Health and social care professionals are required to work together to deliver person-centred care. Professionals therefore find themselves making decisions within multidisciplinary teams. For educators, there has been a call to bring students from differing professions together to learn to enable more effective teamwork, interprofessional communication, and collaborative practice. This multidisciplinary working is complicated by the increasingly complex nature of ethical dilemmas that health and social care professionals face. It is therefore widely recognised that the teaching and learning of ethics within health and social care courses is valuable. In this paper, we briefly make the casein support of teaching and learning health and social care ethics through the medium of interprofessionaleducation (IPE). The purpose of this paper is provide guidance to educators intending to design ethics- orientated IPE for health and social care students. The guidance is based on the ongoing experiences of designing and implementing ethics-orientated IPE across five departments within two universities located in the North of England over a five year period. Descriptions of the ethics-orientated IPE activities are included in the guide, along with key resources recommended.
Despite recent advances in healthcare, there is a short- age of people with experience in interprofessional working to manage and operate healthcare and very few training pathways to develop such professionals. The proposal to form the Interprofessional Fellowship Program is to develop leaders with vision, who will develop and evaluate interprofessionaleducation to advance the nation’s healthcare. The Interprofessional Fellowship Program can have a robust curriculum, an appropriate infrastructure, and qualified fellowship faculty who are experts in simulation practice, edu- cation, and research. Institutions can select efficient and enthusiastic staff members and equip them by attending these fellowship programs which may help to implement and sustain IPL in India.
reference to others. Some comments overlapped between the type of experience and those referenced, providing insight into how they described certain experiences and how they spoke about certain people, including themselves. I organized these codes into groups, progressing my axial coding before revisiting my transcripts (Merriam & Tisdell, 2016; Tesch, 1990). I used these as a preliminary coding scheme, utilizing NVivo for categorizing appropriate segments while looking for additional categories and codes in the process of analytical coding (Merriam & Tisdell, 2016; Tesch, 1990). After all initial codes were applied to all transcripts, I reviewed them for opportunities to collapse. The background and previous experiences code was originally subcoded to include personal, family, and professional experiences, but these were combined into the larger code. This code also included educational experiences as they were previous experiences for the graduates at the time of the interview. Similarly, a subcode for the capstone course was merged into the interprofessionaleducation code, professional role was combined into reference to self, and subcodes for the specific people referenced, such as family member or nurse, were combined into reference to others. I used these initial codes to write a reflective summary of each participant, looking initially at how each responded to their interprofessionaleducation experiences, interprofessional collaborative practice
Traditionally, healthcare students are educated uniprofessionally with little or no interaction with other healthcare professions. As such, students focus on their own professional competencies. These students lack opportunities to develop interprofessional communication skills and to understand other healthcare professionals’ contributions to a team. This impedes collaborative practice in healthcare settings after they graduate (Poore, Cullen, & Schaar, 2014). However, in the last twenty years, InterprofessionalEducation (IPE) has gained momentum globally and is established in countries such as Canada, United States, Australia, and the United Kingdom (H. Barr, 2015). Yet IPE is still in its infancy in the Middle East with only a few recent studies from Middle Eastern countries (El-Awaisi, Awaisu, et al., 2017; El- Zubeir, Rizk, & Al-Khalil, 2006; Khan, Madu Emeka, Aljadhey, & Haseeb, 2015; Wilbur & Kelly, 2015; Wilby et al., 2015; Zeeni et al., 2016).
implementation of interprofessionaleducation to impact healthcare. The WHO holds that clinicians trained in interprofessional care more effectively optimize the skillsets of all team members, which ultimately improves patient care (WHO, 2010). Thus, purposeful integration of professional education with collaborative practice in the healthcare setting is necessary in order to achieve optimal health outcomes. Next, IPEC has advocated for the continuous development of health care professionals through the implementation of IPE experiences in congruence with core competencies to promote interactive learning and crossover to team-based care when entering the workforce. IPEC identified desired principles for an IPE program which include patient-centered care, outcome-driven assessment, applicability across practice settings, and activities and assessments that are appropriate for the learner (IPEC, 2011).
