Workplace learning through collaboration in primary healthcare: A BEME realist review of what works, for whom and in what circumstances: BEME Guide No. 46.

BACKGROUND: Changes in healthcare practice toward more proactive clinical, organizational and interprofessional working require primary healthcare professionals to learn continuously from each other through collaboration. This systematic review uses realist methodology to consolidate knowledge on the characteristics of workplace learning (WPL) through collaboration by primary healthcare professionals. METHODS: Following several scoping searches, five electronic bibliographic databases were searched from January 1990 to December 2015 for relevant gray and published literature written in English, French, German and Dutch. Reviewers worked in pairs to identify relevant articles. A set of statements, based on the findings of our scoping searches, was used as a coding tree to analyze the papers. Interpretation of the results was done in alternating pairs, discussed within the author group and triangulated with stakeholders' views. RESULTS: Out of 6930 references, we included 42 publications that elucidated who, when, how and what primary healthcare professionals learn through collaboration. Papers were both qualitative and quantitative in design, and focused largely on WPL of collaborating general practitioners and nurses. No striking differences between different professionals within primary healthcare were noted. Professionals were often unaware of the learning that occurs through collaboration. WPL happened predominantly through informal discussions about patient cases and modeling for other professionals. Any professionals could both learn and facilitate others' learning. Outcomes were diverse, but contextualized knowledge seemed to be important. DISCUSSION/CONCLUSIONS: Primary care professionals' WPL is multifaceted. Existing social constructivist and social cognitivist learning theories form a framework from which to interpret these findings. Primary care policy makers and managers should ensure that professionals have access to protected time, earmarked for learning. Time is required for reflection, to learn new ways of interaction and to develop new habits within clinical practice.

Preparing palliative home care nurses to act as facilitators for physicians' learning: Evaluation of a training programme.

BACKGROUND: Palliative care requires a multidisciplinary care team. General practitioners often ask specialised palliative home care teams for support. Working with specialised nurses offers learning opportunities, also called workplace learning. This can be enhanced by the presence of a learning facilitator. OBJECTIVES: To describe the development and evaluation of a training programme for nurses in primary care. The programme aimed to prepare palliative home care team nurses to act as facilitators for general practitioners' workplace learning. DESIGN: A one-group post-test only design (quantitative) and semi-structured interviews (qualitative) were used. METHODS: A multifaceted train-the-trainer programme was designed. Evaluation was done through assignments with individual feedback, summative assessment through videotaped encounters with simulation-physicians and individual interviews after a period of practice implementation. RESULTS: A total of 35 nurses followed the programme. The overall satisfaction was high. Homework assignments interfered with the practice workload but showed to be fundamental in translating theory into practice. Median score on the summative assessment was 7 out of 14 with range 1-13. Interviews revealed some aspects of the training (e.g. incident analysis) to be too difficult for implementation or to be in conflict with personal preferences (focus on patient care instead of facilitating general practitioners' learning). CONCLUSION: Training palliative home care team nurses as facilitator of general practitioners' workplace learning is a feasible but complex intervention. Personal characteristics, interpersonal relationships and contextual variables have to be taken into account. Training expert palliative care nurses to facilitate general practitioners' workplace learning requires careful and individualised mentoring.

What, how and from whom do health care professionals learn during collaboration in palliative home care: a cross-sectional study in primary palliative care.

BACKGROUND: Palliative care often requires inter-professional collaboration, offering opportunities to learn from each other. General practitioners often collaborate with specialized palliative home care teams. This study seeks to identify what, how and from whom health care professionals learn during this collaboration. METHODS: Cross-sectional survey in Belgium. All palliative home care teams were invited to participate. General practitioners (n = 267) and palliative care nurses (n = 73) filled in questionnaires. RESULTS: General practitioners (GPs) and palliative care nurses learned on all palliative care aspects. Different learning activities were used. Participants learned from all others involved in patient care. The professionals' discipline influences the content, the way of learning and who learns from whom. Multiple linear regression shows significant but limited association of gender with amount of learning by GPs (M < F; p = 0.042; Adj R2 = 0.07) and nurses (M > F; p = 0.019; Adj R2 = 0.01). CONCLUSIONS: This study is the first to reveal what, how and from whom learning occurs during collaboration in palliative care. Training professionals in sharing expertise during practice and in detecting and adequately responding to others' learning needs, could optimize this way of learning.

'I beg your pardon?' Nurses' experiences in facilitating doctors' learning process--an interview study.

OBJECTIVE: Working alongside specialized palliative care nurses brings about learning opportunities for general practitioners. The views of these nurses toward their role as facilitator of learning is unknown. The aim of this study is to clarify the views and preferences of these nurses toward their role as facilitator of physicians' learning. METHODS: Qualitative study based on semi-structured interviews. We interviewed 21 palliative care nurses in Belgium who were trained in the role of learning facilitator. Data were analyzed using Grounded Theory principles. RESULTS: First all interviewees shared the conviction that patient care is their core business. Secondly two core themes were defined: nurses' preferences toward sharing knowledge and their balancing between patient care and team care. Combining these themes yielded a typology of nurses' behavioral style: the clinical expert-style, the buddy-style, the coach-style and the mediator-style. CONCLUSIONS: Palliative care nurses' interpretation of the role as facilitator of general practitioners' learning diverges according to personal characteristics and preferences. PRACTICE IMPLICATIONS: Asking clinical expert nurses to become a facilitator of other professional's learning requires personal mentoring during this transition. Nurses' preferences toward practice behavior should be taken into account.

