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Evans MK, Lane H, Hitch DP, Tull V, Pepin G. Are two occupational therapists better than one? Occupational therapists' perspectives of intra-disciplinary practice within community health. Aust Occup Ther J 2023; 70:678-689. [PMID: 37438958 DOI: 10.1111/1440-1630.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Intra-disciplinary practice is rarely discussed in occupational therapy and the broader health-care literature. Community-based occupational therapists often work autonomously in clients' homes and consequently have limited access to routine intra-disciplinary practices. Additionally, the community-based role covers a large scope of practice requiring comprehensive expertise. This study aimed to describe occupational therapists' perspectives on intra-disciplinary practice within community health settings. METHODS This study utilised an online cross-sectional survey design, collecting quantitative and qualitative data to explore perspectives of occupational therapists working within Australian community health services. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using thematic analysis. Both forms of data were compared and contrasted. RESULTS/FINDINGS Eighty occupational therapists completed the survey. Seventy-eight participants (97%) previously used or currently use intra-disciplinary practice in their workplace. Participants predominantly consult their peers when client needs are perceived as complex. Participants indicated that intra-disciplinary practice can benefit the client, therapist, and workplace. Enablers and barriers to the use of intra-disciplinary practice had overlapping themes, including access to therapists, attitudes towards intra-disciplinary practice, management support, and funding influences. Most participants expressed a desire to utilise intra-disciplinary practices (n = 70, 87%) and were also likely or extremely likely to incorporate it into their clinical work (n = 73, 91%). Participants who did not want to utilise intra-disciplinary practices or who were unsure provided reasons related to cost, practice inefficiencies, and being uncertain of the benefit. CONCLUSIONS Occupational therapists perceive intra-disciplinary practice as beneficial for problem-solving and an opportunity for knowledge sharing that supports therapist confidence with clinical reasoning. Conversely, some therapists believe its use may lead to client confusion, a greater need for communication and coordination among therapists, and that power differentials between therapists may discourage equal collaboration. Greater understanding of intra-disciplinary practice will help guide how it is used and supported in community health settings.
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Affiliation(s)
| | | | - Danielle Patricia Hitch
- Western Health, St Albans, Victoria, Australia
- Deakin University, Geelong, Victoria, Australia
| | - Victoria Tull
- Fight Parkinson's, Surrey Hills, Victoria, Australia
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Teheux L, Wollaars H, Draaisma JMT, Coolen EHAJ, Kuijer-Siebelink W, van der Velden JAEM. Learning for doctor-to-doctor collaboration: a qualitative study exploring the experiences of residents and supervisors with intraprofessional workplace learning in complex tertiary care. BMC MEDICAL EDUCATION 2023; 23:478. [PMID: 37370026 DOI: 10.1186/s12909-023-04363-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/16/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND To deliver high-quality care for individuals with complex medical conditions, residents need to be trained across the boundaries of their specialties. This study aimed to explore learning activities and influencing factors in intraprofessional workplace learning by residents in complex tertiary care. METHODS This qualitative study was conducted in a tertiary care children's hospital. In September - December 2017, fourteen individual and two focus group interviews were conducted with a purposive sample of residents and supervisors of various specialties. Transcribed interviews were thematically analyzed to describe learning activities and influencing factors that play a role in intraprofessional workplace learning in complex tertiary care settings during residency training. RESULTS Respondents described numerous activities that they considered opportunities for intraprofessional learning, both directly and not directly related to patient care. However, deliberate attention to intraprofessional learning often seemed to be lacking in clinical practice. Influencing factors on a system (macro), organization (meso) and personal and interpersonal level (micro) level were identified. Factors on the macro and meso level mainly determined whether intraprofessional learning opportunities arose, while micro level factors mainly influenced whether opportunities were seized. CONCLUSIONS There are ample opportunities for intraprofessional workplace learning in complex tertiary care for residents. Residents may benefit more from intraprofessional learning opportunities if these are made more intentional and deliberate. Influencing factors at the macro, meso and micro level provide targets for interventions aimed at enhancing intraprofessional workplace learning in postgraduate medical training.
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Affiliation(s)
- Lara Teheux
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands.