developmental progression of interprofessional skills. Students start out positive about their own interprofessional readiness. However, after experiencing the reality and challenges inherent in actual interprofessional collaboration, they may retreat behind their own scope of practice. Then, after they fully establish their own professional identity, they are able to look outside of their own profession for an understanding of how others integrate into the bigger health care picture. This theory fits with the information obtained in the qualitative journals. The students spoke of the value of this interprofessionaleducation program in terms of a greater understanding of and
If this new vision of interprofessional teamwork is accepted, then it is logical to commence interprofessional activity during the education and training pathways that produce all health professionals. Interprofessionaleducation (IPE) is currently defined as follows: ‘InterprofessionalEducation occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care’ 4 . However, while this definition may be easy to embrace philosophically and has a reasonably strong theoretical base 5 , there is as yet only limited evidence of success 6 . While education research design often poses challenges to proving effectiveness of any educational intervention, it may also be that converting IPE theory to action and outcomes is much more challenging at the level of educational design. Questions remain to be answered about just how to develop genuine interprofessional engagement, when in a curriculum to schedule interprofessional activities, and where to do it. An important question to ask is: are we expecting too much of IPE activities, particularly at undergraduate level? This article addresses these contextual and educational design issues, with a particular focus on how to achieve meaningful, high quality IPE in rural practice settings.
Thus far research on transferability of interprofessionaleducation to collaborative practice is ambiguous (Illingworth & Chelvanayagam, 2017; Lapkin et al., 2013; Ravet, 2012; Reeves et al., 2013). Botma et al. (2013) found that health science students can transfer learning from the classroom to a practical setting (theory-practice gap). Ketcherside and colleagues’ (2017) study yielded similar findings. They surveyed community/public health professionals and registered nurses ten years after graduation to assess their ability to integrate IPE into their professional practice (Ketcherside, Rhodes, Powelson, Cox, & Parker, 2017). The authors found that community/public health professionals were able to transfer their IPE knowledge from the classroom to their clinical practice whereas registered nurses did not report similar experiences (Ketcherside et al., 2017). Ketcherside et al. (2017), noted that it was not possible to generalize the findings for these two professions to other healthcare professions. Knowledge gained about healthcare students’ ability to demonstrate behaviors required to practice collaboratively after receiving interprofessionaleducation would be useful to support the accreditation requirement of IPE and demonstrate students’ ability to bridge the theory-practice gap (Andrews, 2016;
Joan was an upbeat, young new nurse full of excitement about her experience as an emergency room nurse. I received Joan’s contact information through my IPE connection, contacted her, and received an immediate response to be part of the study. She presented as energized and was in athletic clothes, admitting she had come from exercising that morning ready for our FaceTime interview. Joan lives in the Midwest and is currently working in a major medical facility. She explained how the environment in the emergency room is “very fast-paced” and one needs to be able to communicate with the physicians who have probably not seen the patient yet and are “relying on you and your judgment to tell them what the patient needs.” Joan also expressed how it can be intimidating at first to approach a physician who has 25 years of experience and how her IPE experience made it easier for her to talk to other professions by “knowing what their practice is, what their scope is, and how they can assist me in my own job and in taking care of patients.” Joan told me a story about how her IPE experience helped her right after her orientation period:
interprofessional and cross-institutional collaboration in Fort Worth, Texas, USA. While the initial point of connection involved administrators and faculty members from TCU and the UNTHSC collaborating to create interprofessional training opportunities for health professions students, this collaboration continues to generate new innovations and cooperative initiatives. These initiatives include research projects supported by significant external funding awards and a decision by the leaders of the two institutions to collaborate to develop a new medical school. Strategies implemented that helped accelerate the successful implementation of interprofessionaleducation and practice within and between UNTHSC and TCU have been identified. Institutions attempting to accelerate the development of their interprofessionaleducation initiatives may benefit from the strategies implemented in this cross-institutional interprofessionaleducation implementation approach.
