Implementing a Palliative Care Junior Faculty Visiting Professor Program: Pearls and Pitfalls

MOTIVATION

Palliative Care (PC) is a small, relatively young interprofessional sub-specialty; hence mentorship for early-career research faculty is widely dispersed across schools and universities. We developed the Junior Visiting Professor Program (JVPP) to provide junior faculty in palliative care (PC) with opportunities to meet multidisciplinary PC researchers from other institutions and to advance their research through networking and presenting their work. We describe how we designed and implemented the program, and we report on the first cohort of participants.

METHODS

We invited PC research groups from US schools of medicine and nursing to participate in this 5-year interprofessional exchange program by nominating junior faculty and serving as hosts. We matched nominees to host institutions based on nominee training experiences, nominee research interests, and host institution faculty expertise. In addition, we provided logistical guidance on visit planning. Post-visit, we surveyed both hosts and junior visiting professors (JVPs) regarding their satisfaction, perceived value, and suggestions regarding the program.

RESULTS

We recruited 13 schools to participate and matched 10 nominees to host institutions in our first year. Nine JVPs completed their visit; 6 JVPs and 8 host faculty/staff responded to the post-visit survey. Overall, JVPs were highly satisfied with their matches and the visiting professor experience. Hosts were generally satisfied with their matches and believed the program to be mutually beneficial. The most frequent suggestion was for greater administrative support to plan visits.

CONCLUSIONS

Structured, well-supported opportunities for networking across institutions is beneficial for emerging PC researchers and for building PC research capacity.

A university-wide seed grant program accelerates interprofessional education through faculty and staff engagement

The University of Texas Health Science Center at San Antonio launched an annual university-wide seed grant program in 2019 to foster innovation in interprofessional education (IPE) and increase IPE opportunities for learners. Program objectives included leveraging hypothesis-driven research to identify sustainable IPE activities for integration into educational programs (i.e. mandated for at least one cohort of learners), increasing scholarly dissemination of IPE efforts, and using pilot data to secure extramural funding. Over the first four funding cycles (2019-2022), US$100,509.00 was awarded to support 22 IPE projects (10 curricular, 12 co-curricular) involving 80 faculty and staff collaborators and over 2,100 student participants. To date, funded projects have yielded nine sustained IPE activities (four of which have been integrated), produced 24 scholarly presentations and three peer-reviewed publications, and contributed to the success of one extramural grant. Barriers experienced are discussed in this report alongside lessons learned and unexpected positive outcomes, including identification of future IPE champions.

The symphony of open-heart surgical care: A mixed-methods study about interprofessional attitudes towards family involvement

PURPOSE

The overall aim of this study was to describe the attitudes towards family involvement in care held by nurses and medical doctors working in open-heart surgical care and the factors influencing these attitudes.

METHODS

Mixed-methods convergent parallel design. A web-based survey was completed by nurses (n = 267) using the Families' Importance in Nursing Care-Nurses Attitudes (FINC-NA) instrument and two open-ended questions, generating one quantitative and one qualitative dataset. Qualitative interviews with medical doctors (n = 20) were conducted in parallel, generating another qualitative dataset. Data were analysed separately according to each paradigm and then merged into mixed-methods concepts. Meta-inferences of these concepts were discussed.

RESULTS

The nurses reported positive attitudes in general. The two qualitative datasets from nurses and medical doctors resulted in the identification of seven generic categories. The main mixed-methods finding was the attitude that the importance of family involvement in care depends on the situation.

CONCLUSIONS

The dependence of family involvement on the situation may be due to the patient's and family's unique needs. If professionals' attitudes rather than the family's needs and preferences determine how the family is involved, care runs the risk of being unequal.