| | - Hanna Wollaars
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Ester H A J Coolen
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Wietske Kuijer-Siebelink
- Department of Research on Learning and Education, Radboud University Medical Center, Radboudumc Health Academy, Nijmegen, The Netherlands
- School of Education, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Janssen M, Fluit CRMG, Lubbers RR, Cornelissen SA, de Graaf J, Scherpbier ND. Learning collaboration at the primary-secondary care interface: a dual-method study to define design principles for interventions in postgraduate training programmes. BMC MEDICAL EDUCATION 2023; 23:308. [PMID: 37138295 PMCID: PMC10158135 DOI: 10.1186/s12909-023-04254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Collaboration between primary and secondary care (PSCC) is important to provide patient-centered care. Postgraduate training programmes should provide training to learn PSCC. With a design based research (DBR) approach design principles can be formulated for designing effective interventions in specific contexts. The aim of this study is to determine design principles for interventions aimed to learn PSCC in postgraduate training programmes. METHODS DBR is characterised by multi-method studies. We started with a literature review on learning collaboration between healthcare professionals from different disciplines within the same profession (intraprofessional) to extract preliminary design principles. These were used to inform and feed group discussions among stakeholders: trainees, supervisors and educationalists in primary and secondary care. Discussions were audiotaped, transcribed and analysed using thematic analysis to formulate design principles. RESULTS Eight articles were included in the review. We identified four preliminary principles to consider in the design of interventions: participatory design, work process involvement, personalised education and role models. We conducted three group discussions with in total eighteen participants. We formulated three design principles specific for learning PSCC in postgraduate training programmes: (1) The importance of interaction, being able to engage in a learning dialogue. (2) Facilitate that the learning dialogue concerns collaboration. (3) Create a workplace that facilitates engagement in a learning dialogue. In the last design principle we distinguished five subcategories: intervention emphasises the urge for PSCC and is based on daily practice, the presence of role models, the work context creates time for learning PSCC, learning PSCC is formalised in curricula and the presence of a safe learning environment. CONCLUSION This article describes design principles for interventions in postgraduate training programmes with the aim to learn PSCC. Interaction is key in learning PSCC. This interaction should concern collaborative issues. Furthermore, it is essential to include the workplace in the intervention and make adjacent changes in the workplace when implementing interventions. The knowledge gathered in this study can be used to design interventions for learning PSCC. Evaluation of these interventions is needed to acquire more knowledge and adjust design principles when necessary.
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Affiliation(s)
- Marijn Janssen
- Department of Internal Medicine Nijmegen, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO box 9101, postal route 463, Nijmegen, 6500 HB, The Netherlands.
| | - Cornelia R M G Fluit
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roel R Lubbers
- Department of Internal Medicine Nijmegen, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO box 9101, postal route 463, Nijmegen, 6500 HB, The Netherlands
- Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sylvia A Cornelissen
- Department of Internal Medicine Nijmegen, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO box 9101, postal route 463, Nijmegen, 6500 HB, The Netherlands
- Department Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacqueline de Graaf
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nynke D Scherpbier
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, Groningen, The Netherlands
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van Wijngaarden MT(M, van Asselt DZB(D, Grol SM(, Scherpbier-de Haan ND(N, Fluit CRMG(L. Components and Outcomes in Under- and Postgraduate Medical Education to Prepare for the Delivery of Integrated Care for the Elderly: A Scoping Review. Int J Integr Care 2023; 23:7. [PMID: 37091493 PMCID: PMC10120600 DOI: 10.5334/ijic.6959] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 04/06/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction The ageing society requires physicians who can deliver integrated care, but it is unclear how they should be prepared for doing so. This scoping review aims to create an overview of educational programmes that prepare (future) physicians to deliver integrated care while addressing components and outcomes of the interventions. Method We included papers from five databases that contained: (1) integrated care (2) education programme (3) medical students (4) elderly, or synonyms. We divided the WHO definition of integrated care into ten components for the concept of 'integrated care'. Data were collected with a charting template, and template analysis was used to formulate themes. Results We found 17 educational programmes in different learning settings. All programmes addressed several components of the WHO definition. The programmes primarily focused on care for individual patients (micro-level), and the outcomes suggested that experiencing the complexity of care is key. Conclusion This review revealed the limited evidence on educational programmes about integrated care for the elderly. Our findings suggest that educational programmes on integrated care should not be limited to the micro-level, and that students should obtain adaptive expertise by experiencing complexity. Future research should contain an explicit description and definition of integrated care.
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Affiliation(s)
| | | | - S. M. (sietske) Grol
- Radboud University Medical Center, Corporate Staff Strategy Development, Nijmegen, the Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands
| | | | - C. R. M. G. (Lia) Fluit
- Radboud University Medical Center, Radboudumc Health Academy, Research on Learning and Education, Nijmegen, the Netherlands
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Bajwa NM, Sader J, Kim S, Park YS, Nendaz MR, Bochatay N. Development and validity evidence for the intraprofessional conflict exercise: An assessment tool to support collaboration. PLoS One 2023; 18:e0280564. [PMID: 36800365 PMCID: PMC9937497 DOI: 10.1371/journal.pone.0280564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/02/2023] [Indexed: 02/18/2023] Open
Abstract
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.
