Situating Interprofessional Education Curriculum within a Theoretical Framework for Productive Engaged Learning: Integrating Epistemology, Theory, and Competencies

Interprofessional education (IPE) has a longstanding presence in the health and social care (HASC) professions, by which its sustainable implementation in HASC professional education has the potential to effectively prepare HASC professional students for interprofessional collaborative practice (IPCP). Implementation of IPE has increased over the last two decades with the emergence of a curriculum guided by constructivist epistemology and learning theories that emphasize demonstrating competence in practice. Nonetheless, since IPE first emerged in the early 1960s, most IPE initiatives have been sporadic and lacked guidance through theoretical underpinnings. This conceptual article first discusses why it is important to have theory drive HASC professional education. Next, it explores what is meant by curriculum, followed by a discussion on the importance of curriculum theory to HASC professional education processes. This article then illustrates the learning theories arising from behaviourist and constructivist epistemologies that inform curriculum theory in the HASC professions, with particular emphasis on how constructivist learning theories inform IPE. Lastly, the article proposes a theoretical framework for productive engaged learning through which IPE opportunities may be grounded, leading to student proficiency in interprofessional professional competencies (knowledge, skills, and dispositions), establishment of professional communities of practice, and eventual improvement of patient/client-oriented outcomes

The Barriers to Interprofessional Collaborative Practice: Perspectives from Australian Physiotherapy Private Practitioners

Background: Despite the growing presence of physiotherapy private practitioners within Australia’s healthcare workforce, little is known about their perspectives of interprofessional collaborative practice (IPCP). This study aims to explore the barriers to IPCP from the perspective of Australian physiotherapy private practitioners. Methods: Semi-structured interviews were conducted with 28 physiotherapists and 64 hours of observation was completed in 10 private practice sites in Queensland, Australia. Interview and observation data were pooled and analyzed using reflexive thematic analysis. Findings: Data analysis produced five themes that characterized physiotherapists’ perspectives of IPCP: a) competition for clientele, b) personal attitudes and beliefs, c) time constraints and work schedules, d) geographic location, and e) rules of funding schemes. Conclusion: The findings from this study suggest that implementing IPCP in the Australian physiotherapy private practice setting presents several challenges. Financial concerns, such as physiotherapy private practitioners’ perceived need to compete for clientele, were significant barriers to IPCP. The introduction of financial incentives and adoption of alternative payment models may be necessary to provide physiotherapy private practitioners with a clear motivation to engage in IPCP. The need for more formal opportunities to bring health practitioners from diverse professional backgrounds together to gain new insights and knowledge of other professions’ expertise and challenge their own assumptions was also highlighted

A Case Study of Organizational and Curricular Attributes for Interprofessional Education: A Model for Sustainable Curriculum Delivery

Background: In health and social care (HASC) professional education, interprofessional competencies are optimally developed by engaging in interprofessional education (IPE) activities that are delivered sustainably along a continuum. Ultimately, active engagement in IPE is meant to prepare future practitioners for interprofessional collaborative practice (IPCP), which leads to improved patient/client and community-oriented outcomes. Methods and Findings: This qualitative case study explores how four Canadian post-secondary institutions deliver IPE within their HASC professional education programmatic structures. Data were collected from institutional websites, publicly available IPE relevant records and documents, and interviews with coordinators and faculty/facilitators of IPE curriculum. Data were inductively analyzed to generate relevant themes, followed by a deductive analysis guided by the five accreditation standards domains identified in the Accreditation of Interprofessional Health Education (AIPHE) projects. Analyses of the data resulted in five attributes: 1) central administrative unit, 2) longitudinal and integrative program, 3) theoretically informed curriculum design, 4) student-centred pedagogy, and 5) patient/client-oriented approach. Conclusions: Using these attributes and guided by AIPHE’s accreditation standards domains, an organizational-curricular model for sustainable IPE is proposed, through which we assert that IPE reinforced through these organizational and curricular supports reflects successful programming, leading to patient/client-oriented outcomes

A Peer-to-Peer Approach to Implementation of a Chronic Disease Management Program

