for APC professional development and formalization of APCs' educational role should be considered.

ALLin4IPE- an international research study on interprofessional health professions education: a protocol for an ethnographic multiple-case study of practice architectures in sites of students' interprofessional clinical placements across four universities

BACKGROUND

The global discourse on future health care emphasises that learning to collaborate across professions is crucial to assure patient safety and meet the changing demands of health care. The research on interprofessional education (IPE) is diverse but with gaps in curricula design and how IPE is enacted in practice.

PURPOSE AND AIMS

This research project will identify. 1) how IPE in clinical placements emerges, evolves, and is enacted by students when embedded in local health care practices, 2) factors critical for the design of IPE for students at clinical placements across the four countries.

METHODS

A study involving four countries (Sweden, Norway, Australia and New Zealand) using the theory of practice architectures will be undertaken between 2023 and 2027. The project is designed as an international, collaborative multiple-case ethnographic study, using the theoretical framework of practice architectures (TPA). It will include four ethnographic case studies of IPE, one in each country. Data will be collected in the following sequence: (1) participant observation of students during interprofessional placements, (2) interviews with students at clinical placement and stakeholders/professionals, (3) Non-clinical documents may be used to support the analysis, and collection of photos may be use as memory aids for documenting context. An analysis of "sayings, doings and relatings" will address features of the cultural- discursive, material-economic, social-political elements making up the three key dimensions of TPA. Each of the four international cases will be analysed separately. A cross case analysis will be undertaken to establish common learning and critical IPE design elements across the four collaborating universities.

DISCUSSION

The use of TPA framework and methodology in the analysis of data will make it possible to identify comparable dimensions across the four research sites, enabling core questions to be addressed critical for the design of IPE. The ethnographic field studies will generate detailed descriptions that take account of country-specific cultural and practice contexts. The study will also generate new knowledge as to how IPE can be collaboratively researched.

Sharpening the lens to evaluate interprofessional education and interprofessional collaboration by improving the conceptual framework: a critical discussion

It has been difficult to demonstrate that interprofessional education (IPE) and interprofessional collaboration (IPC) have positive effects on patient care quality, cost effectiveness of patient care, and healthcare provider satisfaction. Here we propose a detailed explanation for this difficulty based on an adjusted theory about cause and effect in the field of IPE and IPC by asking: 1) What are the critical weaknesses of the causal models predominantly used which link IPE with IPC, and IPE and IPC with final outcomes? 2) What would a more precise causal model look like? 3) Can the proposed novel model help us better understand the challenges of IPE and IPC outcome evaluations? In the format of a critical theoretical discussion, based on a critical appraisal of the literature, we first reason that a monocausal, IPE-biased view on IPC and IPC outcomes does not form a sufficient foundation for proper IPE and IPC outcome evaluations; rather, interprofessional organization (IPO) has to be considered an additional necessary cause for IPC; and factors outside of IPC additional causes for final outcomes. Second, we present an adjusted model representing the "multi-stage multi-causality" of patient, healthcare provider, and system outcomes. Third, we demonstrate the model's explanatory power by employing it to deduce why misuse of the modified Kirkpatrick classification as a causal model in IPE and IPC outcome evaluations might have led to inconclusive results in the past. We conclude by applying the derived theoretical clarification to formulate recommendations for enhancing future evaluations of IPE, IPO, and IPC. Our main recommendations: 1) Focus should be placed on a comprehensive evaluation of factual IPC as the fundamental metric and 2) A step-by-step approach should be used that separates the outcome evaluation of IPE from that of IPC in the overarching quest for proving the benefits of IPE, IPO and IPC for patients, healthcare providers, and health systems. With this critical discussion we hope to enable more effective evaluations of IPE, IPO and IPC in the future.

Having a Voice: Resident Perceptions of Supervision, Decision-Making and Patient Care Ownership

OBJECTIVE

Heightened resident supervision due to patient safety concerns is increasingly common in pediatrics and may leave residents with fewer opportunities for independent decision-making, a diminished sense of autonomy, and decreased engagement. This may ultimately threaten their development into competent clinicians. Understanding how pediatric residents experience supervision's influence on their involvement in decision-making, engagement in patient care, and learning is crucial to safeguard their transition to independent practice. In relation to supervision, our research investigated: 1) how residents navigated their involvement with clinical decision-making and 2) how opportunities to make clinical decisions influenced their engagement in patient care and learning.

METHODS

From 2019-2020, we recruited 38 pediatric residents from three different programs for a qualitative interview-based study. Through a constructivist stance, we explored clinical decision-making experiences and performed thematic analysis using an iterative and inductive process.

RESULTS

We identified three themes: 1) Residents perceived having autonomy when they had space to make independent decisions, regardless of supervisor's presence; 2) Patient care ownership resulted from having a voice in a variety of contributions to patient care; and 3) Supervisors' behaviors modulated patient care ownership and thereby residents' sense of feeling heard, their engagement in patient care, and their learning.

CONCLUSIONS

Our results suggest that focusing on patient care ownership may better fit with current learning environments than aiming for independence and autonomy. They provide insight on how, in the pediatric learning climate of enhanced supervision, supervisors can preserve resident engagement in patient care and learning by augmenting patient care ownership and ensuring residents have a voice.

Embedding Interprofessional Education in Clinical Settings: Medical and Dental Student Perceptions of a Patient Interview-Storytelling Experience

PROBLEM

Interprofessional education (IPE) is valued but difficult to deliver, given logistical and other barriers. Centering IPE around patients and grounding it in authentic practice settings are challenging within early undergraduate medical education.

APPROACH

This intervention facilitated student-patient conversations to elicit patient reflections on the health care professionals who keep them healthy and care for them when they are unwell. After being introduced to the Interprofessional Education Collaborative (IPEC) core competencies, first-year medical (n = 127) and dental (n = 34) students conducted a brief semistructured patient interview, using an interview card with guiding questions, during a precepted outpatient clinic session in March-May 2021. Students transcribed patients' stories and wrote their own reflections on the interview card. These reflections were used as a stimulus for a class IPE discussion. The authors employed a pragmatic qualitative research approach to explore what students learned about interprofessional collaboration from reflecting on patients' stories.

OUTCOMES

Of the 161 students, 158 (98%) completed an interview card. Sixteen health professions were represented in patients' stories. The patients' stories prompted students to recognize and expand their understanding of the IPEC competencies. Students' responses reflected synthesis of the competencies into 3 themes: students value patient-centered holistic care as the goal of interprofessional collaboration; students reflect emerging professional and interprofessional identities in relating to patients, teams, and systems; and students appreciate interprofessional care is complex and challenging, requiring sustained effort and commitment.

