Interprofessional Education and Practice Guide No. 6: Developing practice-based interprofessional learning using a short placement model

Video-based peer assessment of collaborative teamwork in a large-scale interprofessional learning activity

BACKGROUND

The assessment of team performance within large-scale Interprofessional Learning (IPL) initiatives is an important but underexplored area. It is essential for demonstrating the effectiveness of collaborative learning outcomes in preparing students for professional practice. Using Kane's validity framework, we investigated whether peer assessment of student-produced videos depicting collaborative teamwork in an IPL activity was sufficiently valid for decision-making about team performance, and where the sources of error might lie to optimise future iterations of the assessment.

METHODS

A large cohort of health professional students (n = 1218) of 8 differing professions was divided into teams containing 5-6 students. Each team collaborated on producing a short video to evidence their management of one of 12 complex patient cases. Students from two other teams, who had worked on the same case, individually rated each video using a previously developed assessment scale. A generalisability study quantified sources of error that impacted the reliability of peer assessment of collaborative teamwork. A decision study modeled the impact of differing numbers of raters. A modified Angoff determined the pass/fail mark.

RESULTS

Within a large-scale learning activity, peer assessment of collaborative teamwork was reliable (G = 0.71) based on scoring by students from two teams (n = 10-12) for each video. The main sources of variation were the stringency and subjectivity of fellow student assessors. Whilst professions marked with differing stringency, and individual student assessors had different views of the quality of a particular video, none of that individual assessor variance was attributable to the assessors' profession. Teams performed similarly across the 12 cases overall, and no particular professions marked differently on any particular case.

CONCLUSION

A peer assessment of a student-produced video depicting interprofessional collaborative teamwork around the management of complex patient cases can be valid for decision-making about student team performance. Further refining marking rubrics and student assessor training could potentially modify assessor subjectivity. The impact of professions on assessing individual peers and the case-specificity of team performances in IPL settings need further exploration. This innovative approach to assessment offers a promising avenue for enhancing the measurement of collaborative learning outcomes in large-scale Interprofessional learning initiatives.

Successful implementation of interprofessional education: A pedagogical design perspective

Interprofessional collaboration (IPC) is crucial within healthcare teams that must provide safe and quality care to their patients. Competent professionals in this area offer better care and contribute to a medical culture where IPC and teamwork are valued. To become competent, they must be adequately trained. Unfortunately, the literature describes that collaboration training is uneven across professions. Interprofessional education (IPE) could fill this educational gap but remains challenging to implement. This article aims to present ten clear and concise considerations to implementing IPE initiatives successfully, following a well-described pedagogical designing process. After reading, the clinician-educator will be informed of the newest evidence in IPE as well as the common pitfalls to avoid. From the starting point of a recent synthesis article on IPE, several additional syntheses, analyses, and recommendations articles were consulted and synthesized. From that, the findings are organized according to the "ADDIE" model, a flexible methodology used in pedagogical design through iterative cycles in context. The phases of "ADDIE" are analysis, design, development, implementation, and evaluation. According to these phases, the considerations will be presented to allow the reader to apply them "step by step" in their educational planning process. Ten considerations are presented, from the needs analysis, stakeholders and Faculty involvement, composition of the design team, selection of students and types of learning activity, the role of reflexivity, training of facilitators, supervision, and the continuous improvement process. Taken together, these will contribute to highlighting the essential nature of training in collaboration in modern professionalizing programs.

Exploring experiential learning within interprofessional practice education initiatives for pre-licensure healthcare students: a scoping review

BACKGROUND

Interprofessional collaborative team-based approaches to care in health service delivery has been identified as important to health care reform around the world. Many academic institutions have integrated interprofessional education (IPE) into curricula for pre-licensure students in healthcare disciplines, but few provide formal initiatives for interprofessional practice (IPP). It is recognized that experiential learning (EL) can play a significant role supporting IPP education initiatives; however, little is known of how EL is used within education for IPP in healthcare settings.

METHODS

We conducted a scoping review to map peer-reviewed literature describing IPP education initiatives involving EL for pre-licensure students in healthcare disciplines. A literature search was executed in MEDLINE, CINAHL, EMBASE, ERIC, PsycINFO, Scopus, and Social Services Abstracts. After deduplication, two independent reviewers screened titles and abstracts of 5664 records and then 252 full-text articles that yielded 100 articles for data extraction. Data was extracted using an Excel template, and results synthesized for presentation in narrative and tabular formats.

RESULTS

The 100 included articles represented 12 countries and IPP education initiatives were described in three main typologies of literature - primary research, program descriptions, and program evaluations. Forty-three articles used a theory, framework, or model for design of their initiatives with only eight specific to EL. A variety of teaching and learning strategies were employed, such as small interprofessional groups of students, team huddles, direct provision of care, and reflective activities, but few initiatives utilized a full EL cycle. A range of perspectives and outcomes were evaluated such as student learning outcomes, including competencies associated with IPP, impacts and perceptions of the IPP initiatives, and others such as client satisfaction.