Background: Peer-to-peer (P2P) learning occurs when individuals from similar social groups or professions help each other to learn new knowledge skills or problem solving. Peer-to-peer learning is used across many disciplines but has not been widely studied in primary care or chronic disease management. This study explored the use of an interprofessional P2P approach to support the implementation of a chronic disease management program in primary care for patients with chronic obstructive pulmonary disease (COPD), known as Best Care COPD (BCC). Methods and findings: A single descriptive case study design was used to explore P2P learning implementation approach. Focus groups and key informant interviews were held with providers involved in implementation (n = 26). Three key components of the P2P approach were identified: 1) an interprofessional team, 2) iterative peer-led training, and 3) continuous peer connection. Three recommendations are provided to support future P2P efforts: 1) enlist a champion in each profession, 2) build a P2P community, and 3) implement succession planning. Conclusion: This article provides an empirical example of the use of a P2P approach in primary care program implementation. The results will inform the future implementation of programs for chronic disease management as well as the continued sustainability of the BCC program

Introductory Experiential Learning in IPE Teams: Changes in Team Collaboration and Cultural Attitudes and Beliefs

Background: An introductory, longitudinal, authentic experiential IPE opportunity named LIFE was delivered. The objectives were to 1) compare attitudes, including cultural attitudes and beliefs, and team behaviours of learners over time, and 2) assess association between participation in LIFE and changes in team attitudes and performance. Methods: Students (n = 48) from eight schools worked in eight teams. Each team was assigned to a patient/family, who was asked about health and healthcare experiences. Students completed Students’ Perceptions of Interprofessional Clinical Education–Revision 2 (SPICE-R2), Cultural Attitude and Belief Scale (CABS), and Interprofessional Collaborator Assessment Rubric (ICAR). Analyses focused on differences over time for all participants and by team. Findings: Knowledge of roles improved for four teams, and five teams showed improvements in “techniques” to interact with diverse patients. Notably, “communication,” “collaborative working,” and “roles” changed across three teams for ICAR. One team showed improvements in all three assessments and two teams showed little to no changes. Conclusion: LIFE was associated with improvements in “roles” and “techniques” to help teams interact with diverse patients

Scoping Review: Interprofessional Simulation as an Effective Modality to Teaching Interprofessional Collaborative Competencies in the Emergency Department

Background: A scoping review was conducted to map the current body of research pertaining to simulation-enhanced interprofessional education (Sim-IPE) as a modality for teaching interprofessional collaboration (IPC) in the emergencydepartment (ED). Methods and Findings: The research team followed the PRISMA Extension for Scoping Reviews framework. Studies were included if they involved two or more healthcare professions, utilized simulation as the learning method for interprofessional education (IPE), involved simulation pertaining to the ED, and identified at least one Canadian Interprofessional Health Collaborative or Interprofessional Education Collaborative IPC competency as a learning outcome. In total, 896 studies were included for title and abstract screening and 806 were deemed irrelevant. Ninety full-text studies were assessed for eligibility and 34 were included in the review. Conclusions: Eighteen studies found Sim-IPE to be an effective method for teaching interprofessional competencies in the ED. Simulation-enhanced interprofessional education appears to be a promising methodology for teaching IPC competencies to ED healthcare professionals. Interprofessional collaboration competency frameworks should be utilized to guide Sim-IPE, and assessment tools specific to interprofessional competencies should be used in the assessment phase of Sim-IPE. Faculty development is a crucial component of Sim-IPE. Further longitudinal and outcome-based research is required

Factors Influencing Health Career Choices During Clinicians’ First Three Years in Practice

Background: Health systems globally need more clinicians to work rurally and in community-based primary care. This study explores factors influencing health graduates’ choice of clinical setting and geographical location during early careers, across a range of disciplines that work together to support the health of people in community-based and rural locations.Methods: Students from eight disciplines (n = 611) were recruited prior to their final year of pre-registration training. Data were collected via three electronic surveys completed at the end of participants’ first, second, and third year of clinical practice. Data were managed and analyzed with Template Analysis.Findings: Similar factors influenced clinical setting and location choice but differed in relative importance for each. The nature of the job itself was the most important factor influencing clinical setting choices. A broader range of influences were important to geographical location choices including personal reasons, the nature of the job, the nature of the location, and job availability and opportunities. Regulatory or training requirements limited choices available to some clinicians, particularly those from medicine.Conclusion: A range of complex and interacting factors influenced health graduates’ career choices. Findings indicate that a broad system-wide approach is needed to address community and rural health workforce needs