NEXT STEPS

Next steps include continuing to integrate patient voices through structured conversations across the undergraduate and graduate medical education spectrum and adapting the model to support conversations with other health professionals engaged in shared patient care. These experiences could foster ongoing deliberate reflection by students on their professional and interprofessional identity development but would require investments in student time and faculty development.

"Ego massaging that helps": a framework analysis study of internal medicine trainees' interprofessional collaboration approaches

INTRODUCTION

Patient care depends on collaborative practice. Debate remains as to the best approach to providing education for collaboration, with educational interventions often far removed from the realities of the clinical workplace. Understanding the approaches used for collaboration in clinical practice could inform practical strategies for training. For internal medicine trainees, this involves collaboration with other professions but also with other specialties. This study aimed to explore the approaches that internal medicine trainees use for interprofessional collaboration and the ways that these approaches vary when internal medicine trainees interact with different healthcare provider groups.

METHODS

Following ethical approval and participant consent, interprofessional communication workshops between August 2020 and March 2021 were audio recorded and transcribed verbatim. Workshops involved groups of internal medicine trainees discussing collaboration challenges and the approaches they use in clinical practice. This framework analysis study used the interprofessional collaboration framework described by Bainbridge and Regehr (building social capital, perspective taking and negotiating priorities and resources), and cross-referenced the categorised data with the healthcare groups that trainees collaborate with, to look for patterns in the data.

RESULTS

Seventeen workshops, involving 100 trainees, were included. Trainees described relationship building, perspective taking and negotiating priorities and resources. Relationship building was a modification to the original framework domain of building social capital. Themes of power and civility transcended domains with evidence of using hierarchy as leverage when negotiating and employing civility as a tactical approach throughout.

DISCUSSION

This bi-dimensional analysis highlights patterns of perspective taking when collaborating with other specialties and professions, and the approaches to negotiation of courting favour and coercion when interacting with other specialties. This study provides evidence of the strategies currently utilised by internal medicine trainees, with different healthcare groups, and presents a modified framework which could inform the development of training for collaboration.

A longitudinal, narrative case-study of interprofessional socialization among pharmacy students

INTRODUCTION

Despite growing evidence that interprofessional education (IPE) develops students' attitudes and competencies towards collaboration, there is a lack of theoretical, longitudinal research to inform the development of IPE initiatives. The purpose of this study was to examine pharmacy student interprofessional identity development during early professional and interprofessional socialization experiences in the pharmacy curriculum and at early entry into pharmacy practice.

METHODS

This longitudinal, narrative case study used one-on-one, semi-structured interviews conducted at four time points; pre-entry, end of first term, end of first year, and two years post-graduation. Data were analyzed by narrative analysis.

RESULTS

Three participants completed interviews at all four time points. Narratives revealed that participants focused on understanding the roles of pharmacists and other health professionals during early pharmacy curriculum and IPE experiences. Expansion of profession-specific role understanding and confronting pre-existing views or stereotypes were an emphasis early in the curriculum. Participants most valued IPE opportunities that allowed them to enact their own role while working with others in authentic case-based, simulated, or experiential experiences that enabled the development of professional relationships. Interprofessional identity development early upon entry into pharmacy practice varied based on the practice setting context and the ability to form relationships with other health care providers.

CONCLUSIONS

This study provides a preliminary exploration into the process of early interprofessional socialization for pharmacy students. Understanding the process of interprofessional identity development may affirm or enhance understanding of IPE curricula; further exploration in pharmacy curricula and practice is warranted.

Interprofessional education in problem-based learning: A frontier form of PBL in medical education

BACKGROUND

Interprofessional education (IPE) aims to educate healthcare students to improve collaboration and the quality of care. The delivery of IPE through a problem-based learning (PBL) setting appears to hold good validity. However, there are few studies that show the value of combining these two teaching modes.

MATERIALS AND METHODS

The research was a longitudinal intervention study. A total of 360 students were randomly divided into three interprofessional PBL (IPBL) groups that mixed nursing, pharmacy, and clinical medical students and three uniprofessional PBL (UPBL) groups that consisted of a single profession. An improved Attitude and Learning Ability Questionnaire (ALAQ) was used to measure the improvement in attitudes toward interprofessional cooperation and learning outcomes. The tutorial session and final examination grades were compared between IPBL and UPBL by Chi-square tests and Cochran-Mantel-Haenszel tests. Cronbach's α analysis was calculated to assess the validity and reliability. Cronbach's alpha coefficient of the questionnaire was 0.887, demonstrating high levels of reliability (95% confidence interval [CI]: 0.842 0.916).

RESULTS

According to Chi-square tests and Cochran-Mantel-Haenszel tests, we observed the student's positive attitudes toward interprofessional collaboration and the student's role awareness in the IPBL students was increased compared with UPBL students. In addition, a great majority of IPBL students felt that they had improved their self-learning ability and maintained a high enthusiasm for learning during the course.

CONCLUSION

Our study found that the IPBL teaching model was more effective than the UPBL teaching model in healthcare student's positive attitudes toward interprofessional collaboration and learning outcomes.

Interprofessional education and collaborative practice in Nigeria - Pharmacists' and pharmacy students' attitudes and perceptions of the obstacles and recommendations

INTRODUCTION

Many countries have implemented interprofessional education (IPE) and interprofessional collaborative practice (IPCP), but there is a dearth of information on the state of IPE in Nigeria. We evaluated the attitude of Nigerian pharmacy students and pharmacists towards IPE and IPCP and the perceived barriers to and recommendations for the implementation of IPE and IPCP.

METHODS

A cross-sectional survey of 238 community and hospital pharmacists and 765 pharmacy students in Nigeria was conducted with an online questionnaire using the Interprofessional Attitude Scale. Information on the perceived barriers to and recommendations for implementing IPE was also collected.

RESULTS

Two hundred and seven pharmacists (87%) and 629 (82.2%) pharmacy students agreed that it is necessary for health profession students to learn together. Perceived barriers to the implementation of IPE and IPCP included professional pride [pharmacists = 51 (21.42%), pharmacy students = 55 (7.19%)], prejudice against other health professions [pharmacists = 35 (14.7%), pharmacy students = 74 (9.67%)], uni-professional training [pharmacists = 5 (2.1%), pharmacy students = 7 (0.92%)], and government policies that discourage IPE and IPCP [pharmacists = 10 (4.2%), pharmacy students = 20 (2.61%)]. Recommendations proposed were the integration of IPE in undergraduate pharmacy curricula, cooperation among health professionals to curb professional rivalry, and the provision of necessary facilities and resources by the government.

