An exploratory, cross-sectional and multi-institutional study using three instruments to examine student perceptions of interprofessional education.

Interprofessional education (IPE) research needs to expand beyond single site, single event inquiry. Multi-institutional studies increase methodologic rigor and generalizability, advancing the pedagogical science of IPE. Four U.S. institutions used three different validated measures to examine early learner interprofessional outcomes. The three assessment tools included the Communication and Teamwork subscale of the University of West England Entry Level Interprofessional Questionnaire (UWE-ELIQ), the Self-Assessed Collaboration Skills (SACS), and the Interprofessional Teamwork and Team-based Practice factor of the Student Perceptions of Interprofessional Clinical Education-Revised, version 2 (SPICE-R2). Across the four institutions, 659 eligible participants, representing 19 programs completed the pre-survey, and 385 completed the post-survey. The UWE-ELIQ showed a statistically significant difference between the pre- and post-survey overall, but the effect size was small. One institution demonstrated a positive change in scores on the UWE-ELIQ with a small effect size, while the other institutions saw no significant change. Two institutions observed lower post-survey scores on the SPICE-R2. Cumulative results from the study indicated no statistically significant change from pre- to post- in total SACS or SPICE-R2 scores. Additional multi-site longitudinal research is needed to investigate use of validated instruments, as well as the impact of curricula and learning environment on educational outcomes.

Undergraduate students' perspectives of healthcare professionals' use of shared decision-making skills.

Essential for future healthcare professionals (HCPs) to delivering ethical and empathetic patient-centred care (PCC) as a team is the understanding of appropriate shared decision-making (SDM) responses when facilitating discussions with patients and family members. The purpose of this study was to evaluate undergraduate students' perspectives about HCPs' use of SDM as described in a case-study reflection assignment. An exploratory qualitative approach was used to analyse student-reflection assignments. The sample included 42 undergraduate students enrolled in an interprofessional education (IPE) course at a Midwest university based in the United States. Data consisted of student responses in a course reflection assignment that captured their perspectives about recommended SDM responses by HCPs. Student assignments were randomly selected using stratified sampling to provide representation of eight HCP roles. Analysis revealed two themes related to students' use of SDM responses. Results provide evidence supporting the tenet that through IPE, healthcare students can develop an understanding of SDM and ethical principles related to PCC.

Accuracy of Parent-Measured Weight and Height of Preschool Children at Home With Increasing Levels of Instruction.

Background: The purpose of this study was to determine how accurately parents measure their preschool child's weight and height with increasing levels of instruction. Methods: Parents measured their child's (n = 30 dyads) weight (own weight scale) and height (soft tape measure) using three levels of instruction: instructional guide (level 1); guide, demonstration video (level 2); and guide, video, and virtual monitoring (level 3), which were compared to researcher measurements (electronic weight scale, Stadiometer). Paired t-tests were used to determine differences between researcher and parent measurements and between the three parent levels. Inaccurate classifications were calculated using parent-measured values for the four categories (underweight, healthy, overweight, obese). Results: Raw mean parent-measured weights (17.4 ± 2.3 kg) differed from researcher by 0.2 kg (level 1), 0.3 kg (level 2), and 0.1 kg (level 3). Raw mean parent-measured heights (104.0 ± 5.9 cm) differed from researcher by 0.9 cm (level 1, p = 0.005), 0.4 cm (level 2, NS), and 0.3 cm (level 3, NS). Across all levels, 48.9% and 65.5% parents overmeasured their children's weights and heights, respectively. Using parent-measured values, 29.4% of children were classified high while 70.5% were classified low. Parents were more likely to make errors if their children were on the borderline between any of the two weight categories. Conclusion: Findings indicate that an instructional guide with demonstration video is helpful in improving the parents' accuracy of their children's weights and heights. More research is needed to determine accuracy in population other than White parents with high education levels and children under overweight and obese category.

Early-learners' expectations of and experience with IPE: A multi-institutional qualitative study.

