Exploring differences in and factors influencing self-efficacy for competence in interprofessional collaborative practice among health professions students.

The value of health care delivered via effective interprofessional teams has created an imperative for interprofessional education (IPE) and interprofessional collaborative practice (ICP). To inform IPE strategies, we investigated differences in perceived self-efficacy (SE) for competence in ICP among health professions students. The study data were collected between 2015 and 2019 from students from 13 different health professions programmes (N = 3,497) before an annual institutional interprofessional programme. Students completed the IPECC-SET-27, a validated instrument evaluating perceived SE for competence in ICP, and rated their 1) amount of previous contact with, and 2) perceived understanding of, the role of different health professions. Students in different health professions education programmes were compared using parametric statistics. Regression analyses explored factors influencing SE for competence in ICP. Findings revealed significant differences in perceived SE for competence in ICP between programmes (p < .05). Specifically, health information management/health informatics, dentistry, medicine, and nursing students expressed relatively higher SE, whereas physical therapy and occupational therapy students expressed relatively lower SE. Perceived understanding of the role of health professions (p < .01) and gender (p < .01) contributed significantly to predicting perceived SE for competence in ICP, while the amount of previous contact with other health professions did not (p = .42). The findings highlight the value of designing IPE with consideration of specific learner needs.

Is Academic Medicine Prepared to Teach About the Intersection of Childhood Experiences and Health? An Exploratory Survey of Faculty.

INTRODUCTION: Childhood experiences affect health across the lifespan. Evidence-based strategies targeting early-life stress are emerging. Nevertheless, faculty physicians' preparation to incorporate this science into practice has not been well studied. This study explores medical faculty knowledge and beliefs, timing and route of knowledge acquisition, perceived relevance and application of study topics, and characteristics associated with concept mastery. METHODS: The authors developed and administered an exploratory survey to faculty from six departments at two medical schools. The team analyzed responses using quantitative and qualitative methods. RESULTS: Eighty-one (8.8%) eligible faculty completed the survey. Of respondents, 53 (65.4%) achieved high knowledge, 34 (42.0%) high beliefs, and 42 (59.1%) high concept exposure question scores, but only 6 (7.4%) through a formal route. Although 78 (96.8%) respondents indicated that survey concepts are relevant, only 18 (22.2%) reported fully incorporating them in their work, and 48 (59.2%) identified the need for additional coaching. Respondents reporting full incorporation were significantly more likely to attain high concept exposure scores (17 respondents, 94.4%, versus 25 respondents, 39.7%, P < .001). Quantitative and qualitative analysis highlighted limited respondent awareness of trauma prevalence among health care workers, lack of familiarity with interventions, and time and resource challenges addressing childhood adversity. DISCUSSION: Although survey respondents had some familiarity with study concepts and perceived their relevance, most are not fully applying them. Results suggest that exposure to study concepts is associated with full incorporation. Therefore, intentional faculty development is essential to prepare faculty to include this science in practice.

Let's Not Reinvent the Wheel: Using Communities of Learning and Practice to Address SDOH and Advance Health Equity.

BACKGROUND: Despite advances in knowledge and science, evidence indicates that health care disparities and inequities continue to exist across diverse populations. Educating and training the next generation of health professionals to focus on addressing social determinants of health (SDOH) and advancing health equity is a key priority. This aim requires educational institutions, communities, and educators to strive for change in health professions education, to attain the goal of creating transformative educational systems that better meet the public health needs of the 21st Century. PURPOSE AND OUTCOMES: Communities of practice (CoPs) are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly. The National Collaborative for Education to Address Social Determinants of Health (NCEAS) CoP is focused on integrating SDOH into the formal education of health professionals. The NCEAS CoP is one model to replicate how health professions educators can work together for transformative health workforce education and development. The NCEAS CoP will continue to advance health equity by sharing evidence-based models of education and practice that address SDOH and help build and sustain a culture of health and well-being through sharing models for transformative health professions education. CONCLUSIONS: Our work is an example that shows we can build partnerships across communities and professions, thereby freely sharing ideas and curricular innovations that address the systemic inequities that continue to fuel persistent health disparities and inequities, and contribute to moral distress and burnout of our health professionals.

Challenges of interprofessional geriatric practice in home care settings: an integrative review.