CONCLUSIONS

Nigerian pharmacists and pharmacy students had positive attitudes towards IPE and IPCP. The perceived barriers to implementing IPE in Nigeria include discouraging government policies. Deliberate and implementable government policies on IPE are needed.

Which learning experiences support an interprofessional identity? A scoping review

In recent years, health professions researchers have suggested that a dual identity that includes both a professional and interprofessional identity is essential to interprofessionality. This scoping review sought to describe the learning experiences that may support the development of an interprofessional identity, providing direction for future research. A scoping review was conducted to identify papers published between 2000 and 2020 that provided empiric evidence to support the impact of planned or spontaneous learning experiences involving two or more healthcare professions that fostered the development of an "interprofessional identity," or a sense of belonging to an interprofessional community. Twelve papers were identified for inclusion. Articles varied regarding both the professional groups studied and the developmental levels of their participants. A wide variety of learning experiences were described in the identified studies, including designed activities and programs, as well as those occurring spontaneously in authentic clinical environments. Examples of longitudinal and integrated programs were also identified. The construct of an interprofessional identity and its potential impact on interprofessional practice has yet to be sufficiently studied. The results of this scoping review suggest that a variety of experiences that occur throughout the professional development trajectory may foster an interprofessional identity. Longitudinal, integrated interprofessional learning programs may result in a more long-lasting impact on interprofessional identity and these types of programs should be the focus of future research.

It Takes a Village: Optimal Graduate Medical Education Requires a Deliberately Developmental Organization

Coaching is proposed as a means of improving the learning culture of medicine. By fostering trusting teacher-learner relationships, learners are encouraged to embrace feedback and make the most of failure. This paper posits that a cultural shift is necessary to fully harness the potential of coaching in graduate medical education. We introduce the deliberately developmental organization framework, a conceptual model focusing on three core dimensions: developmental communities, developmental aspirations, and developmental practices. These dimensions broaden the scope of coaching interactions. Implementing this organizational change within graduate medical education might be challenging, yet we argue that embracing deliberately developmental principles can embed coaching into everyday interactions and foster a culture in which discussing failure to maximize learning becomes acceptable. By applying the dimensions of developmental communities, aspirations, and practices, we present a six-principle roadmap towards transforming graduate medical education training programs into deliberately developmental organizations.

What do you mean, 'negotiating?': Patient, physician, and healthcare professional experiences of navigating hierarchy in networks of interprofessional care

Interprofessional collaborative practice is a phenomenon that can be fraught with power dynamics between professions, within professions, and between professionals and patients. In the literature, the dominant notion is that conflicting viewpoints and interests arising from unequal power dynamics can be resolved through negotiation. This study examined COPD patients, health professionals, and physician experiences of negotiation within 10 interprofessional collaborative COPD care teams. Physicians, patients, and healthcare professionals each had strikingly different conceptions and experiences of negotiating their perspective with other team members. Our study suggests that negotiation is an idealized notion rather than a relational process embedded in interprofessional collaborative practice. Importantly, we found that the ability and opportunity to negotiate one's perspective is heavily influenced by one's position in the workplace division of labor and professional hierarchy. We conclude that "negotiation" is only one approach among many in navigating interprofessional relations. Further, the rhetorical and ideological appeal of "negotiation" may overstate its role in interactions in interprofessional care settings, and lead to a misunderstanding of the power dynamics at play. It may be naïve to assume team members can control their situation through the competitive assertion of their individual perspective in a rational debate. Unfortunately, adopting the language of negotiation uncritically may not offer relevant solutions to structural and collective problems within a healthcare workplace.

Exploring nurses' role in guiding residents' workplace learning: A mixed-method study

INTRODUCTION

Understanding residents' workplace learning could be optimized by not only considering attending physicians' role but also the role of nurses. While previous studies described nurses' role during discrete activities (e.g. feedback), a more profound understanding of how nurses contribute to residents' learning remains warranted. Therefore, we used the educational concept of guidance and explored the extent to which residents' and nurses' perceptions align regarding nurses' guiding role and which reasons they provide for their perceptions.

METHODS

This mixed-method study was conducted at four Dutch university medical centres in 2021. We simultaneously collected quantitative and qualitative data from 103 residents and 401 nurses through a theory-informed questionnaire with a Likert-scale and open-ended questions. We analyzed quantitative data to explore respondents' perceptions of nurses' guiding role by using anova. The thematically analyzed qualitative open comments explored respondents' reasons for their perceptions.

RESULTS

Nurses indicated to provide significantly more support (p = .01) and guidance on learning from patient care (p < .01) than perceived by residents. Moreover, nurses indicated that attending physicians did not always involve them in guiding residents, whereas residents perceived nurses were being involved (p < .001). Themes suggest that nurses and residents could be divided into two groups: (i) respondents who felt that guiding was inextricably linked to good interprofessional collaboration and patient care and (ii) respondents who saw the guiding role as limited and emphasised the distinct fields of expertise between nurses and physicians.

CONCLUSIONS

Residents and nurses felt that nurses played an important role in guiding residents' workplace learning. However, some residents did not always perceive to be guided. To further capitalise on nurses' guiding role, we suggest that residents can be encouraged to engage in the learning opportunities nurses provide to achieve optimal team-based patient care.

How do former medical and nursing undergraduates describe their learning on an interprofessional training Ward 12-18 months later? - A retrospective qualitative analysis

BACKGROUND

Interprofessional training wards (IPTWs) seem to deliver good results in terms of development of interprofessional competencies. However, evidence of long-term effects of these training wards on learners' competency development is lacking and little is known about retrospective evaluation of IPTWs. Therefore, this study aimed to explore the retrospective evaluation of competency development and interprofessional collaboration of former undergraduates 12 or more months after a placement on an IPTW.

METHODS

Eight follow-up interviews were conducted with four nursing and four medical professionals 12-18 months after they had finished a placement on an ITPW throughout their vocational training. Interviews were translated verbatim and analysed deductively and inductively based on qualitative content analysis.