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Affiliation(s)
- Nadia M. Bajwa
- Department of General Pediatrics at the Children’s Hospital, Geneva University Hospitals in Geneva, Geneva, Switzerland
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- * E-mail:
| | - Julia Sader
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sara Kim
- Department of Surgery, School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Yoon Soo Park
- MGH Institute of Health Professions at Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Mathieu R. Nendaz
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Naïke Bochatay
- Department of Pediatrics at the University of California, San Francisco, San Francisco, California, United States of America
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Mokoena EM, Rabie T, du Preez A. Challenges in the working relationship between professional nurses and clinical associates in selected district hospitals in South Africa. Health SA 2023; 28:1927. [PMID: 37151614 PMCID: PMC10157416 DOI: 10.4102/hsag.v28i0.1927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/16/2022] [Indexed: 02/25/2023] Open
Abstract
Background Clinical associates were introduced in South Africa to address physician shortages in healthcare. Professional relationships between physicians and professional nurses (PNs) have been widely researched, but none specifically between the new cadre of clinical associates and PNs. Aim This study aimed to understand the professional working relationship between PNs and clinical associates. Setting Selected district hospitals within Mpumalanga Province, South Africa. Method A qualitative descriptive design was used. Professional nurses were purposely sampled, and an all-inclusive sampling method was used for clinical associates in selected district hospitals within Mpumalanga Province, South Africa. Twelve (N = 12) semi-structured, individual interviews (PNs n = 6; clinical associates n = 6) guided by an interview guide were conducted in English. The interviews were audio recorded and transcribed verbatim by an independent transcriptionist. Tesch's eight steps of data analysis were employed to analyse the data. An independent co-coder assisted with data analysis. Results This study yielded four themes: (1) professional relationship defined, (2) professional relationship characteristics, (3) professional challenges applicable to both PNs and clinical associates and (4) personal professional challenges applicable to clinical associates only. Conclusion This study demonstrated that the professional relationships between PNs and clinical associates are affected by various challenges, which could be resolved within the department through in-service training and good communication. Contribution This is one of the first studies that highlight the professional relationship challenges between PNs and clinical associates.
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Mather C, Colgan L, Binnie V, Donn J, McKerlie R, Bell A. COVID-19 Adaptations for Biomedical Teaching and Assessment Within the Undergraduate Dental Curriculum. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1397:43-54. [DOI: 10.1007/978-3-031-17135-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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De Vocht K, Verheyen K, Michels NR. Learning objectives of Belgian general practitioner trainees regarding their hospital training: A qualitative study. Eur J Gen Pract 2022; 28:173-181. [PMID: 35833734 PMCID: PMC9291655 DOI: 10.1080/13814788.2022.2081319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In Europe, hospital training is integrated in the postgraduate curriculum of General Practitioners (GPs) according to the European Directives. However, little is known about the specific learning objectives of GP trainees during this training. Objectives This exploratory study investigated GP trainees’ expected learning objectives for their hospital training and the factors influencing the learning process. Methods Semi-structured interviews were conducted in three focus groups consisting of first-year GP trainees before their hospital training. Data were coded thematically and analysed in NVivo. Results A total of 22 Belgian GP trainees (55% females, average age of 26.2 years) were interviewed. Three major themes emerged: learning objectives, factors influencing learning and organisational aspects. GP trainees mainly wanted to improve their knowledge of common conditions by conducting consultations and follow certain patients’ hospitalisation trajectory. Emergency medicine or internal medicine was the preferred specialty. Other GP trainees wanted to learn more about some specific conditions. Conversely, an overloaded work schedule was dreaded to hinder effective learning. Regular meetings and supervision from their hospital trainer were deemed crucial to strengthen GP trainees’ learning trajectory. Conclusion GP trainees wanted to learn more about both common conditions and some specific conditions. Their previous year in a GP setting strengthened their confidence and facilitated purposeful learning. Relieving GP trainees from administrative tasks when working as supplementary doctors could strike a better balance between the continuity of the clinical department and their personal learning objectives.
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Affiliation(s)
- Kimberley De Vocht
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Katleen Verheyen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Nele R Michels
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Learning mechanisms and outcomes of an interprofessional molecular pathology workshop for residents. Acad Pathol 2022; 9:100056. [PMID: 36281273 PMCID: PMC9587361 DOI: 10.1016/j.acpath.2022.100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/10/2022] [Accepted: 09/03/2022] [Indexed: 11/06/2022] Open
Abstract
The developments in targeted therapies and molecular pathology have changed the classification of tumors and precision oncology. Pathologists and clinical scientists in molecular pathology and oncologists have regular multidisciplinary meetings and are responsible for translating molecular results into an appropriate treatment plan. This requires expertise and skills to be effective team players. Interprofessional collaboration (IPC) is essential for professionals in medicine; however, learning opportunities in current resident training are limited. This narrative study explores the collaborative output and learning mechanisms of interprofessional learning (IPL) of residents of different disciplines in the Morphology & MolecularPLUS workshop and its preparation. Topics that were discussed in the workshop were technologies for the detection of mutations, copy number variations, tumor mutational burden, and circulating tumor DNA (ctDNA) analysis in the context of differential diagnosis and precision oncology. Data were collected by analyzing pre- and post-workshop questionnaires and interviews. An interprofessional team of three residents of each hospital had to be formed by one of the residents, which was challenging as not all residents from a hospital knew each other. Residents reported to have got to know each other and have learned about each other's roles and perspectives. They gained knowledge of molecular pathology and the added value of IPC, in particular, for residents early in their training. Enabling meetings for medical residents of different disciplines to get acquainted was perceived as the most facilitating factor for IPL. Time constraints as the biggest barrier in daily practice. We recommend offering IPL activities as early as possible in residency programs.