This integrative review identified challenges for interprofessional home care and provided recommendations for improving geriatric home care. A search of six databases identified 982 articles; 11 of them met the review's eligibility criteria and were included in the review. Quality appraisal of the included studies was performed using two tools (Critical Appraisal Skills Program for Qualitative Research and Mixed Methods Appraisal Tool), and their overall methodological quality was found to be satisfactory. After applying D'Amour et al.'s framework, four "challenge" themes emerged: (1) lack of sharing, (2) lack of partnership, (3) limited resources and interdependency, and (4) power issues. Recommendations included providing practical multidisciplinary training guided by a standardized model, establishing streamlined communication protocols and a communication platform reflecting the actual needs of users by involving them in its design, and asking interprofessional team members to commit to home care planning and to cultivate a collaborative culture and organizational support.

Hypertension: Are Current Guidelines Inclusive of Sex and Gender?

Background: Hypertension (HTN) accounts for one in five deaths of American women. Major societies worldwide aim to make evidence-based recommendations for HTN management. Sex- or gender-based differences exist in epidemiology and management of HTN; in this study, we aimed to assess sex- and gender-based language in major society guidelines. Materials and Methods: We reviewed HTN guidelines from four societies: the American College of Cardiology (ACC), the American College of Emergency Physicians (ACEP), the European Society of Cardiology (ESC), and the Eighth Joint National Committee (JNC8). We quantified the sex- and gender-based medicine (SGBM) content by word count in each guideline as well as identified the gender of guideline authors. Results: Two of the four HTN guidelines (ACC, ESC) included SGBM content. Of these two guidelines, there were variations in the quantity and depth of content coverage. Pregnancy had the highest word count found in both guidelines (422 words in ACC and 1,523 words in ESC), which represented 2.45% and 3.04% of the total words in each guideline, respectively. There was minimal coverage, if any, of any other life periods. The number of women authors did not impact the SGBM content within a given guideline. Conclusions: Current HTN management guidelines do not provide optimal guidance on sex- and gender-based differences. Inclusion of sex, gender identity, hormone therapy, pregnancy and lactation status, menopause, and advanced age in future research will be critical to bridge the current evidence gap. Guideline writing committees should include diverse perspectives, including cisgender and transgender persons from diverse racial and ethnic backgrounds.

Challenges to Interprofessional Education: will e-Learning be the Magical Stick?

PURPOSE: In Egypt, the main challenges to interprofessional education (IPE) implementation are complexity of the required curricular design, the attitudinal barriers between professions, and the needed resources. Action research work was planned and implemented to identify alternative solutions to overcome barriers to IPE in the local Egyptian context. METHODS: -An 8-week e-learning elective course was developed, implemented, and evaluated. A mixed group of 30 nursing and medical students was enrolled voluntarily in the course. Female to male ratio was 3:2. Four faculty members were assigned to manage the course. Based on the EMRO-WHO guidelines, ethics content was selected and organized. A closed Facebook group was created and utilized as the e-learning platform. Facilitated large-group and case-based discussions were the main instructional methods. Scoring of mixed small group assignments was the main assessment tool. Course evaluation was conducted using the Interprofessional Socialization and Valuing Scale (ISVS) and an Online-Course Evaluation Questionnaire (OCEQ). RESULTS: ISVS results revealed that students' perception of ability, comfort and value in working with others, were all positive. The OCEQ provided additional evidence regarding the satisfaction of students with the Facebook group as a learning platform. Assignment submission rate was 90%. Success rate of small group assignments (scores ≥ 60%) was 100%. Response rate to the open online discussions was 63%. Through peer evaluation as well as direct observation of online discussions, there was evidence of distinct contributions by females and by medical students compared to nursing students. CONCLUSION: As evidenced by the students' perception and performance, our IPE distance learning experience was valuable. Motivation of medical students as well as females was evident. IPE is a challenging process. The elective approach and using DL can offer solutions. Conducting relevant practical sessions as well as sustainability of this IPE e-learning experience remain key challenges.

Contributions of US Medical Schools to Primary Care (2003-2014): Determining and Predicting Who Really Goes Into Primary Care.