RESULTS

The qualitative content analyses deductively identified two main categories regarding the research question, namely the uniqueness of the programme and interprofessional competencies developed by the Interprofessional Education Collaborative. Sub categories were identified inductively, representing the perceived competency development and the learning opportunities on the IPTW as compared to other clinical placements throughout vocational training and in transition to practice. Interviewees seemed to have developed competencies that are important for interprofessional collaboration such as communication, roles and responsibilities, as well as competencies in patient care and management. Considered beneficial for learning were the opportunity to work self-responsibly and the interprofessional collaboration on the IPTW, both of which were neither possible in almost any other placement nor in transition to practice.

CONCLUSION

Findings show that IPTWs can be sufficient in competency development and role clarification and are perceived positively by learners, but structures in clinical practice can impede sustaining competency development and efficient interprofessional collaboration.

Recognizing and Maximizing the Nexus of Perioperative Medicine and Narrative Medicine

Perioperative medicine remains an evolving, interdisciplinary subspecialty, which encompasses the unique perspectives and incorporates the respective vital expertise of numerous stakeholders. This integrated model of perioperative medicine and care has a wide-ranging set of clinical, strategic, and operational goals. Among these various programmatic goals, a subset of 4, specific, interdependent goals include (1) enhancing patient-centered care, (2) embracing shared decision-making, (3) optimizing health literacy, and (4) avoiding futile surgery. Achieving and sustaining this subset of 4 goals requires continued innovative approaches to perioperative care. The burgeoning field of narrative medicine represents 1 such innovative approach to perioperative care. Narrative medicine is considered the most prominent recent development in the medical humanities. Its central tenet is that attention to narrative-in the form of the patient's story, the clinician's story, or a story constructed together by the patient and clinician-is essential for optimal patient care. If we can view the health care experience through the patient's eyes, we will become more responsive to patients' needs and, thereby, better clinicians. There is a potential clinical nexus between the perioperative medicine practice and narrative medicine skills, which, if capitalized, can maximize perioperative patient care. There are a number of untapped educational and research opportunities in this fruitful nexus between perioperative medicine and narrative medicine.

Development and validity evidence for the intraprofessional conflict exercise: An assessment tool to support collaboration

BACKGROUND

Effective collaboration is the foundation for delivering safe, high quality patient care. Health sciences curricula often include interprofessional collaboration training but may neglect conflicts that occur within a profession (intraprofessional). We describe the development of and validity evidence for an assessment of intraprofessional conflict management.

METHODS AND FINDINGS

We designed a 22-item assessment, the Intraprofessional Conflict Exercise, to evaluate skills in managing intraprofessional conflicts based on a literature review of conflict management. Using Messick's validity framework, we collected evidence for content, response process, and internal structure during a simulated intraprofessional conflict from 2018 to 2019. We performed descriptive statistics, inter-rater reliability, Cronbach's alpha, generalizability theory, and factor analysis to gather validity evidence. Two trained faculty examiners rated 82 trainees resulting in 164 observations. Inter-rater reliability was fair, weighted kappa of 0.33 (SE = 0.03). Cronbach's alpha was 0.87. The generalizability study showed differentiation among trainees (19.7% person variance) and was highly reliable, G-coefficient 0.88, Phi-coefficient 0.88. The decision study predicted that using one rater would have high reliability, G-coefficient 0.80. Exploratory factor analysis demonstrated three factors: communication skills, recognition of limits, and demonstration of respect for others. Based on qualitative observations, we found all items to be applicable, highly relevant, and helpful in identifying how trainees managed intraprofessional conflict.

CONCLUSIONS

The Intraprofessional Conflict Exercise provides a useful and reliable way to evaluate intraprofessional conflict management skills. It provides meaningful and actionable feedback to trainees and may help health educators in preparing trainees to manage intraprofessional conflict.

Autonomous motivation predicts students' engagement and disaffection in interprofessional education: Scale adaptation and application

OBJECTIVES

Despite the popularity of interprofessional education, the empirical and theoretical development of its scholarship and science is just emerging. This may be caused in part by the non-availability of measures that can be used by researchers in this field. This study aimed to contribute to the psychological theorizing of interprofessional education by uncovering the psychometric properties of Perceived Locus of Causality adapted to Interprofessional Education (PLOC-IPE) in healthcare education and provide a comprehensive guide on how this can be used to advance the IPE research agenda.

METHODS

Confirmatory factor analysis (quantitative design) was used to examine the acceptability of psychometric properties of PLOC-IPE. Data were collected through questionnaires administered at two different time points. The participants consisted of 345 students from Chinese Medicine, Clinical Psychology, Medicine, Nursing, Pharmacy, and Social Work from a university in Hong Kong.

RESULTS

Based on confirmatory factor analysis, results of within-network construct validity showed good psychometric properties of PLOC-IPE while between-network validity indicated that the scale can predict IPE-related outcomes. Students' intrinsic motivation in IPE positively predicted emotional engagement and negatively predicted emotional disaffection, demonstrating the applicability of the newly validated PLOC-IPE. Amotivation was a negative predictor of emotional engagement and a positive predictor of emotional disaffection.

CONCLUSIONS

Findings support the acceptability of PLOC when adapted to IPE. PLOC-IPE obtained acceptable psychometric properties as a measure of students' academic motivation in IPE. It is an adapted scale that can be used to understand self-determined motivation in the context of IPE in health and social care education. A guide on how PLOC-IPE can be a means by which researchers can contribute to the advancement of scholarship of IPE was provided.

Team cohesiveness and collective efficacy explain outcomes in interprofessional education

BACKGROUND

Team cohesiveness and collective efficacy have been construed as important characteristics of a high-functioning team. However, the psychological mechanism through which they promote positive outcomes remains unknown. Understanding this psychological process is important to teachers and programme implementers to yield actionable interventions that can be used to craft effective practices for optimizing team outcomes. This is especially true in interprofessional education (IPE) in medical education, where a team-based approach to patient management is promoted. Drawing from the social-cognitive theory, we examined a hypothesized model where team cohesiveness predicts collaboration outcomes (teamwork satisfaction, overall satisfaction with the team experience, and IPE goal attainment) via collective efficacy.

METHODS

We used data from Chinese medicine, medicine, nursing, and social work students in Hong Kong (n = 285) who were enrolled in IPE. They were invited to respond to scales in two time points. We performed mediation analysis using structural equations modelling to test the indirect effect model: team cohesiveness → collective efficacy → outcomes.

RESULTS

Results of structural equation modelling revealed that collective efficacy fully mediated the relationships between team cohesiveness and all three team outcomes, providing support for the hypothesised model [RMSEA = 0.08, NFI = 0.90, CFI = 0.93, IFI = 0.93, TLI = 0.93]. Team cohesiveness predicted the achievement of collaboration outcomes via collective efficacy.