BACKGROUND: Multi-institutional qualitative studies are scarce within the interprofessional education (IPE) literature; such a report would provide comprehensive evidence for the application of interprofessional instruction among earlier learners. OBJECTIVE: This investigation explored students' expectations of and barriers to introductory IPE across four institutions. DESIGN: Qualitative inductive content analysis was utilized to interpret students' narrative responses to assigned pre- and post-survey questions. SETTING: Health science schools of four U.S. institutions at Institution A, Institution B, Institution C, and Institution D. PARTICIPANTS: Twenty-two percent (n = 385) of eligible participants completed both pre- and post-surveys. Nursing student participation was greatest (n = 113, 33%), followed by occupational therapy (n = 44, 13%), and physical therapy (n = 36, 10%). All other program participation was <10%. In total, students' narrative comments from 19 degree programs were a part of the data set. METHODS: Responses from one pre-survey question on expectations of introductory IPE and two post-survey questions on IPE benefits and barriers were studied using qualitative inductive thematic analysis. RESULTS: Four themes emerged as IPE learning expectations and benefits: my own professional role, professional role of others, teamwork, and communication. The theme of interacting with peers surfaced as an additional IPE benefit. There were four themes noted as IPE barriers: course logistics, lack of context, course content, and social dynamics. CONCLUSION: This multi-institutional qualitative study adds to the literature by providing empirical evidence regarding early learner perceptions of IPE experiences. Student expectations and benefits of their introductory IPE course/curriculum aligned. Perceived barriers are useful in informing future IPE implementation and research.

Quality of Nutrition Environments, Menus and Foods Served, and Food Program Achievement in Oklahoma Family Child Care Homes.

Child care environments foster children's healthy eating habits by providing exposure to healthy foods and feeding practices. We assessed the healthfulness of nutrition environments, menu/meal quality, and the achievement of Child and Adult Care Food Program (CACFP) guidelines and best practices in Oklahoma CACFP-enrolled family child care homes (FCCHs) (n = 51). Two-day classroom observations were conducted. Healthfulness of classroom nutrition environments was assessed using the Environment and Policy Assessment and Observation (EPAO). Foods served to and consumed by children were quantified using the Dietary Observations in Child Care (DOCC) tool. Nutrient analysis was performed to determine total energy for foods listed on menus, served to, and consumed by children. Menu and meal food variety and CACFP Guideline Achievement Scores were determined. Average nutrition environment score was 11.7 ± 1.2 (61.5% of maximum possible score). Energy (kcals) from menus and consumed by children was insufficient to meet two-thirds of their daily reference intake. Children were exposed to 1.7 vegetables and 1.3 fruits per meal. CACFP Guideline Achievement Scores were 66.3% ± 7.8 for menus and 59.3% ± 7.6 for mealtimes. Similar to previous research, our findings indicate a need for improved FCCH nutrition practices. Tailored interventions for FCCHs are needed.

Student Perceptions of Collaboration Skills in an Interprofessional Context: Development and Initial Validation of the Self-Assessed Collaboration Skills Instrument.

An integral component of interprofessional education (IPE) is the development of a collaboration-ready health-care workforce. While collaboration is a fundamental element of IPE, there is no existing measure of collaboration skills that is not context specific. This article describes the development and initial validation of the Self-Assessed Collaboration Skills (SACS) measure. Items were initially drawn from the Collaboration Skills Assessment Tool rubric, an educational assessment tool. The SACS measure was piloted in a sample of students in an introductory IPE course. Following scale revision, the SACS was piloted a second time in a sample of students in an IPE health systems course and then validated in a sample of students in an introductory IPE course. Exploratory factor analysis was used to assess scale factor structure in Pilots 1 and 2 and confirmatory factor analysis to confirm factor structure in the validation sample. Convergent and discriminant validity were also assessed. The final SACS measure is an 11-item scale consisting of three dimensions of collaboration: information sharing, learning, and team support. The SACS measure demonstrates high internal consistency and both convergent and discriminant validity as a measure of collaboration. The SACS can be implemented in any setting for assessing collaboration in clinical and nonclinical contexts.

Utilizing Shared Expertise Across Contexts to Engage in Multi-institutional Interprofessional Scholarship.

Interprofessional education (IPE) research has grown dramatically, but it has primarily occurred at single institutions/contexts with unique assessment tools. Comparing pedagogical approaches and assessment tools across contexts and learner levels is necessary to advance the educational preparation of "collaborative-ready" health professionals. One common thread through IPE initiatives is a learning experience that introduces students to the basic tenets of professional roles, communication and collaboration. Commonly accepted objectives focus on competencies such as those defined by the Interprofessional Education Collaborative (IPEC). The IPE Research Collaborative (IPE-RC) brings together researchers from four universities that deliver introductory interprofessional learning experiences seeking to leverage this relationship to improve IPE research in support of collaborative person-centered quality healthcare. Donabedian's quality improvement (QI) model provides a framework of structure, process and outcomes for assessing and improving the quality of healthcare. The IPE-RC operationalized the IPEC competencies in their collaboration using Donabedian's QI model. They demonstrate, using a systematic approach that mirrors interprofessional practice, how researchers from multiple institutions can study learning experiences across different contexts and learner levels to inform best practice for an introductory interprofessional learning experience.