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AlSarhan MA, Alaqeely RS, Ahmedani MS, AL Jasser RN, Alotaibi DH, Aloraini SS, Habib SR. Dental students' attitudes and perceptions about intraprofessional collaboration/education. J Taibah Univ Med Sci 2022; 18:287-294. [PMID: 36817224 PMCID: PMC9926108 DOI: 10.1016/j.jtumed.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/22/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022] Open
Abstract
Objectives To investigate dental students' attitudes and perceptions about intraprofessional collaboration/education (IPC/IPE) and shared learning, and to explore the impact of IPC/IPE on the personal and professional development of participating students. Methods A custom-designed questionnaire was used in this cross-sectional study. The questionnaire comprised 17 questions targeting to capture the student's perceptions about IPC/IPE using three factors: (1) dental students' preference/opinion about the IPC/IPE; (2) dental students' experience about the impact of IPC/IPE on learning outcomes and professional development; and (3) students' feedback about the significance of IPC/IPE in clinical/clinical simulation labs and workplace setting. The students rated each of the 17 statements on the 5-point Likert scale (range: 1 = strongly disagree to 5 = strongly agree). Results A total of 259 responses were analysed (response rate = 65%). All students were aware of IPC/IPE in the field of dentistry (mean score = 4.22). The students preferred collaborative/shared learning with their own classmates. There was a consensus among students about the positive impact of IPC/IPE on enhanced learning, enhancement of communication skills, and enrichment of professional relationships with supporting staff as well as with the patients. There was also improved analytical and psychomotor skills, understanding of complex problems in the clinic, and understanding of strengths and limitations leading to self-improvement and increased efficiency and productivity. Conclusion IPC/IPE had a compelling, powerful, and positive impact according to the experience of the participating dental students. It is recommended that a standardized curriculum be designed and guidelines set for IPC/IPE at dental institutions for effective interactions among students of all stages.
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Affiliation(s)
- Mohammed A. AlSarhan
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Razan S. Alaqeely
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Shoaib Ahmedani
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Reham N. AL Jasser
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Dalal H. Alotaibi
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Saleh S. Aloraini
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Syed R. Habib
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia,Corresponding address: Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
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Attivissimo LA, Friedman MI, Williams M, Rimar A, Nouryan C, Patel V, Kozikowski A, Zhang M, Pekmezaris R. Goals of care conversation education program: An intervention to help health care professionals break bad news to patients with advanced illness. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:407-417. [PMID: 33627035 DOI: 10.1080/02701960.2021.1893171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The purpose of the study was to measure the effectiveness of communication skills intervention results for healthcare professionals. A multi-site pretest-posttest survey assessing the efficacy of a Goals of Care conversation education program. The program aimed to educate healthcare professionals concerning having Goals of Care conversations with patients and families. This research was implemented in a large healthcare organization in the Northeastern United States. This study found significant differences between pretests and posttests across professions, palliative care specialty, degree types, and years of experience in the participant's self-reported ability and comfort levels in having conversations about Goals of Care with patients and families. Providing education on Goals of Care was effective in improving the knowledge and comfort of health care professionals with conducting advanced illness conversations.