CONCLUSION

The findings demonstrated the important roles of team cohesiveness and collective efficacy in promoting successful team collaboration. Team cohesiveness predicted collective efficacy, and collective efficacy, in turn, predicted collaboration outcomes. This study contributed to theorising the pathways towards successful team collaboration outcomes.

Can We Realize Our Collaborative Potential? A Critical Review of Faculty Roles and Experiences in Interprofessional Education

PURPOSE

Faculty within interprofessional education (IPE) are essential contributors to IPE implementation efforts. Although the majority of existing IPE literature consists of reports on IPE innovations, few insights are available into the experiences of the faculty members who deliver IPE. This critical narrative review was designed to synthesize the knowledge available about (1) roles assigned to IPE educators and (2) IPE faculty members' experiences of fulfilling these roles.

METHOD

Six databases for English-language studies published between 2000 and March 2021 were searched: PubMed, Embase, Web of Science, MEDLINE, CINAHL, PsycINFO, ERIC, and MedEdPortal. A total of 1,717 manuscripts were identified for possible inclusion. After applying inclusion/exclusion criteria, 214 articles constituted the final literature corpus. Harden and Crosby's original framework of 6 roles of medical educators augmented with the manager role introduced in Harden and Lilley's 2018 framework informed the analysis.

RESULTS

IPE faculty take on all 6 roles identified by Harden and Crosby: facilitator, planner, information provider, examiner, role model, and resource developer, as well as the manager role. Faculty were most commonly identified as facilitator and planner, and rarely as role models. The authors identified 3 main struggles experienced by IPE faculty: personal (e.g., confidence as a cross-professions educator), interpersonal (e.g., co-teaching IPE), and institutional (e.g., supporting IPE logistics).

CONCLUSIONS

This review highlights the complexity of the roles taken on by IPE faculty and the struggles they experience in the process. The results suggest that attention to the different roles that IPE faculty play in educational interventions and to equipping faculty with the necessary competencies, tools, and support, is fundamental to the success of IPE. Future research should harness the explanatory power of theories to help explain dynamics at play between personal, interpersonal, and institutional barriers to identify interventions that can aid IPE faculty in delivering collaboration-ready professionals.

Together or not together: Paving the way to boundary crossing

The authors discuss how interprofessional education could ease the transition into collaborative practice by laying the foundation for interprofessional boundary crossing, suggesting that virtual IPE be used to nurture interprofessional feedback‐seeking behaviours.

Sustainable interprofessional education programmes: What influences teachers to stay involved?

Delivery of interprofessional education (IPE) initiatives for pre-licensure students is increasingly the norm in health and social care training programmes. This collaborative form of education relies on teachers from various disciplines joining together to facilitate IPE. When IPE programmes first start, goodwill often prevails and facilitators are keen to take part. But as time goes on, retaining the IPE facilitator workforce is challenging. Research was undertaken to explore the experience of IPE facilitators who were part of a New Zealand university-based ten year old IPE programme. The research used a qualitative survey approach. Responses were received from 29% of all those invited to participate. Closed questions were collated and free-text survey responses analyzed using Template Analysis. Three themes and one integrative theme were identified. Themes include facilitators who are recognized, facilitators who are confident, and facilitators who are inspired. Themes were mediated by macro, meso and micro level forces. The cross-cutting integrative theme showed IPE facilitators experienced individual tipping points, with the potential to influence their continued involvement. These tipping points need to be recognized and addressed by those in senior level positions (macro-governance and meso-management), to ensure IPE facilitators continue and IPE programmes remain sustainable.

Designing the learning of intraprofessional collaboration among medical residents

BACKGROUND

To preserve quality and continuity of care, collaboration between primary-care and secondary-care physicians is becoming increasingly important. Therefore, learning intraprofessional collaboration (intraPC) requires explicit attention during postgraduate training. Hospital placements provide opportunities for intraPC learning, but these opportunities require interventions to support and enhance such learning. Design-Principles guide the design and development of educational activities when theory-driven Design-Principles are tailored into context-sensitive Design-Principles. The aim of this study was to develop and substantiate a set of theory-driven and context-sensitive Design-Principles for intraPC learning during hospital placements.

METHODS

Based on our earlier research, we formulated nine theory-driven Design-Principles. To enrich, refine and consolidate these principles, three focus group sessions with stakeholders were conducted using a Modified Nominal Group Technique. Next, two work conferences were conducted to test the feasibility and applicability of the Design-Principles for developing intraPC educational activities and to sharpen the principles into a final set of Design-Principles.

RESULTS

The theoretical Design-Principles were discussed and modified iteratively. Two new Design-Principles were added during focus group 1, and one more Design-Principle was added during focus group 2. The Design-Principles were categorised into three clusters: (i) Culture: building collaborative relations in a psychologically safe context where patterns or feelings of power dynamics between primary and secondary care physicians can be discussed; (ii) Connecting Contexts: making residents and supervisors mutually understand each other's work contexts and activities; and (iii) Making the Implicit Explicit: having supervising teams act as role models demonstrating intraPC and continuously pursuing improvement in intraPC to make intraPC explicit. Participants were unanimous in their view that the Design-Principles in the Culture cluster were prerequisites to facilitate intraPC learning.

CONCLUSION

This study led to the development of 12 theory-driven and context-sensitive Design-Principles that may guide the design of educational activities to support intraPC learning during hospital placements.

Exploring the impact of interprofessional simulation on the professional relationships of trainee pharmacists and medical students: a constructivist interview study

Members of clinical teams can hold stereotyped views of one another that can form barriers to interprofessional cohesion and collaboration. Interprofessional education (IPE) is often championed as a way of teaching individuals to be better team players through the adoption of collaborative attitudes and behaviours. However, the potentially detrimental effects of IPE are not well understood. This study used the social identity approach (SIA) as a lens to explore the impact of interprofessional simulation on the identities and professional relationships of trainee pharmacists and medical students.

Across three different locations in Scotland, trainee pharmacists were paired with medical students to participate in immersive simulation scenarios with post-scenario debriefs. Participants were individually interviewed shortly after their simulation session, using a semi-structured interview schedule based on SIA. Transcripts were analysed using template analysis, with sub-categorizations of SIA forming the initial coding template.