The concepts underlying interprofessionaleducation and practice are hardly new. A report of a conference on interrelationships of educational programs for health professions (Institute of Medicine [IOM], 1972) called for both interdisciplinary education and interdisciplinary patient care.The recommendations included development of methods to link education with practice realities, and development and use of educational models of interprofessional collaborationin the classroom and in the clinical area.Two IOM reports on quality and safety in the early part of this century: “To Err is Human” (IOM, 2000), and “Crossing the Quality Chasm” (IOM, 2001), gave rise to IOM’s second summit on the education of health professionals (IOM, 2003). At this summit, five competencies were identified as essential in the education of all health care professionals:
Of the TIPE students participating in the programme in the study period, ninety four percent (123/131) responded, completing questionnaires at the end of their rotation. Overall satisfaction with the programme was high, (mean 5-point Likert scale scores between 3 and 5; 5 = most posi- tive), with student satisfaction further increasing across programme objectives and learning domains in the second year (mean 5-point Likert scale scores between 4 and 5) - (Table 3). Opportunities for effective interprofessional learning in the rural setting were well regarded from the outset, with TIPE students strongly agreeing that their knowledge of and confidence in working interprofessionally across the health disciplines, and their understanding of the rural health environment, improved a great deal over the course of the 5-week rotation. Students also agreed that their knowledge of Māori culture and customs, and ability to incorporate these values and skills into their practice had greatly improved as a result of the programme. In contrast, opportunities for skill acquisition in aspects of long-term condition management were slower to build up as the programme developed, with mixed results from the 2013 cohort, but by 2014, students reported high satisfaction with this aspect of the programme.
Support and mentoring must be provided to the clinical coaches as well, since stereotyping and power disparities may be reinforced by faculty, clinical coaches and clinicians. Anticipate that power issues will surface in subtle ways. Examples include letterhead communication disseminated to the community without acknowledging the graduate school of nursing or expressions that the “doctor” writes the medical orders rather than the “clinician” or the “health care provider”. Role bias can also be seen in duties assigned to different students, such as clinical coaches asking the GEPN students to inspect the supply closet, while the PA and medi- cal students participated in medical rounding. Our faculty ILCE team addressed these issues, respectively, by creating our own ILCE letterhead inclusive of all three programs, using a direct approach as reinforcement to all clinicians and faculty that Advanced Practice Registered Nurses (APRNs) and PAs write patient orders, and by counseling clinical coaches that students must be treated equitably.
The use of autoethnography as a qualitative inquiry technique allows researchers to contribute as storytellers and share insights into their own research and learning experiences [4,8]. In the current study, autoethnography is employed to gain a reﬂexive understanding from eight collaborators who partnered together as design- ers and facilitators for the IPE simulation. Two group narrative interviews were con- ducted in June 2013 and June 2015. All eight of the IPE collaborators from nursing, pharmacy, medicine, and medical education participated in the ﬁrst interview, while seven participated in the second interview (one member accepted a position at another institution). The serial group interviews permitted a longitudinal perspec- tive initiated by developing relationships within an IPE collaborative, as well as exploring the resulting preparation needed and practice events of the separate IPE simulations for healthcare students.
