Measuring Interprofessional Collaboration's Impact on Healthcare Services Using the Quadruple Aim Framework: A Protocol Paper.

Despite decades of research on the impact of interprofessional collaboration (IPC), we still lack definitive proof that team-based care can lead to a tangible effect on healthcare outcomes. Without return on investment (ROI) evidence, healthcare leaders cannot justifiably throw their weight behind IPC, and the institutional push for healthcare manpower reforms crucial for facilitating IPC will remain variable and fragmentary. The lack of proof for the ROI of IPC is likely due to a lack of a unifying conceptual framework and the over-reliance on the single-method study design. To address the gaps, this paper describes a protocol which uses as a framework the Quadruple Aim which examines the ROI of IPC using four dimensions: patient outcomes, patient experience, provider well-being, and cost of care. A multimethod approach is proposed whereby patient outcomes are measured using quantitative methods, and patient experience and provider well-being are assessed using qualitative methods. Healthcare costs will be calculated using the time-driven activity-based costing methodology. The study is set in a Singapore-based national and regional center that takes care of patients with neurological issues.

Wow, woo, win"- Healthcare students' and facilitators' experiences of interprofessional simulation in three-dimensional virtual world: A qualitative evaluation study.

BACKGROUND: In an age disrupted by COVID-19 pandemic, three-dimensional virtual world (3DVW) offers an opportunity for healthcare students from different higher education institutions to participate in interprofessional education. Despite its growing evidence, there is a need to unravel the complex learning process in order to ensure high quality of interprofessional education delivery. AIM: This study aimed to explore the experiences of healthcare students and facilitators on the use of 3DVW for interprofessional team-based virtual simulation. METHODS: Interprofessional teams, each comprising six different healthcare students (Medicine, Nursing, Pharmacy, Physiotherapy, Occupational Therapy, and Medical Social Work) and two clinicians who acted as facilitators, logged into the 3DVW from their own remote locations to participate in team-based care delivery that included an interprofessional bedside round and a family conference. A qualitative descriptive study was conducted on a purposive sample of 30 healthcare students and 12 facilitators using focus group discussions and individual interviews. RESULTS: Four themes emerged from their experiences: the "wow experience", authentic experience on collaborative care, ease of learning, and preeminent role of the facilitator. The simulation provided the "wow" experiences through contextual, collaborative and experiential learning approaches. Despite technical challenges, the participants were wooed by the comforts of learning from home and the psychological safety in virtual environment. The facilitators played a critical role in optimizing learning engagement to win learners over. CONCLUSION: Our study explicates how attention to the "wow, woo and win" trilateral factors can transform the interprofessional learning experiences offered by 3DVW simulation. Future developments in the use of this learning technology should include developing the clinicians' facilitation skills and the provision of technical support to make this 3DVW a success calls in winning students' learning engagement.

Design and evaluation of a 3D virtual environment for collaborative learning in interprofessional team care delivery.

BACKGROUND: Collaborative learning in interprofessional team care delivery across different healthcare courses and institutions is constrained by geographical locations and tedious scheduling. Three dimensional virtual environments (3D-VE) are a viable and innovative tool to bring diverse healthcare students to learn together. AIM: The aim of this study is to describe the development of a 3D-VE and to evaluate healthcare students' experiences of their collaborative learning in the environment. METHOD: A mixed methods study design was employed. Participants from six healthcare courses (Medicine, Nursing, Pharmacy, Physiotherapy, Occupational Therapy, and Medical Social Work) were recruited from three institutions to form six interprofessional teams to participate in team care delivery via a 3D-VE. Pre- and post-tests were conducted to evaluate the students' attitudes toward healthcare teams and interprofessional collaboration. Four focus groups were conducted with 27 healthcare students after they completed questionnaires to evaluate their perceived usability, the sociability of computer-supported collaborative learning, and senses of presence. Interview transcripts were analyzed using thematic analysis. RESULT: The students demonstrated significant improvements in their attitudes toward healthcare teams (p < 0.05) and interprofessional collaboration (p < 0.001) after the collaborative learning. Four themes emerged from the focus group discussions: "feeling real", whereby the students felt immersed in their own roles; the virtual environment was perceived as "less threatening" compared to face-to-face interactions; "understanding each other's roles" among different healthcare professionals; and there were some "technical hiccups" related to sound quality and navigation. The participants reported positively on the usability (mean 3.48, SD 0.64), feasibility (mean 3.39, SD 0.60) and perceived sense of presence (mean 107.24, SD 17.78) of the 3D-VE in supporting collaborative learning. CONCLUSION: Given its flexibility, practicality, and scalability, this 3D-VE serves as a promising tool for collaborative learning across different healthcare courses and institutions in preparing for future collaborative-ready workforces.

Finding the Right Blend of Technologically Enhanced Learning Environments: Randomized Controlled Study of the Effect of Instructional Sequences on Interprofessional Learning.