Twenty-five interviews were undertaken across both groups. The interprofessional simulation session effectively challenged pre-existing stereotypes. For the trainee pharmacists, the alteration of self-stereotypes influenced motivation through self-enhancement and, in turn, altered group norms via the promotion of genuine collaboration and joint decision-making. However, social comparisons focussed on status remained prominent.

This study has shown that interprofessional simulation can effectively challenge and alter stereotypes (including self-stereotypes), but social comparisons may be less easy to overcome in this context. As it continues to be embedded within healthcare education, the limitations of IPE must be better understood to ensure that the potential value of such opportunities is maximized.

Exploring implicit influences on interprofessional collaboration: a scoping review

Interprofessional collaboration (IPC) is fraught with multiple tensions. This is partly due to implicit biases within teams, which can reflect larger social, physical, organizational, and historical contexts. Such biases may influence communication, trust, and how collaboration is enacted within larger contexts. Despite the impact it has on teams, the influence of bias on IPC is relatively under-explored. Therefore, the authors conducted a scoping review on the influence of implicit biases within interprofessional teams. Using scoping review methodology, the authors searched several online databases. From 2792 articles, two reviewers independently conducted title/abstract screening, selecting 159 articles for full-text eligibility. From these, reviewers extracted, coded, and iteratively analyzed key data using a framework derived from socio-material theories. Authors found that many studies demonstrated how biases regarding dominance and expertise were internalized by team members, influencing collaboration in predominantly negative ways. Articles also described how team members dynamically adapted to such biases. Overall, there was a paucity of research that described material influences, often focusing on a single material element instead of the dynamic ways that humans and materials are known to interact and influence each other. In conclusion, implicit biases are relatively under-explored within IPC. The lack of research on material influences and the relationship among racial, age-related, and gender biases are critical gaps in the literature. Future research should consider the longitudinal and reciprocal nature of both positive and negative influences of bias on collaboration in diverse settings.

Components of interprofessional education programs in neonatal medicine: A focused BEME review: BEME Guide No. 73

BACKGROUND

Care delivery in neonatology is dependent on an interprofessional team. Collaborative learning and education amongst professionals can lead to successful management of critically ill patients. This focused BEME review synthesized the components, outcomes, and impact of such interprofessional education (IPE) programs in neonatal medicine.

METHODS

The authors systematically searched four online databases and hand-searched MedEdPublish up to 10 September 2020. Two authors independently screened titles, abstracts, full-texts, performed data extraction and risk of bias assessment related to study methodology and reporting. Discrepancies were resolved by a third author. We reported our findings based on BEME guidance and the STORIES (STructured apprOach to the Reporting in health education of Evidence Synthesis) statement.

RESULTS

We included 17 studies on IPE in neonatal medicine. Most studies were from North America with varying learners, objectives, instruction, and observed outcomes. Learners represented nurses, respiratory therapists, neonatal nurse practitioners, patient care technicians, parents, early interventionists, physicians, and medical trainees amongst others. Risk of bias assessment in reporting revealed poor reporting of resources and instructor training. Bias assessment for study methodology noted moderate quality evidence with validity evidence as the weakest domain. IPE instruction strategies included simulation with debriefing, didactics, and online instruction. Most studies reported level 1 Kirkpatrick outcomes (76%) and few reported level 3 or 4 outcomes (23%). Challenges include buy-in from leadership and the negative influence of hierarchy amongst learners.

CONCLUSIONS

This review highlights IPE program components within neonatal medicine and exemplary practices including a multimodal instructional approach, asynchronous instruction, an emphasis on teamwork, and elimination of hierarchy amongst learners. We identified a lack of reporting on program development and instructor training. Future work should address long term knowledge and skill retention and impact on patient outcomes and organizations.

What characterize high and low achieving teams in Interprofessional education: A self-determination theory perspective

OBJECTIVES

Calls to promote team-based interprofessional collaborative practice in managing patients with complex health problems are ubiquitous. However, the literature remains silent on what characterises successful teams in interprofessional education (IPE) and on profiling successful teams. To help conceptualise successful teams, this study investigated the differences in attitudes and achievement between high- and low-performing teams in an online asynchronous and synchronous IPE programme, and the role of autonomous motivation in determining team membership.

METHODS

Using extreme case sampling involving health and social care students, we identified ten high-performing teams and seven low-performing teams based on their team composite scores on three interprofessional collaborative outcomes: team effectiveness, goal achievement, and scores on the readiness assurance test. Each team had five to seven members of diverse backgrounds. Independent t-tests were performed to identify differences in interprofessional collaborative outcomes, namely teamwork and collaboration, patient-centredness, diversity and ethics, community-centeredness, and interprofessional biases for the affective domain and application exercise for the cognitive domain. We employed logistic regression in which autonomous motivation was used to predict group membership.

RESULTS

High-performing teams were characterised as those whose members endorsed or valued "teamwork and collaboration" in IPE simulations. Compared with the low-performing groups, they better recognised and endorsed diversity and ethics, patient-centeredness, and community-centeredness. Membership to high- and low-performing teams was linked to autonomous motivation.

CONCLUSIONS

High-performing teams have higher favourable valuing of important interprofessional collaborative competencies, and membership to which is predicted by autonomous motivation. The results suggest the need to pay special attention to struggling teams to facilitate desirable collaborative competencies, especially in terms of members' motivation. Theoretical, methodological, and practical implications are discussed.

Identifying contributing factors influencing pediatric nurses' and health professionals' self-reported collaborative practice behaviors

PURPOSE

In this study, we examined the influence of interprofessional American Heart Association (AHA) resuscitation courses on pediatric health care professionals' (N = 218) self- reported collaborative practice behaviors (CPBs) and examined differences in CPBs between nursing, medicine, and respiratory therapy.

DESIGN AND METHODS

A mixed methods explanatory design was utilized with a sample of pediatric nurses, nurse practitioners, physicians, and respiratory therapists. Data were collected using the Interprofessional Collaborative Competency Attainment Survey (ICCAS) and two open-ended questions. Data analysis included: exploratory factor analysis, paired t-tests, mixed effects modeling and directed content analysis. Inferences were made across quantitative and qualitative data.

RESULTS

Statistically significant improvement in mean CPB scores was demonstrated by all professions (t (208) = -12.76; ρ < 0.001) immediately after the AHA courses. Qualitative responses indicated physicians identified roles and responsibilities (94%, n = 17) as the most important CPB. Communication was identified by nurses (78%, n = 76), nurse practitioners (100%, n = 11) and respiratory therapists (71%, n = 5) as most important.