CONCLUSION

Few educational frameworks specific to EL have been used to inform EL teaching and learning strategies to consolidate IPE learning and prepare students for IPP in healthcare settings. Further development and evaluation of existing EL frameworks and models would be beneficial in supporting robust IPP educational initiatives for students in healthcare disciplines. Intentional, thoughtful, and comprehensive use of EL informed by theory can contribute important advances in IPP educational approaches and the preparation of a future health care workforce.

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

Introduction

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

Methods

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

Results

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

Discussion

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

Determining the impact of an interprofessional learning in practice model on learners and patients

The Institute of Medicine recently expressed a need to measure the impact of interprofessional education (IPE) on health professions collaborative behavior in practice environments and patient outcomes, and the National Center for Interprofessional Practice and Education has focused research efforts to connect interprofessional practice and education. We describe a model intentionally designed to link interprofessional practice experience in ambulatory care setting and an IPE curriculum for students, called the Interprofessional Learning in Practice (ILIP) model. The study objective was to determine the impact of the ILIP model on student and patient outcomes during a 24-month intervention period. Student satisfaction was collected through a brief survey administered post-ILIP model. Patient outcomes were collected from before and after the intervention period through a retrospective chart review of patients who received care through the ILIP model. For the study, disease indicators for the top three chronic diagnoses of depression, hypertension, and type 2 diabetes mellitus were chosen as the patient outcomes. Student outcomes were analyzed using descriptive statistics and the Mann-Whitney U test. Patient outcomes were analyzed using McNemar's test and paired t-tests. Of the 382 students who participated in the ILIP model during the study period, 179 completed surveys, indicating that they valued the experience, valued learning from interprofessional preceptors, and gained interprofessional skills to use in their future practice. During the 24-month intervention, 401 patients were evaluated post-ILIP model, statistically significant results demonstrated HbA1c values for patients with diabetes were reduced by 0.5% and depression screening improved from 9% to 91%. Additionally, patients' hypertension control was similar to baseline and diabetes control (as defined as HbA1c ≤8%) was improved compared to baseline but did not reach statistical significance. By aligning interprofessional practice and education in the ILIP model, students had a positive experience, gained interprofessional collaboration skills, and provided value-added benefits to improve patient outcomes.

Conceptualisation, development and implementation of Interprofessional Education programmes: A qualitative document analysis

Interprofessional Education (IPE) occurs when two or more health professionals learn with, from and about each other to improve collaboration within a healthcare team and represents a key step towards the realisation of Interprofessional Collaborative Practice (IPCP) which, in turn, enhances the healthcare outcomes of patients. Many health professions education institutions are taking on the challenge of developing IPE programmes and it is essential to provide evidence-based information to guide these institutions in their journey. We analysed the IPE programmes of six health professions education institutions from High-Income Countries and Low- and Middle-Income Countries according to the 12 steps of IPE programme introduction for health professions. This paper provides a step-by-step guide and 'to-do list' to help educators to conceptualise, develop, implement and review their IPE programmes. We recommend that institutions review and contextualise these findings and implement them in their IPE programmes from conception to final review.

Teaching interprofessional collaboration among future healthcare professionals

Healthcare has become more complex in recent years. Such complexity can best be addressed by interprofessional teams. We argue that to ensure successful communication and cooperation in interprofessional teams, it is important to establish interprofessional education in health-related study programs. More precisely, we argue that students in health-related programs need to develop interprofessional competencies and a common language, experience interprofessional contact, build inclusive identities and establish beliefs in the benefit of interprofessional diversity. We give examples how these goals can be implemented in interprofessional education. We also discuss challenges and future avenues for respective research healthcare professionals.

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

BACKGROUND

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

METHOD

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

RESULTS

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

DISCUSSION

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

Interprofessional education and practice guide: profiling readiness for practice-based IPE

Practice-based interprofessional education (IPE) is both a valuable and complex model of practice education. To support educators design, deliver, and implement high-quality practice-based IPE, this guideline was developed in conjunction with a placement profile. Underpinned by educational theory, this guideline and placement profile identifies key factors to consider before, during, and after practice-based IPE. Development of the profile has involved interprofessional collaboration as well as international feedback via conference workshops. The profile has been trialed in two clinical sites involved in practice-based IPE and refined following consultation with and feedback from educators. Educators can also use the profile to track site development over time and evidence resource and support requirements. Through use additional features may become relevant and users are encouraged to add or amend as is most beneficial to their site.