Institutional Readiness for Interprofessional Education Among Nutrition and Dietetics and Athletic Training Education Programs.

Organizations recommend interprofessional education (IPE) as a means of promoting collaborative patient-centered care. In turn, various external accreditors in the health professions have integrated IPE competencies into their standards. However, little is known about how athletic training (AT) and nutrition and dietetics (ND) have incorporated IPE into their educational programs. This study examined institutional factors that affect the level of IPE participation within ND and AT programs in the United States. The Interprofessional Education Assessment and Planning Instrument for Academic Institutions was distributed electronically to directors of accredited programs in ND and AT. In addition to gathering demographic information, survey questions addressed the institutions' level of involvement and commitment to IPE. Differences emerged between ND and AT programs for several items in the instrument. Factors that affected the differences included program level and academic unit in which the program resides. Results also suggest that ND and AT programs have similar levels of IPE participation, but there are great opportunities for growth. Institutional factors such resource commitment, academic unit type, and level of program may affect implementation and contribute to the development and success of IPE initiatives.

Dicarboxylic Acid Excretion in Normal Formula-Fed and Breastfed Infants.

PURPOSE: Infant formulas are often supplemented with medium-chain triglycerides (MCTs) to optimize calories for small for gestational age or preterm infants. High amounts of MCTs have been associated with an increase in dicarboxylic acid (DCA) in the urine. Elevated DCA in the urine is also a clinical indicator for fatty acid metabolism disorders. The purpose of this study was to identify if there is an amount of MCTs that can be provided without elevating urinary DCA excretion. METHODS: A metabolic screening laboratory provided urinary DCA excretion data for 175 infants. It was verified that no infants were diagnosed with metabolic disorders and therefore were considered "metabolically normal." All infants were either formula fed or breastfed at the time of screening. The type and volume of formula provided at the time of urine screening was documented. The exact amount of MCTs provided to each infant was calculated. RESULTS: The mean age of the infants was 3.09 months. The mean total DCA was determined for both the breastfeeding and formula groups. Within the formula group, the means were 32.07, 13.36, and 5.77 mmol/mol creatinine for adipic, suberic, and sebacic acids, respectively. Spearman correlation coefficient indicated correlations of r = 0.0693, r = 0.0166, and r = -0.0128 between percent MCT and adipic, suberic, and sebacic acids, respectively. No value was statistically significant. DCA excretion amounts did not vary between breastfed and formula-fed infants. Our data suggest that clinicians should not expect elevated dicarboxylic aciduria in infants who are fed a standard formula without added MCT oil.

Acute sodium bicarbonate loading has negligible effects on resting and exercise blood pressure but causes gastrointestinal distress.

Oral ingestion of sodium bicarbonate (bicarbonate loading) has acute ergogenic effects on short-duration, high-intensity exercise. Because sodium bicarbonate is 27% sodium, ergogenic doses (ie, 300 mg∙kg⁻¹) result in sodium intakes well above the Dietary Reference Intakes upper limit of 2300 mg/day. Therefore, it is conceivable that bicarbonate loading could have hypertensive effects. Therefore, we performed a double-blind crossover trial to evaluate the hypothesis that bicarbonate loading increases resting and exercise blood pressure (BP). A secondary hypothesis was that bicarbonate loading causes gastrointestinal distress. Eleven endurance-trained men and women (exercise frequency, 4.6 ± 0.4 sessions/wk; duration, 65 ± 6 min/session) underwent testing on two occasions in random sequence: once after bicarbonate loading (300 mg∙kg⁻¹) and once after placebo ingestion. BP and heart rate were measured before bicarbonate or placebo consumption, 30 minutes after consumption, during 20 min of steady state submaximal cycling exercise, and during recovery. Bicarbonate loading did not affect systolic BP during rest, exercise, or recovery (P = .38 for main treatment effect). However, it resulted in modestly higher diastolic BP (main treatment effect, +3.3 ± 1.1 mmHg, P = .01) and higher heart rate (main treatment effect, +10.1 ± 2.4 beats per minute, P = .002). Global ratings of gastrointestinal distress severity (0-10 scale) were greater after bicarbonate ingestion (5.1 ± 0.5 vs 0.5 ± 0.2, P < .0001). Furthermore, 10 of the 11 subjects (91%) experienced diarrhea, 64% experience bloating and thirst, and 45% experienced nausea after bicarbonate loading. In conclusion, although a single, ergogenic dose of sodium bicarbonate does not appear to have acute, clinically important effects on resting or exercise BP, it does cause substantial gastrointestinal distress.