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Affiliation(s)
| | - M Isabel Friedman
- Department of Clinical Transformation, Northwell, Lake Success, New York, USA
| | - Myia Williams
- Department of Medicine, Northwell Health, Manhasset, New York, USA
| | - Alexander Rimar
- Department of Medicine, Long Island Jewish Medical Center, Queens, New York, USA
| | - Christian Nouryan
- Department of Medicine, Northwell Health, Manhasset, New York, USA
- Department of Medicine, The Feinstein Institute for Medical Research, Manhasset, New York, USA
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Vidhi Patel
- Department of Medicine, Northwell Health, Manhasset, New York, USA
| | - Andrzej Kozikowski
- Department of Medicine, Northwell Health, Manhasset, New York, USA
- Department of Medicine, The Feinstein Institute for Medical Research, Manhasset, New York, USA
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Meng Zhang
- Department of Medicine, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Renee Pekmezaris
- Department of Medicine, Northwell Health, Manhasset, New York, USA
- Department of Medicine, The Feinstein Institute for Medical Research, Manhasset, New York, USA
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Meeker D, Friedberg MW, Knight TK, Doctor JN, Zein D, Cayasso-McIntosh N, Goldstein NJ, Fox CR, Linder JA, Persell SD, Dea S, Giboney P, Yee HF. Effect of Peer Benchmarking on Specialist Electronic Consult Performance in a Los Angeles Safety-Net: a Cluster Randomized Trial. J Gen Intern Med 2022; 37:1400-1407. [PMID: 34505234 PMCID: PMC8428492 DOI: 10.1007/s11606-021-07002-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since the advent of COVID-19, accelerated adoption of systems that reduce face-to-face encounters has outpaced training and best practices. Electronic consultations (eConsults), structured communications between PCPs and specialists regarding a case, have been effective in reducing face-to-face specialist encounters. As the health system rapidly adapts to multiple new practices and communication tools, new mechanisms to measure and improve performance in this context are needed. OBJECTIVE To test whether feedback comparing physicians to top performing peers using co-specialists' ratings improves performance. DESIGN Cluster-randomized controlled trial PARTICIPANTS: Eighty facility-specialty clusters and 214 clinicians INTERVENTION: Providers in the feedback arms were sent messages that announced their membership in an elite group of "Top Performers" or provided actionable recommendations with feedback for providers that were "Not Top Performers." MAIN MEASURES The primary outcomes were changes in peer ratings in the following performance dimensions after feedback was received: (1) elicitation of information from primary care practitioners; (2) adherence to institutional clinical guidelines; (3) agreement with peer's medical decision-making; (4) educational value; (5) relationship building. KEY RESULTS Specialists showed significant improvements on 3 of the 5 consultation performance dimensions: medical decision-making (odds ratio 1.52, 95% confidence interval 1.08-2.14, p<.05), educational value (1.86, 1.17-2.96) and relationship building (1.63, 1.13-2.35) (both p<.01). CONCLUSIONS The pandemic has shed light on clinicians' commitment to professionalism and service as we rapidly adapt to changing paradigms. Interventions that appeal to professional norms can help improve the efficacy of new systems of practice. We show that specialists' performance can be measured and improved with feedback using aspirational norms. TRIAL REGISTRATION clinicaltrials.gov NCT03784950.
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Affiliation(s)
- Daniella Meeker
- Department of Population and Public Health Sciences, University of Southern California, 2250 Alcazar St, Los Angeles, CA, 90033, USA.
| | - Mark W Friedberg
- Brigham and Women's Hospital, Boston, MA, USA
- Blue Cross Blue Shield of Massachusetts, Boston, MA, USA
| | - Tara K Knight
- Sol Price School of Public Policy & Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Jason N Doctor
- Sol Price School of Public Policy & Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Dina Zein
- Department of Population and Public Health Sciences, University of Southern California, 2250 Alcazar St, Los Angeles, CA, 90033, USA
| | | | - Noah J Goldstein
- Anderson School of Management, University of California, Los Angeles, Los Angeles, USA
| | - Craig R Fox
- Anderson School of Management, University of California, Los Angeles, Los Angeles, USA
| | - Jeffrey A Linder
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephen D Persell
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stanley Dea
- Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Paul Giboney
- Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Hal F Yee
- Los Angeles County Department of Health Services, Los Angeles, CA, USA
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Looman N, van Woezik T, van Asselt D, Scherpbier‐de Haan N, Fluit C, de Graaf J. Exploring power dynamics and their impact on intraprofessional learning. MEDICAL EDUCATION 2022; 56:444-455. [PMID: 34841565 PMCID: PMC9300127 DOI: 10.1111/medu.14706] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 05/12/2023]
Abstract
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.