Development of a European Centre of Excellence (Coe) for Research in Continuing Professional Development (UPGRADE)

The European Centre of Excellence (CoE) for Research in Continuing Professional Development (UPGRADE) is a pan-European network of researchers, clinicians, regulators, educators, and professional bodies, established in 2020 through a consensus group of experts, who defined its mission, vision, values, aims and objectives. The Centre's aim is to advance the science of Continuing Professional Development (CPD) for healthcare professionals through research and dissemination of best practices for CPD. Debate among UPGRADE partners and interchange of research data will yield best practices across countries to optimise quality CPD programmes. Collaboration, information exchange and communication among CPD experts will be facilitated through UPGRADE via an online Community of Inquiry (CoI). UPGRADE aims to evolve as a driving force network of academics and health professional leaders in research, education, professional regulation, and clinical practice whose collaborative work ensures quality and safe person-centred care. UPGRADE members are from 22 European countries, represented by strategic leaders in diverse sectors of health, policy, academia, and professional organisations. Three research-working groups constitute the pillars of UPGRADE, which addresses gaps in research, collect and create critical databases, and solidify the effectiveness of CPD.

Interprofessional primary care: indispensable for family physicians yet invisible to older patients

There is growing consensus that interprofessional primary care is key to delivering timely, coordinated, and comprehensive care, especially in the older patient population who often live with complex and chronic needs. Despite significant investments in reforming health systems toward interprofessional primary care, there is a paucity of evidence describing the importance of interprofessional primary care for older patients and physicians. This qualitative descriptive study aimed to understand the use and utility of interprofessional primary care for older patients and family physicians from the perspective of different stakeholders within primary care in Ontario, Canada. Twenty-five semi-structured interviews (including 16 older patients, six family physicians, three primary care managers) and a focus group with 13 patient representatives were conducted. Our study found that while the benefits of interprofessional primary care teams for family physicians were clearly emphasized, stakeholders consistently reported that older patients often appeared to be unaware of the presence of, or roles played by, non-physician healthcare professionals in their clinic. Better transparency and education regarding available services and roles of different care providers may allow for more optimal use of interprofessional family medicine clinics by patients.

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.

Spanish version of the readiness for interprofessional learning scale (RIPLS) in an undergraduate health sciences student context

The Readiness for Interprofessional Learning Scale (RIPLS) has been widely used to measure students' and professionals' attitudes toward interprofessional learning. However, inconsistencies have been reported concerning its validity and reliability. This study aimed to translate, adapt, and validate the RIPLS questionnaire to be applied to Spanish-speaking health sciences students in Chile. Content and construct validity evidence of the newly created Spanish version of the RIPLS scale were analyzed. An exploratory (EFA) and confirmatory (CFA) analysis were conducted, determining goodness-of-fit indexes. Reliability was evaluated through Cronbach's Alpha Coefficient. We assessed sensitivity to change of the RIPLS scale by comparing pre- and post-interprofessional education workshop scores. The EFA showed that there were three factors. In the CFA, most of the standardized factor loadings were higher than 0.3. Regarding internal consistency, Cronbach's Alpha was 0.86. The differences between the total RIPLS scores before and after the workshops were statistically significant. The Spanish version of RIPLS showed evidence of validity and reliability for use amongst health sciences students. The construct was adequately measured and was shown that it could be used to assess the impact of interprofessional education workshops.

Insights from healthcare academics on facilitating interprofessional education activities