Patients' nursing records revealing opportunities for interprofessional workplace learning in primary care: a chart review study.

BACKGROUND: Working and learning go hand in hand during interprofessional collaborative practice. Patients' nursing records are designed to record patient care and health status. It is not known whether these records are also used to keep track of interprofessional contacts or interprofessional learning between team members. This study explored the usefulness of patients' nursing records in optimising interprofessional workplace learning for general practitioners. METHODS: We utilized a descriptive retrospective chart review. All palliative home care teams of the Dutch speaking part of Belgium were involved. Throughout the year 2010, a representative sample of patient charts was selected. Characteristics of encounters between general practitioners and palliative care nurses were extracted from the charts. RESULTS: Detailed accounts of interprofessional contacts were found in the charts. Palliative care nurses recorded number and type of contacts, topics discussed during contacts and general practitioner's learning activities. DISCUSSION: Palliative care nurses are sensitive and open towards the general practitioners' learning needs. Patients' nursing records provide useful information for interprofessional team discussions on workplace learning. Healthcare professionals should be trained to respond to each other's learning needs.

Health care professionals' perceptions towards lifelong learning in palliative care for general practitioners: a focus group study.

BACKGROUND: There is a growing need for palliative care. The majority of palliative patients prefer their general practitioner (GP) to organize their palliative home care. General practitioners need a range of competences to perform this task. However, there has been no general description so far of how GPs keep these competences up-to-date. The present study explores current experiences, views and preferences towards training and education in palliative care among GPs, palliative home-care professionals and professionals from organizations who provide training and education. METHODS: Five focus groups were brought together in Belgium, with a total of 29 participants, including members of the three categories mentioned above. They were analysed using a constant comparison method. RESULTS: The analysis revealed that undergraduate education and continuing medical education (CME) while in practice, is insufficient to prepare GPs for their palliative work. Workplace learning (WPL) through collaboration with specialized palliative home-care nurses seems to be a valuable alternative. CONCLUSIONS: The effectiveness of undergraduate education might be enhanced by adding practical experience. Providers of continuing medical education should look to organize interactive, practice-based and interprofessional sessions. Therefore, teachers need to be trained to run small group discussions. In order to optimize workplace learning, health care professionals should be trained to monitor each other's practice and to provide effective feedback. Further research is needed to clarify which aspects of interprofessional teamwork (e.g. professional hierarchy, agreements on tasks and responsibilities) influence the effectiveness of workplace learning.

Examining the cross-cultural sensitivity of the Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) and validation of a Dutch version.

The Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) is used to examine students' study approaches in higher education. The questionnaire assumes to measure two factors: a deep and a surface study approach. Analyses into the validity and reliability of the original English R-SPQ-2F yielded positive results. In this study, we examined the degree to which these positive results can also be found for the Dutch version that we developed. By comparing our results with the results of earlier studies in different cultures, we conclude cross-cultural sensitivity is an important point to be borne in mind when using the R-SPQ-2F. Our research supports the validity and reliability of our Dutch version of the R-SPQ-2F.

Instructional development for teachers in higher education: effects on students' perceptions of the teaching-learning environment.

BACKGROUND: Although instructional development for teachers has become an important topic in higher education, little is known about its actual impact. In particular, evidence regarding the impact of teachers' instructional development on students' perceptions of the teaching-learning environment is scarce. AIMS: The impact of an instructional development programme for beginning university teachers on students' perceptions of the teaching and learning environment was investigated. We also explored whether this impact is dependent on class size and student level (first years vs. non-first years). SAMPLE: Quantitative data were gathered from more than 1,000 students at pre- and post-tests, using a quasi-experimental design. METHOD: A multi-level analysis was conducted in which five models were estimated. RESULTS: A basic model made clear that teachers did differ from each other with respect to the dependent variables concerned; however, differences in scale scores also resulted to a large extent from differences between students. A second model, in which the moderating impact by way of teacher characteristics, context, and student characteristics was not taken into account, reported no significant effect of training. A third model, examining the net impact of instructional development revealed some impact, which was, remarkably, negative. A first interaction model proved a differential impact of instructional development for teachers teaching first years and those teaching non-first years. A second one showed that the impact of training depended on the number of students one teaches. CONCLUSIONS: Instructional development for teachers in higher education does not easily result in effects on students' perceptions of the teaching and learning environment. Perspectives for further research into instructional development are discussed.

The landscape of postgraduate education in palliative care for general practitioners: results of a nationwide survey in Flanders, Belgium.

OBJECTIVE: To describe the offer of continuing medical education (CME) in palliative care in Flanders, Belgium and to explore the way providers of CME address the preferences of general practitioners (GP's) towards CME. METHODS: Questionnaire-survey among official providers of formal CME. RESULTS: The response rate was 43%, equally distributed over all 5 provinces of Flanders. Data show large content gaps, an under usage of appropriate educational techniques and an absence of evaluation of the impact of CME on clinical practice. Providers of CME explain how they take the preferences of GP's concerning education in palliative care into account. CONCLUSIONS: The present offer of CME is insufficient to educate GP's in palliative care. The absence of quality criteria and the lack of coordination between different providers results in an unattractive labyrinth of courses leaving GP's and their patients in the cold. PRACTICE IMPLICATIONS: A comprehensive offer of CME sessions should be installed in a coordination between all providers. This could render the use of means (logistics and speakers) more efficient. Further research could look into other ways of acquiring palliative care competences such as evaluating the learning effect of GP's working together with specialized palliative home care teams.