BACKGROUND: With the availability and capabilities of varied technologically enhanced learning activities, the blended learning approach has become increasingly popular in interprofessional education. The combined use of different technologically enhanced learning activities has not been fully examined, particularly to determine the effects of instructional sequences for effective learning outcomes. OBJECTIVE: The objective of this study was to investigate whether the instructional sequences of a blended learning approach can improve students' learning outcomes on interprofessional competencies. METHODS: A randomized controlled study was conducted with 40 interprofessional health care teams. These teams undertook three technologically enhanced learning activities-Web-based instruction (WI), virtual reality (VR), and simulation exercise (SE)-after random assignment to three groups based on three different instructional sequences (WI-VR-SE, WI-SE-VR, and SE-WI-VR). Pretests and posttests were conducted to evaluate the students' learning outcomes on interprofessional competencies. RESULTS: A total of 198 participants from the three groups completed the questionnaires. All three groups reported significant improvement in their levels of self-efficacy (P<.05) and attitudes (P<.001) toward interprofessional team care about 1 month after the interprofessional learning activity. Although no significant difference was found (P=.06) between the WI-VR-SE and WI-SE-VR groups in the self-efficacy posttests, participants in the SE-WI-VR group reported significantly lower (P<.05) posttest scores than those in the WI-SE-VR group. The majority of the participants (137/198, 69.1%) selected the instructional sequence "WI-VR-SE" as their top preference. CONCLUSIONS: This study shows that the instructional sequence of a blended learning approach can have a significant impact on students' learning outcomes. The learning of concepts from WI followed by problem-solving activity in the SE was found to be a more effective learning sequence than the reverse sequence. We recommend that future studies focus on scaffolding students' learning when planning instructional sequences for technologically enhanced learning activities within blended learning environments.

Engaging persons with disabilities as community teachers for experiential learning in occupational therapy education.

BACKGROUND: Cultivating empathy towards persons with disabilities has been highlighted as an essential graduate attribute in the occupational therapy profession. PURPOSE: With the aim to developing a more holistic understanding of disability, this project seeks to translate an experiential learning activity developed in Canada to the local Singaporean context. Small groups of two to three students were paired with a person with physical disability, known as a community teacher, for a series of visits to observe and participate in their self-care, productivity and leisure activities. METHOD: A sequential explanatory mixed methods design was adopted with the administration of an adapted version of the Multidimensional Attitudes Scale Towards Persons with Disabilities on 51 first year occupational therapy students. Seventeen students participated in three focus group discussions at the end of the learning activity.Findings: Comparison of pre- and post-scores using Wilcoxon signed-rank tests of all three subscales of the Multidimensional Attitudes Scale Towards Persons with Disabilities yielded significant improvements. The average score for Affect improved from 42.94 to 32.08, z = -5.43, P < .001; for Cognition improved from 26.12 to 21.41, z = -4.20, P < .001; for Behaviour improved from 23.78 to 20.65, z= -4.44, P < .001. Effect sizes ranged from medium to large. Thematic analysis of focus groups led to the identification of four themes that explained these improvements.Implications: Experiential learning can be effective in cultivating empathy and improving attitudes of occupational therapy students towards persons with disabilities. There is potential to expand this pedagogical approach to other health sciences disciplines.

Considerations for occupational therapy assessment for Indigenous children in Australia.

BACKGROUND: To date, the literature specifically relating to occupational therapy assessment of Australian Indigenous children is lacking. This article aims to present occupational therapists with practice guidelines for conducting assessments with primary school-aged Indigenous children in Australia. It highlights key considerations to be made prior to assessment, reviews potentially culturally relevant assessment tools and discusses key principles to guide assessment practice. METHOD: A literature review was carried out with the aim of investigating: (i) Australian Indigenous culture in relation to health and paediatric development; (ii) current practices for assessment with Australian Indigenous children; and (c) paediatric assessment tools and their potential use with Australian Indigenous children. RESULTS: Research relating to specific assessments does highlight some pertinent points about their use with children from non-Western cultures. CONCLUSIONS: Conducting culturally relevant assessment requires a combination of the right tools, an adaptive approach to both understanding and conducting assessments and, above all, an appreciation that each child is unique.

A brief office-based hazard perception intervention for drivers with ADHD symptoms.

OBJECTIVE: The aim of this study was to develop a simple and brief hazard perception training intervention tailored to meet the needs of male drivers with attention-deficit-hyperactivity disorder symptoms. METHODS: Twenty male drivers with attention-deficit-hyperactivity disorder symptoms were quasi-randomly assigned to either a hazard perception training package (trained group) or a control intervention video (untrained group), presented in an office setting. Video-based hazard perception tests involving real-life driving scenes were conducted both before and after the interventions. RESULTS: The hazard perception response times of the trained group significantly improved compared with the untrained group, t (18) = 3.21, p < 0.005. CONCLUSIONS: Significant improvements in hazard perception response times in male drivers with attention-deficit-hyperactivity disorder symptoms were found following the training intervention. This indicates that such training has potential for inclusion in a management plan for reducing the crash rates of this high risk group of drivers. The training is practical, quick, and affordable, and has the potential to translate into real-world driving outcomes.