Interprofessional collaboration (IPC) is important for the delivery of effective integrated health and social care systems. Interprofessionalpractice learning (IPPL) enables students to learn to work together within a relevant context and prepare for future IPC. Whilst there is some evidence that negative attitudes impact on IPC and interprofessionaleducation, there is a dearth of research on health and social work professionals’ attitudes and perspectives of IPC, and IPPL opportunities for students. A mixed-methods case study was used to investigate practice educators’ attitudes and perspectives of IPC, and IPPL for their students. Results showed that attitudes were positive and that mainly meso and macro level factors, as opposed to micro level, impacted on the implementation of IPC, and IPPL for students’ learning in practice settings. IPC was perceived to be best enabled by effective communication, established teams, IPPL for staff, and shared processes and policies. Close working proximity to other professionals encouraged informal communication and positive interprofessional relationships. Motivation and resources were perceived as
Student leaders as partners for change: Thousands of health professional students from across Canada came together in 2005 to form the National Health Sciences Students’ Association as a grassroots movement to champion interprofessionaleducation. Drawing on a network of 22 university/college-based chapters and over 20 health professions, student leaders design and deliver local academic, social and community service programmes that promote collaborative practice. The Association’s University of Toronto chapter, for example, hosted a series of social events coinciding with the university’s interprofessional ‘Pain Week’ curriculum. The Dalhousie University chapter recruited hundreds of health professional students to participate in a breast cancer charity run while learning about, from and with one another. [italics added] The local chapter at the University of British Columbia partnered with its provincial Ministry of Health to coordinate innovative health programming for elementary and high school students.
The Association of American Medical Colleges (AAMC) formally identified interprofessionaleducation as one of two “horizon” issues for action in 2008, although calls for attention to interprofessionaleducation can be traced back through a series of AAMC reports, including its landmark 1965 Coggeshall Report. An initial survey was conducted of interprofessionaleducation in U.S. medical schools in 2008 and serves as a current benchmark (Blue, Zoller, Stratton, Elam, & Gilbert, 2010). The Accreditation Council on Graduate Medical Education (ACGME) Outcomes Project is being used as a competency guide by many undergraduate programs in medicine. It incorporates general competencies of professionalism, interpersonal and communication skills, and systems-based practice, along with an expectation that residents are able to work effectively as members or leaders of health care teams or other professional groups, and to work in interprofessional teams to enhance patient safety and care quality (ACGME, 2011). Analysis of data from a 2009 ACGME multispecialty resident survey showed that formal team training experiences with non-physicians was significantly related to greater resident satisfaction with learning and overall training experiences, as well as to less depression, anxiety, and sleepiness, and to fewer reports by residents of having made a serious medical error (Baldwin, 2010). Pilot work is ongoing by the American Board of Internal Medicine to evaluate hospitalist teamwork skills (Chesluk, 2010).
Of the qualitative studies about IPE, some do not include nurse practitioner (NP) and graduate social work students (MSW) and/or are from programs outside of the United States [8,9]. One gap noted is that it is not known what students entering IPE programs understand about IPE as an educational strategy and what expectations and concerns they may have prior to and following an IPE program with integrated IPE competencies . The literature related to positive attitudes toward IPE demon- strates that students often enjoy the strategy; however, they may not fully understand discipline roles and practice guidelines, although improvement of their understand- ing of different roles of other healthcare providers may occur [10,11]. Therefore, the specific objective of this program evaluation using qualitative methodology was to describe graduate students’ perceptions of general and specific aspects of IPE at the beginning and the end of a new IPE program.
resources be shared by health professional education pro- grams since these centers are relevant venues for integrating health care professional students, and shared facilities and resources lead to shared curricular activities, creating inter- professional learning experiences. Currently, TCMC shares its Clinical Skills and Simulation Center with a number of health professions programs: nursing and nurse anesthe- tist students from the University of Scranton; physician assistants from Marywood University; internal medicine residents from the Wright Center for Medical Education Residency Program; and biomedical engineering students from Johnson College; and regional pediatric profession- als (ie, pediatricians, nurses, respiratory therapists, and so on). Simulation activities include student learning in the areas of standardized patient exercises, patient assessment, practice in cardiorespiratory arrest (code) situations, and procedural skills such as intubation, placement of epidural catheters, arterial lines and central lines, vaginal birthing, physiology labs using the biopak systems, and repair and maintenance of medical equipment such as defibrillators and intravenous pumps.