CONCLUSIONS

Participation in an interprofessional AHA course significantly increased mean self-reported CPB scores. Changes in mean CPB scores were sustained over 6 weeks upon return to clinical practice.

PRACTICE IMPLICATIONS

Future research focused on CPBs of front-line health care professionals can provide an accurate portrayal of an interprofessional team and can inform how collaborative practice is established in everyday clinical practice.

A behavioural study of obedience in health professional students

Interprofessional Education and Collaborative Practice (IPECP) is a field of study suggested to improve team functioning and patient safety. However, even interprofessional teams are susceptible to group pressures which may inhibit speaking up (positive deviance). Obedience is one group pressure that can inhibit positive deviance leading to negative patient outcomes. To examine the influence of obedience to authority in an interprofessional setting, an experimental simulated clinical scenario was conducted with Respiratory Therapy (RT) (n = 40) and Advanced Care Paramedic (ACP) (n = 20) students. In an airway management scenario, it was necessary for students to challenge an authority, a senior anesthesiologist, to prevent patient harm. In a 2 × 2 design cognitive load and an interventional writing task designed to increase positive deviance were tested. The effect of individual characteristics, including Moral Foundations, and displacement of responsibility were also examined. There was a significant effect for profession and cognitive load: RT students demonstrated lower levels of positive deviance in the low cognitive load scenario than students in other conditions. The writing task did not have a significant effect on RT or ACP students' behaviour. The influence of Moral Foundations differed from expectations, In Group Loyalty was selected as a negative predictor of positive deviance while Respect for Authority was not. Displacement of responsibility was influential for some participants thought not for all. Other individual variables were identified for further investigation. Observational analysis of the simulation videos was conducted to obtain further insight into student behaviour in a compliance scenario. Individual differences, including experience, should be considered when providing education and training for positive deviance. Simulation provides an ideal setting to use compliance scenarios to train for positive deviance and for experimentation to study interprofessional team behaviour.

Exploring power dynamics and their impact on intraprofessional learning

BACKGROUND

During postgraduate training, considerable efforts for intraprofessional education are in place to prepare primary care residents (PC residents) and medical specialty residents (MS residents) for intraprofessional collaboration (intraPC). Power dynamics are inherently present in such hierarchical medical contexts. This affects intraPC (learning). Yet little attention has been paid to factors that impact power dynamics. This study aims to explore power dynamics and their impact on intraPC learning between PC residents and MS residents during hospital placements.

METHODS

This study expands on previously published ethnographic research investigating opportunities and barriers for intraPC learning among residents in five Dutch hospitals. We analysed transcripts of observations and in-depth interviews using template analysis. A critical theory paradigm was employed. Discourse analysis additionally informed the data.

RESULTS

We defined five interrelated themes that describe characteristics of power dynamics in intraPC learning during hospital placements: beliefs; power distribution; interaction style; subjection; and fearless learning. Power dynamics operate both within and between the themes: power distribution between PC residents, MS residents and MS supervisors seemed to be an attribution affected by underlying beliefs about professional norms or about other professions; beliefs influenced the way PC residents, MS residents and MS supervisors interacted; power distribution based on inequity could lead to subjection of PC residents; power distribution based on equity could lead to fearless learning; and open interactions enabled fearless intraPC learning.

CONCLUSIONS

Power dynamics have an impact on intraPC learning among residents in hospitals. Constructive power dynamics occur when power distribution is based on equity, combined with sincere open interactions, actively inviting each other into discussions and enlisting the support of MS supervisors to foster fearless learning. This can be achieved by creating awareness of implicit beliefs and making them explicit, recognising interaction that encourages intraPC learning and creating policies that support fearless intraPC learning.

Applying Landscapes of Practice Principles to the Design of Interprofessional Education

ISSUE

Although interprofessional education (IPE) is acknowledged as a way to prepare health professions students for future interprofessional collaboration (IPC), there is a need to better ground IPE-design in learning theory. Landscapes of practice and its concepts of knowledgeability and identification are suggested as a framework that may help optimize IPE. This Observation paper provides an explanation of how these concepts might be used in IPE-design.

EVIDENCE

We propose using three modes of identification, i.e., engagement, imagination, and alignment, described in this framework, for an IPE-design that fosters IPC skills, professional identity formation, and knowledgeability about a field and its actors. Identification and knowledgeability are through to enable successful collaboration across professional and practice boundaries.

IMPLICATIONS

Focusing on identification implies that students develop a sense of relevance to one another in solving complex problems (engagement), they become aware of their own roles and responsibilities in relation to others (imagination), and they gain awareness of the context in which the different professions align and collaborate (alignment). Altogether, this enables students to become knowledgeable in the landscape, which prepares them for successful interprofessional collaboration in practice.

Consensus about GP interprofessional competencies: A nominal group study

BACKGROUND

Since the requirements for collaboration in primary care increase, effective interprofessional teamwork between general practitioners (GPs) and other primary care professionals is crucial. The need for more training in interprofessional collaborative competencies is widely recognised. However, existing competency frameworks do not sufficiently specify interprofessional collaboration to guide interprofessional competency development.

AIM

Consensus among GPs and other primary care professionals on interprofessional competencies that GP and GP-trainees should learn.

DESIGN & SETTING

Qualitative consensus study among Dutch GPs and other primary care professionals, all with expertise in primary care interprofessional collaborative practice.

METHOD

Three nominal group sessions were held, each resulting in its own group consensus on GP interprofessional collaborative competencies. The researchers conducted a content analysis to merge and thematise the prioritised competencies into one list. Participants prioritised this list of competencies. A pre-set cut-off point was applied to determine the overall consensus on core GP interprofessional competencies.

RESULTS

Eighteen professionals from nine different disciplines participated. The content analysis resulted in 31 unique competencies of which fourteen competencies were prioritised in the final ranking into three main themes: 1. Professional identity development and role definition by the GP. (three competencies); 2. Developing and executing shared care plans for individual patients (6); 3. Setting up and maintaining interprofessional collaborative partnerships.(5) CONCLUSION: An interprofessional group of experts reached consensus on 14 competencies within 3 themes. This framework provides a steppingstone for GPs to focus on their development regarding interprofessional collaboration.