Facilitators are of paramount importance to the success of interprofessional education (IPE) activities; hence, it is crucial to explore their perspectives and experiences in delivering IPE in Qatar. Using an exploratory case study approach, semi-structured interviews were conducted, in 2018, among faculty members, who had facilitated at least one IPE activity in Qatar, from healthcare professional education programs at Qatar University Colleges of Pharmacy, Medicine, and Health Sciences, Weill Cornell Medicine in Qatar, the University of Calgary in Qatar, and the College of North Atlantic. Interviews were recorded and transcribed verbatim. Inductive thematic content analysis was implemented. Twenty-one interviews were conducted with the following professions represented: medicine (n = 6), pharmacy (n = 5), nursing (n = 4), biomedical science (n = 3), respiratory theory (n = 2) and public health (n = 1). Four main themes emerged from the interviews: drivers to facilitator involvement that included interest and commitment to IPE and awareness of collaborative practice benefits; facilitator participation which was based on facilitator attributes and preparedness and readiness for IPE facilitation; the organizational support in terms of dedicated structure for IPE and IPE design and delivery and; student participation in terms of group dynamics and student engagement. Some key recommendations include having a dedicated unit for IPE, scheduling protected time for IPE, and organizing facilitators' training and debriefing workshops. The facilitators valued and appreciated IPE in preparing students for future collaborative practice. These findings can inform the development of quality and sustainable IPE activities in the future.

Writing for publication: increasing the likelihood of success

The aim of this paper is to help writers at all levels improve their likelihood of success in having papers accepted by academic peer-reviewed journals, including the Journal of Interprofessional Care. We discuss the importance of reading both in your own discipline and also more widely across disciplines and fields of study. There are sections on the attributes of good authors, how to choose a journal, types of articles that are published and the structure of these, the contrast between research and evaluation, and how to plan a paper. We stress the importance of reading and complying with a journal's author guidelines and answering the 'so what' question by the end of the article. There is more detail about the main elements of a paper and what should be included in the introduction, methods, results (findings) and discussion to improve the quality of the reporting. As well as content we also focus on the style of writing. We finish with a discussion of the submission and review processes, why papers may be rejected and how to manage decisions on papers. Dissemination of scholarly work is paramount to the advancement of the interprofessional field; we invite authors to consider our advice and in so doing help strengthen the quality and rigor of interprofessional scholarship.

Doing interprofessional research in the COVID-19 era: a discussion paper

The COVID-19 pandemic, and ensuing physical distancing measures, poses challenges for researchers in the field of interprofessional care. Pandemic management has highlighted the centrality of interprofessional working to effective healthcare delivery during crises. It is essential to find ways to maintain interprofessional research that has commenced, while also designing research to capture important learning from pandemic management and response. However, it also creates opportunities for new research projects and novel research designs. This discussion paper explores ways of adapting existing research methodologies and outlines potential avenues for new research. Specifically, considerations to bear in mind when designing interprofessional research during the pandemic include research ethics and integrity, research design, data collection methods, research opportunities, implications and limitations. Interprofessional research can continue to make a valuable contribution in informing global responses to COVID-19 and in planning for future global health crises. We call for, insofar as possible, for interprofessional research to continue to be developed during this time.

"We have two different agendas": the views of general practitioners, social workers and hospital staff on interprofessional coordination for patients with chronic widespread pain

Patients with chronic widespread pain (CWP) are often unfit for work and go through lengthy treatment. In Denmark, this includes contacts with the job center in their municipality, their general practitioner (GP) and one or more hospital units. Little is known about how coordination around patients with CWP functions and is perceived by professionals. Therefore, our aim is to explore how GPs, social workers from municipality job centers and hospital staff experience interprofessional coordination for patients with CWP. Interviews with 7 GPs, 12 social workers, and 10 hospital staff were analyzed using interpretative phenomenological analysis. The participants experienced challenges with coordination, primarily in the relations between social workers and GPs. There was an over-reliance on written communication in situations where the actors had divergent agendas, opposing professional roles and conflicting approaches to time. GPs tended to lengthen the time spans for treating patients, while social workers tried to shorten them so that patients could get back to work. Applying the theory of relational coordination (RC), the findings correspond to a low level of RC, indicating a need for shared accountability, and strengthened interpersonal communication between professionals.Abbreviations: CWP: Chronic widespread pain; GPs: General practitioners; RC: Relational coordination; IPA: Interpretative phenomenological analysis.