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Affiliation(s)
- Natasja Looman
- Department of Primary and Community CareRadboudumcNijmegenThe Netherlands
| | - Tamara van Woezik
- Department of Primary and Community CareRadboudumcNijmegenThe Netherlands
| | | | - Nynke Scherpbier‐de Haan
- Department of General Practice and Elderly CareUniversity Medical Centre GroningenThe Netherlands
| | - Cornelia Fluit
- Department for Research in Learning and EducationRadboudumc Health AcademyNijmegenThe Netherlands
| | - Jacqueline de Graaf
- Department of Internal MedicineRadboudumc Health AcademyNijmegenThe Netherlands
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14
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Howey ML, Yoon MN. Insights in interprofessional education: Dental hygiene students' suggestions for collaboration. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2022; 56:9-21. [PMID: 35401761 PMCID: PMC8937569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 06/14/2021] [Accepted: 09/08/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Interprofessional education (IPE) promotes team-based approaches to professional practice and lifelong collaboration. However, there is little consensus on its "best practice" in dentistry and dental hygiene curricula. This study aimed to explore dental hygiene students' perceptions and experiences of collaboration with dentistry students in an IPE program that authentically represents private practice settings and work processes. The intent was to identify what students thought would best help prepare them to work collaboratively in an oral health team once they graduated after participating in this experience. METHODS Data were collected from 40 dental hygiene student written reflections and 6 dental hygiene students through a focus group session that was audiorecorded and transcribed. Data were examined using thematic analysis. RESULTS Five interrelated themes emerged: 1) understanding of roles and responsibilities; 2) hierarchical perceptions and level of experience; 3) team dynamics; 4) instructor and staff involvement and support; and 5) timing and structure of IPE activities. The findings suggest that dental hygiene students need consistent and sustained access to realistic environments in which to practise team roles and work directly with dentistry students. Opportunities to build relationships with dentistry students before working together in professional roles appear to alleviate hierarchical concerns that impede teamwork. CONCLUSION IPE should occur throughout students' education as hierarchical perceptions appear to influence collaboration. Informal and/or non-clinical IPE opportunities should be introduced early in students' education to develop a foundation for team dynamics in later formal and/or clinical IPE activities. Students should collaborate in ways that will be reflected in professional expectations after graduation; the environment in which they learn their team role should provide the opportunity to authentically practise it.
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Affiliation(s)
- Madison L Howey
- Research assistant, Educational Research & Scholarship Unit, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Minn N Yoon
- Associate professor, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
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15
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Teheux L, Coolen EHAJ, Draaisma JMT, de Visser M, Scherpbier-de Haan ND, Kuijer-Siebelink W, van der Velden JAEM. Intraprofessional workplace learning in postgraduate medical education: a scoping review. BMC MEDICAL EDUCATION 2021; 21:479. [PMID: 34493263 PMCID: PMC8424991 DOI: 10.1186/s12909-021-02910-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/22/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND Residents need to be trained across the boundaries of their own specialty to prepare them for collaborative practice. Intraprofessional learning (i.e. between individuals of different disciplines within the same profession) has received little attention in the postgraduate medical education literature, in contrast to the extensive literature on interprofessional learning between individuals of different professions. To address this gap, we performed a scoping review to investigate what and how residents learn from workplace-related intraprofessional activities, and what factors influence learning. METHODS The PRISMA guidelines were used to conduct a scoping review of empirical studies on intraprofessional workplace learning in postgraduate medical education published between 1 January 2000 to 16 April 2020 in Pubmed, Embase, PsycINFO, ERIC and Web of Science. This study applied 'best fit' framework-based synthesis to map the existing evidence, using the presage-process-product (3P) model developed by Tynjälä (2013). RESULTS Four thousand three hundred thirty records were screened, and 37 articles were included. This review identified influencing (presage) factors that derived from the sociocultural environment, learner and learning context. Studies described that complexity of care can both facilitate and hinder learning. Furthermore, intraprofessional learning is threatened by professional stereotyping and negative perceptions, and awareness of learning opportunities and explicit reflection are critical in intraprofessional workplace learning. Studies described a range of informal and formal intraprofessional activities (process) under the headings of collaboration in clinical practice, rotations or placements, formal educational sessions and simulated workplace training. In general, learners responded well and their attitudes and perceptions improved, learners reported increased knowledge and skills and positive behavioural changes (product). Learning outcomes were reported in the domains of patient-centred care, collaborative attitudes and respect, mutual knowledge and understanding, collaborative decision making, communication, leadership, teamwork and reflexivity. CONCLUSIONS This review gives insight into the high learning potential of intraprofessional activities. Many of the included studies relied on self-reported perceptions of change, therefore, future research should focus on generating more robust evidence including objectively examined outcome measures. This review offers a comprehensive overview of the factors that influence intraprofessional workplace learning in postgraduate medical education. Finally, we provide recommendations for enhancing intraprofessional learning in clinical practice.
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Affiliation(s)
- Lara Teheux
- Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Ester H A J Coolen
- Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke de Visser
- Department of Research on Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nynke D Scherpbier-de Haan
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wietske Kuijer-Siebelink
- Department of Research on Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
- HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Janiëlle A E M van der Velden
- Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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16
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Michels NRM, Maagaard R, Švab I, Scherpbier N. Teaching and Learning Core Values in General Practice/Family Medicine: A Narrative Review. Front Med (Lausanne) 2021; 8:647223. [PMID: 34046417 PMCID: PMC8145612 DOI: 10.3389/fmed.2021.647223] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/08/2021] [Indexed: 12/03/2022] Open
Abstract
General Practice/Family Medicine (GP/FM) is a key discipline within primary health care and so by extension for the whole health care system. An essential condition for effective GP/FM care is a work force that is highly qualified. As society is changing rapidly, a revision of the GP/FM definition is ongoing, in addition to a recent movement of identifying related core values. In this paper, we want to give an overview on how these new paths and perspectives are currently reflected in GP/FM teaching and training. We selected four core values that fit in with possible future visions: person-centered care, continuity of care, cooperation in care, and community-oriented care. By a narrative review, we observed that GP/FM education toward core values is often built around overarching topics. Teaching and learning take place in specific contexts, most of all through placements within communities, primary care settings, or hospital wards. Mixed teaching- and training methods are used combining knowledge, skills, and attitude. Furthermore, collaboration with other health professionals and peers is stressed, in addition to the importance of role models, a holistic focus and the involvement of patients. Since these core values are important within GP/FM and rather few studies on the educational aspects and learning tools were found we advocate encouraging each other more to share good practices, certainly the innovative ones specifically related to GP/FM.