BACKGROUND AND OBJECTIVES: Schools of medicine in the United States may overstate the placement of their graduates in primary care. The purpose of this project was to determine the magnitude by which primary care output is overestimated by commonly used metrics and identify a more accurate method for predicting actual primary care output. METHODS: We used a retrospective cohort study with a convenience sample of graduates from US medical schools granting the MD degree. We determined the actual practicing specialty of those graduates considered primary care based on the Residency Match Method by using a variety of online sources. Analyses compared the percentage of graduates actually practicing primary care between the Residency Match Method and the Intent to Practice Primary Care Method. RESULTS: The final study population included 17,509 graduates from 20 campuses across 14 university systems widely distributed across the United States and widely varying in published ranking for producing primary care graduates. The commonly used Residency Match Method predicted a 41.2% primary care output rate. The actual primary care output rate was 22.3%. The proposed new method, the Intent to Practice Primary Care Method, predicted a 17.1% primary care output rate, which was closer to the actual primary care rate. CONCLUSIONS: A valid, reliable method of predicting primary care output is essential for workforce training and planning. Medical schools, administrators, policy makers, and popular press should adopt this new, more reliable primary care reporting method.

Entrustable Professional Activity Utilization: A CERA Study of Family Medicine Residency Program Directors.

BACKGROUND AND OBJECTIVES: Entrustable professional activities (EPAs) is a novel assessment framework in competency-based medical education. While there are published pilot reports about utilization and validation of EPAs within undergraduate medical education (UME), there is a paucity of research within graduate medical education (GME). This study aimed to explore the landscape of EPAs within family medicine GME, particularly related to the understanding of EPAs, extent of utilization, and benefits and challenges of EPAs implementation as an assessment framework within family medicine residency programs (FMRPs) in the United States. METHODS: A cross-sectional survey, as part of the 2017 Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) Family Medicine Residency Program (FMRP) Director omnibus online survey was conducted in fall, 2017. ACGME-accredited FMRP directors were invited by email to participate. RESULTS: The survey response rate was 53.1% (267/503). Overall, 90.1% (237/263) of FMRP directors were aware of EPAs as an assessment framework and 82.8% (197/238) understood the principles of EPAs, but 39.9% (95/238) were not confident in utilizing EPAs. Only 15.1% (36/238) of FMRP directors reported currently employing EPAs as an assessment tool. Identified benefits of EPAs use included increased transparency and congruence of expectations between learners and FRMP as well as facilitation for formative feedback. Identified barriers of EPA incorporation included difficulty integrating EPAs into the current assessment framework and faculty development. CONCLUSIONS: While EPAs are well recognized and understood by FMRP directors, there is significant lack of utilization of this assessment framework within FMRP in the United States.

Instrument Refinement for Measuring Self-Efficacy for Competence in Interprofessional Collaborative Practice: Development and Psychometric Analysis of IPECC-SET 27 and IPECC-SET 9.

Assessing competence in interprofessional collaborative practice (ICP) among health professions students is a high priority. This cross-sectional study built on the authors' prior work that led to the development of the 38-item Interprofessional Education Collaborative Competency Self Efficacy Tool (IPECC-SET), an instrument to evaluate health professions students' self-efficacy in interprofessional collaborative competency, and addressed two primary questions. First, could a unidimensional scale based on the IPEC competencies and assessing perceived self-efficacy for competence in ICP and be constructed? Second, could a shorter version of that instrument still meet criteria for unidimensionality and retain the ability to separate students in distinct levels of perceived self-efficacy for competence in ICP? Study participants were two cohorts of students from 11 health professions programs participating in an institutional interprofessional immersion event in 2015 and 2016. Statistical stepwise analyses were conducted using a Rasch rating scale model. The original 38 IPECC-SET items did not meet the criteria to generate a valid unidimensional measure of self-efficacy for competence in ICP, but could be condensed into a 27-item scale that met all set criteria for unidimensionality, with an explained variance of 61.2% and a separation index of 3.02. A shorter, 9-item scale demonstrated a separation index of 2.21. The nine items included also demonstrated a relatively equivalent range (54.93-45.65) as compared to the 27-item scale (57.26-46.16). Findings confirm empirically the conceptual suggestion from our earlier work that the four dimensions in the original IPEC competencies contribute to a shared underlying construct: perceived competence in interprofessional collaboration. Given the emphasis on ICP, psychometrically sound instruments are needed to evaluate the effectiveness of educational efforts to promote competency for ICP. Based on the findings from this study, both the IPECC-SET 27 and IPECC-SET 9 can be used to measure perceived self-efficacy for competence in ICP.