Experiences with and attitudes toward interprofessional health care teams among American clinical, counseling, and school psychology doctoral students: a mixed methods study

Attitudes toward interprofessional collaboration influence interprofessional health care team (IPHCT) functioning and quality of patient care. Yet, research has not examined the attitudes and experiences of psychology doctoral students on IPHCTs. Utilizing a volunteer sample of 214 clinical, counseling, and school psychology doctoral students from at least 47 doctoral programs in the United States, this study aimed to clarify psychology doctoral students' experiences on IPHCTs and explore predictors of their attitudes toward IPHCTs. Discovery-oriented analysis and hierarchical multiple regression were used to identify themes of students' self-reported interprofessional experiences and significant predictors of positive attitudes obtained via online survey questionnaires. Students who had worked on IPHCTs commonly reported taking roles of mental health therapeutic service provision and consultation and reported difficulty with team dynamics and navigating hierarchical structures. Students perceived the psychologist role primarily as clinical expert and team leader. Students reported making positive contributions, increased competency in interprofessional practice, and improvement in patient care as the most common benefits of IPHCTs. Each additional year spent on an IPHCT was related to more positive perceptions of the quality of care delivered by IPHCTs as well as greater endorsement of positive interprofessional socialization practices.

Evaluation of teamwork assessment tools for interprofessional simulation: a systematic literature review

There is growing evidence supporting the use of simulation-based education to improve teamwork in the clinical environment, which results in improved patient outcomes. Interprofessional simulation improves awareness of professional roles and responsibilities, promotes teamwork and provides training in non-technical skills. Tools have been developed to assess the quality of teamwork during simulation, but the use of these tools should be supported by validity evidence in appropriate contexts. This study aims to assess the validity of teamwork tools used in simulation-based interprofessional training for healthcare workers and students, and to compare the design and reporting of these studies. Medline, EMBASE, ERIC, and CINAHL were searched using terms synonymous with simulation, crew resource management, training, assessment, interprofessional, and teamwork, from 2007-2017. Interprofessional healthcare simulation studies involving objectively rated teamwork training were included. The initial search provided 356 records for review, of which 24 were ultimately included. Three tools demonstrated good validity evidence underpinning their use. However, three studies did not explore tool psychometrics at all, and the quality of reporting amongst these studies on design and participant demographics was variable. Further research to generate reporting guidelines and validate existing tools for new populations would be beneficial.

Interprofessional education and practice guide: interprofessional team writing to promote dissemination of interprofessional education scholarship and products

Collaborations to develop, implement, evaluate, replicate, and write about interprofessional education (IPE) activities within and across institutions are wonderful opportunities to experience teamwork, team communication, ethics and values, and the roles and responsibilities of interprofessional team writing. Just as effective communication in interprofessional team-based care is essential for providing safe, high-quality health care, similar communication strategies are necessary to produce high-quality scholarship of IPE curricula and activities. Relationship and communication issues that affect health care teams' abilities to work together effectively (e.g., hierarchy, exclusion, assumptions, non-responsiveness, biases, stereotypes and poor hand-offs of information) can also occur in interprofessional team writing. Between 1970 and 2010, interprofessional practice research publications increased by 2293%. Although there has been tremendous growth in the IPE literature, especially of articles that require collaborative writing, there have not been any papers addressing the challenges of interprofessional team writing. As more teams collaborate to develop IPE, there is a need to establish principles and strategies for effective interprofessional team writing. In this education and practice guide, a cross-institutional team of faculty, staff, and graduate students who have collaborated on externally funded IPE grants, conferences, products, and workshops will share lessons learned for successfully collaborating in interprofessional team writing.