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Affiliation(s)
- Nele R M Michels
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Roar Maagaard
- Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark
| | - Igor Švab
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nynke Scherpbier
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
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van Tuijl AAC, Houwen J, Fluit CRMG, Scherpbier-de Haan NND. Lessons learned for intraprofessional learning between primary and secondary care trainees. EDUCATION FOR PRIMARY CARE 2021; 32:374-375. [PMID: 33942702 DOI: 10.1080/14739879.2021.1909429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Anne A C van Tuijl
- Department of Primary and Community Care, Radboud University Medical center, Nijmegen, The Netherlands,
| | - Juul Houwen
- Department of Primary and Community Care, Radboud University Medical center, Nijmegen, The Netherlands
| | - Cornelia R M G Fluit
- Department for research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
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Meijer LJ, de Groot E, Honing-de Lange G, Kearney G, Schellevis FG, Damoiseaux RAMJ. Transcending boundaries for collaborative patient care. MEDICAL TEACHER 2021; 43:27-31. [PMID: 32767903 DOI: 10.1080/0142159x.2020.1796947] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dutch general practitioners (GPs) and medical specialists (MSs) create collaborative patient care agreements (CPCAs) to improve intraprofessional collaboration. We set out to identify contradictions between the activity systems of primary and secondary care that could result in expansive learning and new ways of working collaboratively. We analysed nineteen semi-structured interviews using activity theory (AT) as a theoretical framework and using these two activity systems as the units of analysis. There were contradictions within and between the activity systems related, for example, to different understandings of 'care' in generalist and specialist settings. GPs and MSs were able to identify contradictions and learn expansively when they iteratively co-created CPCAs in groups. They found it much harder to tackle contradictions, however, when they disseminated these tools within their respective professional communities, leaving unresolved contradictions and missed opportunities for collaboration. This research shows the educational benefits of taking collective responsibility for improving collaborative patient care.
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Affiliation(s)
- Loes J Meijer
- Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
| | - Esther de Groot
- Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
| | - Gerdine Honing-de Lange
- Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
| | - Grainne Kearney
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - François G Schellevis
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Roger A M J Damoiseaux
- Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
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Looman N, Fluit C, van Wijngaarden M, de Groot E, Dielissen P, van Asselt D, de Graaf J, Scherpbier‐de Haan N. Chances for learning intraprofessional collaboration between residents in hospitals. MEDICAL EDUCATION 2020; 54:1109-1119. [PMID: 32564390 PMCID: PMC7754101 DOI: 10.1111/medu.14279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 05/13/2023]
Abstract
CONTEXT Intraprofessional collaboration (intraPC) between primary care (PC) doctors and medical specialists (MSs) is becoming increasingly important. Patient safety issues are often related to intraPC. In order to equip doctors well for their task of providing good quality and continuity of care, intraPC needs explicit attention, starting in postgraduate training. Worldwide, PC residents undertake a hospital placement during their postgraduate training, where they work in proximity with MS residents. This placement offers the opportunity to learn intraPC. It is yet unknown whether and how residents learn intraPC and what barriers to and opportunities for exist in learning intraPC during hospital placements. METHODS We performed an ethnographic non-participatory observational study in three emergency departments and three geriatric departments of five hospitals in the Netherlands. This was followed by 42 in-depth interviews with the observed residents and supervisors. The observations were used to feed the questions for the in-depth interviews. We analysed the interviews iteratively following the data collection using template analysis. RESULTS Hospital wards are rich in opportunities for learning intraPC. These opportunities, however, are seldom exploited for various reasons: intraPC receives limited attention when formulating placement goals, so purposeful learning of intraPC hardly takes place; residents lack awareness of the learning of intraPC; MS residents are not accustomed to searching for expertise from PC residents; PC residents adapt to the MS role and they contribute very little of their PC knowledge, and power dynamics in the hospital department negatively influence the learning of intraPC. Therefore, improvements in mindset, professional identity and power dynamics are crucial to facilitate and promote intraPC. CONCLUSIONS Intraprofessional collaboration is not learned spontaneously during hospital placements. To benefit from the abundant opportunities to learn intraPC, adjustments to the set-up of these placements are necessary. Learning intraPC is promoted when there is a collaborative culture, hierarchy is limited, and there is dedicated time for intraPC and support from the supervisor.