Challenges and opportunities for educating health professionals after the COVID-19 pandemic

The education of health professionals substantially changed before, during, and after the COVID-19 pandemic. A 2010 Lancet Commission examined the 100-year history of health-professional education, beginning with the 1910 Flexner report. Since the publication of the Lancet Commission, several transformative developments have happened, including in competency-based education, interprofessional education, and the large-scale application of information technology to education. Although the COVID-19 pandemic did not initiate these developments, it increased their implementation, and they are likely to have a long-term effect on health-professional education. They converge with other societal changes, such as globalisation of health care and increasing concerns of health disparities across the world, that were exacerbated by the pandemic. In this Health Policy, we list institutional and instructional reforms to assess what has happened to health-professional education since the publication of the Lancet Commission and how the COVID-19 pandemic altered the education process.

Design and evaluation of a team-based interprofessional practice placement: A design-based research approach

INTRODUCTION

Team-based Interprofessional Practice Placements (TIPPs) are innovative training practices. Evidence to substantiate the design of TIPPs is limited. This study explores the design and evaluation of TIPPs to support undergraduate students in gaining a better understanding of the complexity of patient problems in primary care settings and of collaboration within interprofessional teams.

METHOD

We implemented TIPPs at a University of Applied Sciences, Belgium based on three principles: (1) authentic tasks with real clients, (2) students collaborated in small interprofessional teams, and (3) students were supported by teachers. TIPPs were evaluated using focus groups (N = 5) that explored teachers' (N = 13) and students' (N = 22) experiences. Data were analysed thematically.

RESULTS

Three themes were constructed. First, TIPPs enhance students' understanding of the complexity of clients' problems and what matters to the client. Second, TIPPs support students to value the expertise of interprofessional team members. Finally, to enhance students' learning, TIPPs must strike an appropriate balance between teacher support and student autonomy.

CONCLUSION

The three design principles used to underpin the TIPPs were viable. Although students reported to receive sufficient support, they also felt this support should have been gradually withdrawn to offer more opportunities for autonomous learning. Teachers reported difficulties in balancing their support.

Models of interprofessional education for healthcare students: a scoping review

The interprofessional education (IPE) literature abounds with examples of IPE and their evaluations, invariably demonstrating improved outcomes for collaborative care. The aim of this research was to identify models of IPE in health curricula reported in the literature to clarify key characteristics of the models. Searches were conducted in Pubmed (Ebsco), CINAHL (Ebsco), Cochrane Library, PsychINFO (Ebsco), Scopus, Web of Science, and Google Scholar databases for articles describing models of IPE. A total of 25 papers met the inclusion criteria. Models fell broadly into: (a) extra-curricular activities or partially integrated models (28%), and (b) integrated models, that is, models where IP activities were embedded across the whole curriculum (72%). A total of 40% of included papers presented phased models designed to incrementally develop interprofessional capability. However, major barriers exist to fully integrated interprofessional curricula: they require a major curriculum restructure, and a willingness on the part of health professionals to reconsider their professional identities. A curriculum that focuses on the patient and on ways to deliver the most appropriate personalized care is proposed. In such a curriculum, the focus can shift from profession-based care to expertise-based care that is likely to be delivered by a team of skilled health professionals.

Introduction to Interdisciplinary Roles in a Nursing Leadership Course: If I Understand You, Then I Know How to Work With You

ABSTRACT

Active learning experiences for undergraduate nursing students build upon their understanding of concepts that transfer to new learning skills throughout the curriculum. Faculty implemented a leadership simulation in the classroom focusing on communication skills as a nurse leader to better understand the role of the nurse in the interdisciplinary team. The classroom setting is an ideal platform to teach interdisciplinary collaboration when opportunities do not present in the clinical setting. Scaffolding simulation experiences throughout the curriculum helps bridge the knowledge and skills gap between classroom and clinical experiences.

The influence of culture, structure, and human agency on interprofessional learning in a neurosurgical practice learning setting: a case study

The World Health Organization supports the notion that interprofessional learning (IPL) improves healthcare outcomes and contributes to safe, effective, and high-quality care. Consequently, IPL is an integral component within most UK undergraduate healthcare programs. Although much is written about IPL, research to date has mainly focused on the classroom or simulation lab as a setting for IPL. Less is known about how the practice learning environment influences the experiences and outcomes for those involved. A case study research design, situated within a critical realist framework, was undertaken which aimed to better understand how IPL was facilitated for undergraduate healthcare students within a neurosurgical practice learning setting. Interviews, non-participatory observations, and secondary documentary data were used as the methods of data collection to inform the case. Thematic analysis was undertaken, and the findings clustered into overarching themes of culture, structure, and human agency, facilitating a more in-depth exploration of the complex interplay between the factors influencing IPL in the study setting. IPL was supported within the setting which operated as an 'interprofessional community of practice,' facilitating student engagement and investing in its staff for the benefit of the patients who had complex neurological needs. A practice-based IPL Multi-Dimensional Assessment Tool was also created to enable colleagues in practice learning environments worldwide to better understand their capability and capacity for the facilitation of practice-based IPL.