Using Visual Methods to Capture Patient Perspectives in Interprofessional Team-Based Care for Chronic Disease Management

Background: Understanding how patients perceive their role in the healthcare team can improve overall satisfaction of care and health outcomes. However, it has been challenging to capture the diversity of patient experiences using traditional research approaches. The goal of this study was to explore the perspectives of patients involved in an interprofessional team-based chronic disease management program for chronic obstructive pulmonary disease using visual research techniques. Methods: Our visual approach began with patients autonomously drawing (or mapping) experiences with their healthcare team. The maps were explored with the patients through focus group discussions. Maps were inductively coded to identify similarities and differences between participants’ perceptions. Focus group transcripts were first analyzed independently, then compared to and integrated into the map analysis. Findings: Overall, participants (n = 13) were satisfied as patients of team-based care. Participants drew multiple healthcare providers, sources of information, and themselves to represent their teams. Relationships and significance were represented using arrows, the size of each team member, facial expressions, and symbols. Four key elements of effective team-based models of care emerged: 1) effective information sharing, 2) diversity of providers’ roles, 3) empowerment through self-management, and 4) enhanced access to care. Conclusion: This study used visualization methodology to obtain patient feedback on the program’s performance, elicit patients’ experiences, and attempt to mitigate some of the limitations of isolated survey and focus group methodology, subsequently obtaining rich data on team-based care. Our research also informs ongoing quality improvement of the team nbased model for chronic disease management

Template Analysis of a Longitudinal Interprofessional Survey: Making Sense of Free-Text Comments Collected Over Time

Surveys are widely used in interprofessional education (IPE) research and these often collect free-text data. The potential contribution of free-text data to analysis and interpretation is often missed through separate reporting of qualitative and quantitative results, or free-text analyses being superficial or limited to subsets of data. There is little published guidance on how to maximize the use and integration of free-text comments with quantitative responses in large datasets collected over multiple years. Analysis of all qualitative comments, within the context of their related quantitative answers, enables exploration of changes in participants’ construction of meaning over time. This article describes how we used template analysis to analyze 3,626 free-text responses, collected as part of a five-year survey exploring the impact of an IPE program on health professionals’ attitudes to teamwork and early careers. We outline the main procedural steps undertaken by a team of researchers and we share our insights into the methodological challenges encountered. This article aims to inspire other researchers at the planning stage of research proposals, and assist them with practical ideas during data extraction, management, analysis, and reporting of large free-text datasets. We conclude that template analysis has methodologically sound, pragmatic utility in IPE longitudinal survey researc

Cultural Considerations in Interprofessional Education: A Systematic Scoping Review

Background: Global culture influences health behaviors and attitudes and the way we communicate and solve problems; it can also significantly affect the efficiency of the multicultural and interprofessional healthcare team. This scoping review aims to understand and identify global cultural considerations that exist in interprofessional education (IPE) and that influence the development, implementation, and effectiveness of IPE. Methods and Findings: The search included peer-reviewed articles focused on both IPE and global culture, also referred to as national, ethnic, or racial culture. There was no limitation placed on levels of learners nor specific health professions. Articles were excluded if they did not explicitly discuss global cultural considerations in IPE. The authors screened 1094 records, and 155 full-text articleswere assessed for eligibility. No eligible papers were found for inclusion yielding an empty review. The most common reasons for exclusion were failure to address global culture and a focus on provider-patient cultural competency as opposed to cultural aspects of IPE. Conclusions: Despite the recognition of the importance of global culture in all interactions, it is not explicitly addressed within the interprofessional healthcare team or the development and implementation of IPE. Studies addressing culturally congruent teamwork and IPE, and the relationship to culturally inclusive patient care, are needed