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Affiliation(s)
- Natasja Looman
- Department of Primary and Community CareRadboudumcNijmegenthe Netherlands
| | - Cornelia Fluit
- Department for Research in Learning and EducationRadboudumc Health AcademyNijmegenthe Netherlands
| | - Marielle van Wijngaarden
- Department of Primary and Community CareRadboudumcNijmegenthe Netherlands
- Department of Geriatric MedicineRadboudumcNijmegenthe Netherlands
| | - Esther de Groot
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Patrick Dielissen
- Department of Primary and Community CareRadboudumcNijmegenthe Netherlands
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20
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Competencies to promote collaboration between primary and secondary care doctors: an integrative review. BMC FAMILY PRACTICE 2020; 21:179. [PMID: 32878620 PMCID: PMC7469099 DOI: 10.1186/s12875-020-01234-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 07/29/2020] [Indexed: 12/02/2022]
Abstract
Background In a society where ageing of the population and the increasing prevalence of long-term conditions are major issues, collaboration between primary and secondary care is essential to provide continuous, patient-centred care. Doctors play an essential role at the primary-secondary care interface in realising ‘seamless’ care. Therefore, they should possess collaborative competencies. However, knowledge about these collaborative competencies is scarce. In this review we explore what competencies doctors need to promote collaboration between doctors at the primary-secondary care interface. Methods We conducted an integrative literature review. After a systematic search 44 articles were included in the review. They were analysed using a thematic analysis approach. Results We identified six themes regarding collaborative competencies: ‘patient-centred care: a common concern’, ‘roles and responsibilities’, ‘mutual knowledge and understanding’, ‘collaborative attitude and respect’, ‘communication’ and ‘leadership’. In every theme we specified components of knowledge, skills and attitudes as found in the reviewed literature. The results show that doctors play an important role, not only in the way they collaborate in individual patient care, but also in how they help shaping organisational preconditions for collaboration. Conclusions This review provides an integrative view on competencies necessary for collaborative practice at the primary-secondary care interface. They are part of several domains, showing the complexity of collaboration. The information gathered in this review can support doctors to enhance and learn collaboration in daily practice and can be used in educational programmes in all stages of medical education.
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21
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Boeckxstaens P, Brown JB, Reichert SM, Smith CNC, Stewart M, Fortin M. Perspectives of specialists and family physicians in interprofessional teams in caring for patients with multimorbidity: a qualitative study. CMAJ Open 2020; 8:E251-E256. [PMID: 32253205 PMCID: PMC7144580 DOI: 10.9778/cmajo.20190222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with multimorbidity often require services across different health care settings, yet team processes among settings are rarely implemented. We explored perceptions of specialists and family physicians collaborating in a telemedicine interprofessional consultation for patients with multimorbidity to better understand the value of bringing physicians together across the boundaries of health care settings. METHODS This was a descriptive qualitative, interview-based study. Physicians who had previously participated in the Telemedicine Interprofessional Model of Practice for Aging and Complex Treatments (Telemedicine IMPACT Plus [TIP] Program) were invited to participate and asked to describe their experience of being a member of the program. Interviews were conducted from March to May 2016. We conducted an iterative and interpretive process using both individual and team analysis to identify themes. RESULTS There were 15 participants, 9 specialists and 6 family physicians. Three themes emerged in the analysis: creating new perspectives on care for patients with multimorbidity by sharing knowledge, skills and attitudes; the shift from a consultant model to an interprofessional team model (allowing a window into the community, extending discussions beyond the medical model and focusing on the patient's health in context); and opportunities for learners, including learning about interprofessional collaboration and gaining exposure to a real-world model for caring for people with multimorbidity in outpatient settings. INTERPRETATION Family physicians and specialists participating in a TIP Program believed the program improved their knowledge and skills, while also serving as an effective care delivery strategy. The findings also support that learners require more exposure to nontraditional consultant models in order to care for patients with multimorbidity effectively.
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Affiliation(s)
- Pauline Boeckxstaens
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.
| | - Judith Belle Brown
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Sonja M Reichert
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Christopher N C Smith
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Moira Stewart
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Martin Fortin
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
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22
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Abstract
Inter-professional education (IPE) can support professionals in developing their ability to work collaboratively. This position paper from the European Forum for Primary Care considers the design and implementation of IPE within primary care. This paper is based on workshops and is an evidence review of good practice. Enablers of IPE programmes are involving patients in the design and delivery, providing a holistic focus, focussing on practical actions, deploying multi-modal learning formats and activities, including more than two professions, evaluating formative and summative aspects, and encouraging team-based working. Guidance for the successful implementation of IPE is set out with examples from qualifying and continuing professional development programmes.
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