Individual-level determinants of interprofessional team collaboration in healthcare

Interprofessional team collaboration (ITC) is pivotal for the safety and the quality of healthcare settings, being associated with higher staff and patient satisfaction. However, individual-level determinants (i.e. socio-demographic and working satisfaction) remain currently largely unexplored. This study aimed to describe the overall ITC (i.e. partnership, cooperation, coordination), identifying the individual-level determinants of each ITC domain. This study had a multicentre approach, using cross-sectional data collection. ITC was assessed using the Interprofessional Team Collaboration Scale II, Italian version (I-AITCS II). The determinants of ITC were investigated through multivariable linear regression models. The study results showed significant associations between the same ITC domains, as well as the important role of work satisfaction in determining cooperation and coordination. Physicians reported more inadequate partnership levels than other healthcare professionals. This study provides insights for future research and gives a useful description of the determinants of ITC for multi-stakeholder healthcare organizations.

Implementation, evaluation, and outcome of TeamSTEPPS in interprofessional education: a scoping review

The ability to effectively work in interprofessional teams is listed as one of the five core competencies in health professions education. Though the importance of interprofessional education (IPE) has been established, results of studies have been difficult to compare due to the high variability of programs. We undertook a scoping review to examine the use of a prescribed curriculum, TeamSTEPPS, in IPE. Articles describing TeamSTEPPS implementations were extracted from Pubmed, Embase, and Scopus. Studies with two or more health professions students reporting on a clear evaluation and published in English were eligible for inclusion. Two researchers independently applied inclusion criteria to studies and reconciled conflicts for a final selection. The reference lists of selected papers were also searched for relevant studies. Data were extracted from each of the articles independently using a standard form. Twenty-four papers describing 23 unique programs were included. Programs used a variety of teaching modalities and included students from two to ten health professions, most commonly medical and nursing students. Programs used a range (n = 11) of validated IPE evaluation surveys, few of which were part of the TeamSTEPPS program. Methods included multimodal evaluations, self-assessment confidence and attitude surveys, pre/post-test models, and external evaluation of simulation performance. There was great variation in the implementation of TeamSTEPPS implying that while a consistent curriculum it can be adapted to meet the needs of different educational contexts. The variation in evaluation methods makes comparing and synthesis of results problematic. Future IPE research can expand on the use of this prescribed curriculum, especially with focus on uniform evaluation methods.

The long-term impact of undergraduate interprofessional education on graduate interprofessional practice: A scoping review

Several recent high-quality systematic reviews have identified the importance of measuring outcomes in evaluating the effectiveness of interprofessional education (IPE) in healthcare, but also the process- and context-dependent nature of these outcomes. This paper presents a scoping review, the objectives of which were to evaluate the evidence for the long-term impact of undergraduate IPE on graduate interprofessional practice (IPP) and to identify areas for further research in the specific context of practice-based IPE. An initial search identified 596 potentially relevant titles published between 2008 and 2016. Screening for inclusion of documented IPE with IPP evaluation reduced this to 130. Abstract reading excluded 99 studies that were not longitudinal. Full reading of the remaining 31 articles identified 23 original studies which were analysed descriptively and tabulated. The main findings were synthesised around three themes: undergraduate evidence for a long-term impact of IPE on IPP; graduate evidence for a long-term impact of IPE on IPP; and barriers to an impact of IPE on graduate IPP. Drawing on these findings, research areas likely to produce further evidence for the impact of practice-based IPE on graduate IPP are discussed, along with some suitable methodologies.

An interprofessional health assessment program in rural amateur sport

Effective interprofessional learning (IPL) in multisectoral collaborations such as those linking health services within communities can provide an authentic experience for students and also appears to be the most effective way to achieve health changes in targeted population groups. The aim of this study was to facilitate the IPL of students at a rural university in a multisectoral health assessment programme and to promote health in players of rural amateur sport. Two rural rugby league teams took part in three pre-season health assessments conducted by general medical practitioners, practice nurses, and nursing, osteopathy, and exercise science students. The Readiness for Interprofessional Learning Scale questionnaire and a series of focus groups were used to evaluate participants' experiences of the programme. Results indicated that students saw the benefits for patients and 93% valued the opportunity to improve interprofessional communication, problem-solving and team skills. Some students felt they needed to learn more about their own professional role before learning about others, and instances of stereotyping were identified. The programme also enabled early detection of potential health risks and referral for medical care, management of musculoskeletal conditions, and health promotion. These health assessments would be readily transferred to other multisectoral sporting settings.