How do we educate medical students interprofessionally about patient safety? A scoping review

Medical education has an important role in developing attitudes, behaviors and cultures that support safe care. Increasingly, however, research has argued for a more interprofessional approach to be taken. This scoping review examines the design and impact of interprofessional education interventions involving medical students that focus on patient safety. We systematically searched PubMed, EMBASE, PsycINFO and CINAHL between January 2000 and November 2019. Studies were eligible if they included medical students and at least one other profession, interactive learning, a strong emphasis on patient safety in the learning objectives, and an empirical method of evaluation. Forty-three studies met these criteria and the diverse range of approaches to intervention design and method of evaluation are detailed in this review. We found that interprofessional patient safety education interventions are generally well received by students with knowledge and skill gain documented; several also reported changes in student behaviour. However, the lack of empirically driven study designs, combined with the lack of rigour when reporting, makes it difficult to draw clear comparisons. Future research should address this, and in particular, report how and why the intervention has been designed to be delivered interprofessionally.

Interprofessional identity: an ethnography of clinical simulation learning in New Zealand

BACKGROUND

This article explores the experiences of clinical healthcare students on an interprofessional simulation course in Auckland, New Zealand. The four-day course aims to provide a formative learning experience for final year medical, pharmacy, nursing, and paramedicine students. It focuses on building skills in professionalism, communication, leadership and interprofessional safe teamwork through structured learning activities and clinical simulation scenarios.

METHODS

In 2018, we commenced focused ethnographic research involving participant observation, field notes, interviews, photography and ethnographic film.

RESULTS

A total of 112 students participated in this research from the disciplines of medicine (n = 53), nursing (n = 27), pharmacy (n = 17), and paramedicine (n = 15). In a revisit to Van Gennep's (1972) seminal work on liminality, we suggest that the course represents a liminal space where students' ideas about what it means to be a healthcare 'professional' are challenged, disrupted and reconstructed. We observed students emerging from the course with transformed professional and interprofessional identities.

CONCLUSIONS

We posit that the ritualised and liminal nature of the course plays a role in the development of interprofessional identities by interrupting the reproduction of siloed biomedical culture. Students are challenged to become effective team members alongside other students and experts from other professions. We discuss these findings as they relate to medical and health sciences education.

Institutional ethnography - a primer

This review introduces a qualitative methodology called institutional ethnography (IE) to healthcare professionals interested in studying complex social healthcare systems. We provide the historical context in which IE was developed, and explain the principles and terminology in IE for the novice researcher. Through the use of worked examples, the reader will be able to appreciate how IE can be used to approach research questions in the healthcare system that other methods would be unable to answer. We show how IE and qualitative research methods maintain quality and rigour in research findings. We hope to demonstrate to healthcare professionals and researchers that healthcare systems can be analysed as social organisations, and IE may be used to identify and understand how higher-level processes and policies affect day-to-day clinical work. This understanding may allow the formulation and implementation of actionable improvements to solve problems on the ground.

Impact of hospitalists' social identities on perceptions of teamwork

Interprofessional teamwork provides unique opportunities for improving patient care. This study used Social Identity Theory as a conceptual framework to characterize the relationships between the social identities of pediatric hospitalists and their perceptions of interprofessional teamwork. We used qualitative methods including free-listing and semi-structured interviews to examine these relationships. We identified five key themes: (a) Pediatric hospitalists' identities fall along a spectrum ranging from profession-centered to team-centered; (b) Familiarity is conducive to formation of team identity; (c) Co-creation of a shared vision and practice of creating shared mental models strengthens sense of team; (d) Institutional culture acts as both a facilitator for and barrier to formation of team identity; (e) High-functioning teams often epitomize the concept of "flexible leadership." We conclude that Social Identity Theory can be a useful theoretical lens for examining interprofessional teamwork in healthcare settings, including among pediatric hospitalists.

Networks of Care: A Social Network Perspective of Distributed Multidisciplinary Care for People With Inflammatory Arthritis

OBJECTIVE

To explore how multidisciplinary inflammatory arthritis (IA) care is accessed from the perspectives of people with IA and their health care network members.

METHODS

In this phenomenological study, we used purposive sampling to recruit patients with IA for less than 5 years and age of more than 18 years who spoke English and reported two or more health care network members. We conducted one-to-one interviews with patients and their health care network members. Data were analysed using a social network perspective.

RESULTS

We interviewed 14 patient participants and 19 health care network members comprising health care providers and informal caregivers. An overarching theme of whole person (holistic) IA care was identified, with the following two broad multifaceted subthemes: 1) connected networks and whole person care and 2) network disconnect and disrupted access to care. The first subtheme notes how access to health care providers and social support was fundamental to holistic care and how care was facilitated by communication pathways that promoted care. The second subtheme illustrates impediments to access, including appointment time pressures, inadequacies in communication delivery modes, and family physicians' unfamiliarity with rheumatology care. Inequities in care were also reported.

CONCLUSION

Participants shared a goal of whole person care. Although health care networks included multiple disciplines, they did not always provide coordinated multidisciplinary care. Communication modes, linkages between network actors, and organizational structures governed the flow of information and resources through networks and influenced access to equitable whole person care. The development of health care system structures to support the flow of information and resource transfer is needed to promote network collaboration and equitable access to resources.

Towards equitable learning environments for medical education: Bias and the intersection of social identities

CONTEXT

Medical educators are increasingly paying attention to how bias creates inequities that affect learners across the medical education continuum. Such bias arises from learners' social identities. However, studies examining bias and social identities in medical education tend to focus on one identity at a time, even though multiple identities often interact to shape individuals' experiences.

METHODS

This article examines prior studies on bias and social identity in medical education, focusing on three social identities that commonly elicit bias: race, gender and profession. By applying the lens of intersectionality, we aimed to generate new insights into intergroup relations and identify strategies that may be employed to mitigate bias and inequities across all social identities.

RESULTS

Although different social identities can be more or less salient at different stages of medical training, they intersect and impact learners' experiences. Bias towards racial and gender identities affect learners' ability to reach different stages of medical education and influence the specialties they train in. Bias also makes it difficult for learners to develop their professional identities as they are not perceived as legitimate members of their professional groups, which influences interprofessional relations. To mitigate bias across all identities, three main sets of strategies can be adopted. These strategies include equipping individuals with skills to reflect upon their own and others' social identities; fostering in-group cohesion in ways that recognise intersecting social identities and challenges stereotypes through mentorship; and addressing intergroup boundaries through promotion of allyship, team reflexivity and conflict management.

CONCLUSIONS

Examining how different social identities intersect and lead to bias and inequities in medical education provides insights into ways to address these problems. This article proposes a vision for how existing strategies to mitigate bias towards different social identities may be combined to embrace intersectionality and develop equitable learning environments for all.