Professional Identity Formation in HIV Care: Development of Clinician Scholars in a Longitudinal, Mentored Training Program.

INTRODUCTION: The Clinician Scholars Program is designed to improve the capacity and quality of HIV care by training clinicians in underserved areas. A mentoring approach is used to deliver individualized educational opportunities over the course of a year focused on preparing clinicians to provide high-quality patient-centered HIV care. Evaluation of the program has illustrated increases in knowledge, skills, and practice behavior, yet critical domains remain unexplored, particularly the potential for the program to affect professional identity formation and networking between individual clinicians. METHODS: Qualitative exit interviews (N = 50) were conducted over 4 years of the Clinician Scholars Program. Interviews were transcribed and analyzed using an open-coding process with multiple coders. Interrater reliability was assessed. Themes related to professional development and networking emerged. RESULTS: Thematic analysis revealed changes in several professional development domains, including self-efficacy, HIV care clinician identity, and career development. In addition, clinicians began to develop key connections with mentors, other clinicians, and health systems-gaining a foundation in the HIV care community, enabled and strengthened by growth in professional confidence and competence within the clinician's care context. DISCUSSION: Evaluations of clinical training programs often focus on knowledge and skill gains without addressing professional identity development and place within the care community. This study illustrates that a longitudinal clinician training program has the potential to influence professional identify development, particularly affect how clinicians view themselves as a resource in the HIV care community and begins to facilitate necessary connections to other clinicians and the wider care system.

Impacts of Longitudinal Mentorship to Strengthen the HIV Workforce: Qualitative Evidence of Changes in Clinicians' Knowledge, Attitudes, and Practice.

The Clinician Scholars Program at the Midwest AIDS Training and Education Center strengthens the workforce by increasing knowledge and skills related to HIV prevention and care. The 1-year individualized training program for minority-serving clinicians includes intensive mentoring and networking. Qualitative exit interviews (N = 50) conducted over 4 years demonstrate the effectiveness of the training, including changes at the individual and systems levels. Findings show that almost all graduates reported improvements in knowledge, two-thirds reported changes in empathic capacity and cultural competence, and nearly three-quarters reported changes in clinical practice. Scholars indicated improvements in knowledge and practice of HIV prevention, including pre-exposure prophylaxis and managing medications and comorbidities. A third of the Scholars reported improvements in their clinical practices related to linking and retaining patients in HIV care, which demonstrated positive movement along the HIV care continuum, a key focus area of the National HIV AIDS Strategy.

Current Status of Family Medicine Faculty Development in Sub-Saharan Africa.

BACKGROUND AND OBJECTIVES: Reducing the shortage of primary care physicians in sub-Saharan Africa requires expansion of training programs in family medicine. Challenges remain in preparing, recruiting, and retaining faculty qualified to teach in these pioneering programs. Little is known about the unique faculty development needs of family medicine faculty within the sub-Saharan African context. The purpose of this study was to assess the current status and future needs for developing robust family medicine faculty in sub-Saharan Africa. The results are reported in two companion articles. METHODS: A cross-sectional study design was used to conduct a qualitative needs assessment comprising 37 in-depth, semi-structured interviews of individual faculty trainers from postgraduate family medicine training programs in eight sub-Saharan African countries. Data were analyzed according to qualitative description. RESULTS: While faculty development opportunities in sub-Saharan Africa were identified, current faculty note many barriers to faculty development and limited participation in available programs. Faculty value teaching competency, but institutional structures do not provide adequate support. CONCLUSIONS: Sub-Saharan African family physicians and postgraduate trainee physicians value good teachers and recognize that clinical training alone does not provide all of the skills needed by educators. The current status of limited resources of institutions and individuals constrain faculty development efforts. Where faculty development opportunities do exist, they are too infrequent or otherwise inaccessible to provide trainers the necessary skills to help them succeed as educators.

Future of Family Medicine Faculty Development in Sub-Saharan Africa.