Development of an interprofessional and interdisciplinary collaborative research practice for clinical faculty

This article describes an interprofessional collaborative research practice fellowship designed to foster the research skills of clinical faculty. The year-long fellowship was grounded in big data analysis and the triangle of informatics--knowledge, information, and data. Fellows were selected to include diverse perspectives, training, and knowledge but had limited experience in team science or being a member of an interprofessional research team. The underlying philosophy of the fellowship was experiential learning. Protected time and formal mentorship were necessary factors for developing the interprofessional research practice and the skills to participate in an interprofessional research team. We believe that this innovative interprofessional faculty research fellowship is a viable option for supporting scholarly activity and research collaboration. The findings could inform interprofessional clinical practice and be implemented for patient care. Engagement in interprofessional collaborative research and incorporation of the perspectives, knowledge and expertise of multiple professions, is a model to de silo knowledge creation.

Measuring renewed expertise for integrated care among health- and social-care professionals: Development and preliminary validation of the ICE-Q questionnaire

Accumulations of health and social problems challenge current health systems. It is hypothesized that professionals should renew their expertise by adapting generalist, coaching, and population health orientation capacities to address these challenges. This study aimed to develop and validate an instrument for evaluating this renewal of professional expertise. The (Dutch) Integrated Care Expertise Questionnaire (ICE-Q) was developed and piloted. Psychometric analysis evaluated item, criterion, construct, and content validity. Theory and an iterative process of expert consultation constructed the ICE-Q, which was sent to 616 professionals, of whom 294 participated in the pilot (47.7%). Factor analysis (FA) identified six areas of expertise: holistic attitude towards patients (Cronbach's alpha [CA] = 0.61) and considering their social context (CA = 0.77), both related to generalism; coaching to support patient empowerment (CA = 0.66); preventive action (CA = 0.48); valuing local health knowledge (CA = 0.81); and valuing local facility knowledge (CA = 0.67) point at population health orientation. Inter-scale correlations ranged between 0.01 and 0.34. Item-response theory (IRT) indicated some items were less informative. The resulting 26-item questionnaire is a first tool for measuring integrated care expertise. The study process led to a developed understanding of the concept. Further research is warranted to improve the questionnaire.

Setting a research agenda for interprofessional education and collaborative practice in the context of United States health system reform

Interprofessional education (IPE) and collaborative practice (CP) have been prolific areas of inquiry exploring research questions mostly concerned with local program and project assessment. The actual sphere of influence of this research has been limited. Often discussed separately, this article places IPE and CP in the same conceptual space. The interface of these form a nexus where new knowledge creation may be facilitated. Rigorous research on IPE in relation to CP that is relevant to and framed by health system reform in the U.S. is the ultimate research goal of the National Center for Interprofessional Practice and Education at the University of Minnesota. This paper describes the direction and scope for a focused and purposive IPECP research agenda linked to improvement in health outcomes, contextualized by health care reform in the U.S. that has provided a revitalizing energy for this area of inquiry. A research agenda articulates a focus, meaningful and robust questions, and a theory of change within which intervention outcomes are examined. Further, a research agenda identifies the practices the area of inquiry is interested in informing, and the types of study designs and analytic approaches amenable to carrying out the proposed work.

Development and pilot testing the Family Conference Rating Scale: A tool aimed to assess interprofessional patient-centred communication and collaboration competencies

There is a paucity of evidence-based literature on the essential communication and collaboration skills to guide health care teams in conducting and assessing their performance in the Family Conference (FC). The authors developed and collected validity evidence for a rating scale of team FC performance, the Family Conference Rating Scale (FCRS). In phase 1, essential FC communication and collaboration skills were identified through a review of existing communication tools and literature on team functioning; a draft 34-item scale was developed. In phase 2, the scale was narrowed to a 6-category, 9-point scale with descriptors of expected behaviours through an iterative process: testing of the scale on 10 FC transcripts by two experts, soliciting feedback from a focus group of seven health care providers, and testing by non-experts on 49 live FCs. In phase 3, scores on the revised scale were validated by 10 health care providers from different disciplines by rating three videos of FCs of variable quality. Raters were able to detect inter-video variation in FC quality. The reliability of the FCRS was 0.95 and the inter-rater reliability, 0.68. The FCRS may enhance the ability of health professions educators to teach and assess interprofessional patient-centred communication and collaboration competencies.

Medical legal partnership and health informatics impacting child health: Interprofessional innovations

Dramatic differences in health are closely related to degrees of social and economic disadvantage. Poverty-induced hardships such as food insecurity, utility shut-offs, and substandard housing, all have the potential to negatively impact the health of families. In an effort to better address social determinants of health in pediatric primary health care settings using the Medical Legal Partnership (MLP) model of health care delivery, an interprofessional team of investigators came together to design an innovative process for using computerized clinical decision support to identify health-harming legal and social needs, improve the delivery of appropriate physician counseling, and streamline access to legal and social service professionals when non-medical remedies are required. This article describes the interprofessional nature of the MLP model itself, illustrates the work that was done to craft this innovative health informatics approach to implementing MLP, and demonstrates how pediatricians, social workers and attorneys may work together to improve child health outcomes.

A scoping review of interprofessional collaborative practice and education using the lens of the Triple Aim

The Triple Aim unequivocally connects interprofessional healthcare teams to the provision of better healthcare services that would eventually lead to improved health outcomes. This review of the interprofessional education (IPE) and collaborative practice empirical literature from 2008 to 2013 focused on the impact of this area of inquiry on the outcomes identified in the Triple Aim. The preferred reporting items for systematic reviews and meta-analyses methodology were employed including: a clearly formulated question, clear inclusion criteria to identify relevant studies based on the question, an appraisal of the studies or a subset of the studies, a summary of the evidence using an explicit methodology and an interpretation of the findings of the review. The initial search yielded 1176 published manuscripts that were reduced to 496 when the inclusion criteria were applied to refine the selection of published manuscripts. Despite a four-decade history of inquiry into IPE and/or collaborative practice, scholars have not yet demonstrated the impact of IPE and/or collaborative practice on simultaneously improving population health, reducing healthcare costs or improving the quality of delivered care and patients' experiences of care received. We propose moving this area of inquiry beyond theoretical assumptions to systematic research that will strengthen the evidence base for the effectiveness of IPE and collaborative practice within the context of the evolving imperative of the Triple Aim.

Barriers and enablers that influence sustainable interprofessional education: a literature review

The effective incorporation of interprofessional education (IPE) within health professional curricula requires the synchronised and systematic collaboration between and within the various stakeholders. Higher education institutions, as primary health education providers, have the capacity to advocate and facilitate this collaboration. However, due to the diversity of stakeholders, facilitating the pedagogical change can be challenging and complex, and brings a degree of uncertainty and resistance. This review, through an analysis of the barriers and enablers investigates the involvement of stakeholders in higher education IPE through three primary stakeholder levels: Government and Professional, Institutional and Individual. A review of eight primary databases using 21 search terms resulted in 40 papers for review. While the barriers to IPE are widely reported within the higher education IPE literature, little is documented about the enablers of IPE. Similarly, the specific identification and importance of enablers for IPE sustainability and the dual nature of some barriers and enablers have not been previously reported. An analysis of the barriers and enablers of IPE across the different stakeholder levels reveals five key "fundamental elements" critical to achieving sustainable IPE in higher education curricula.