BACKGROUND AND OBJECTIVES: High-quality family medicine education is needed in sub-Saharan Africa to facilitate the future growth of primary care health systems. Current faculty educators recognize the value of dedicated teacher training and ongoing faculty development. However, they are constrained by inadequate faculty development program availability and institutional support. METHODS: A cross-sectional study design was used to conduct a qualitative needs assessment comprised of 37 in-depth, semi-structured interviews of individual faculty trainers from postgraduate family medicine training programs in eight sub-Saharan African countries. Data were analyzed according to qualitative description. RESULTS: Informants described desired qualities for a family medicine educator in sub-Saharan Africa: (1) pedagogical expertise in topics and perspectives unique to family medicine, (2) engagement in self-directed, lifelong learning, and (3) exemplary character and behavior that inspires others. Informant recommendations to guide the development of faculty development programs include: (1) sustainability, partnership, and responsiveness to the needs of the institution, (2) intentional faculty development must begin early and be supported with high-quality mentorship, (3) presumptions of teaching competence based on clinical training must be overcome, and (4) evaluation and feedback are critical components of faculty development. CONCLUSIONS: High-quality faculty development in family medicine is critically important to the primary care workforce in sub-Saharan Africa. Our study describes specific needs and recommendations for family medicine faculty development in sub-Saharan Africa. Next steps include piloting and evaluating innovative models of faculty development that respond to specific institutional or regional needs.

Implementing visual cervical cancer screening in Senegal: a cross-sectional study of risk factors and prevalence highlighting service utilization barriers.

BACKGROUND: Senegal ranks 15th in the world in incidence of cervical cancer, the number one cause of cancer mortality among women in this country. The estimated participation rate for cervical cancer screening throughout Senegal is very low (6.9% of women 18-69 years old), especially in rural areas and among older age groups (only 1.9% of women above the age of 40 years). There are no reliable estimates of the prevalence of cervical dysplasia or risk factors for cervical dysplasia specific to rural Senegal. The goals of this study were to estimate the prevalence of cervical dysplasia in a rural region using visual inspection of the cervix with acetic acid (VIA) and to assess risk factors for cervical cancer control. PATIENTS AND METHODS: We conducted a cross-sectional study in which we randomly selected 38 villages across the Kédougou region using a three-stage clustering process. Between October 2013 and March 2014, we collected VIA screening results for women aged 30-50 years and cervical cancer risk factors linked to the screening result. RESULTS: We screened 509 women; 5.6% of the estimated target population (9,041) in the region. The point prevalence of cervical dysplasia (positive VIA test) was 2.10% (95% confidence interval [CI]: 0.99-3.21). Moreover, 287 women completed the cervical cancer risk factor survey (56.4% response rate) and only 38% stated awareness of cervical cancer; 75.9% of the screened women were less than 40 years of age. CONCLUSION: The overall prevalence of dysplasia in this sample was lower than anticipated. Despite both overall awareness and screening uptake being less than expected, our study highlights the need to address challenges in future prevalence estimates. Principally, we identified that the highest-risk women are the ones least likely to seek screening services, thus illustrating a need to fully understand demand-side barriers to accessing health services in this population. Targeted efforts to educate and motivate older women to seek screenings are needed to sustain an effective cervical cancer screening program.

Development and validation of a tool to assess self-efficacy for competence in interprofessional collaborative practice.

Although interprofessional education and collaborative practice have gained increasing attention over the past five decades, development of rigorous tools to assess related competencies is still in infancy. The purpose of this study was to develop an instrument to evaluate health professions students' self-efficacy in interprofessional collaborative competency and to assess the instrument's psychometric properties. We developed a new instrument based on the Interprofessional Education Collaborative's (IPEC) Core Competencies for Interprofessional Collaborative Practice. In a cross-sectional study design, 660 students from 11 health programmes at an urban university in the Midwest USA completed the Interprofessional Education Collaborative Competency Self Efficacy Tool (IPECC-SET). Rasch analysis evaluated the following: (1) functioning of the instrument; (2) fit of items within each subscale to a unidimensional construct; (3) person-response validity; (4) person-separation reliability; and (5) differential item functioning in relation to gender and ethnicity. After removing seven items with suboptimal fit, each subscale demonstrated high internal validity. Two items demonstrated differential item functioning (DIF) for "Gender" and none for "Race/Ethnicity." Our findings provide early evidence of IPECC-SET as a valid measure of self-efficacy for interprofessional competence for health professions students. Additional research is warranted to establish external validity of the new instrument by conducting studies across institutions.

How to study the impact of sex and gender in medical research: a review of resources.

There is a growing appreciation by the biomedical community that studying the impact of sex and gender on health, aging, and disease will lead to improvements in human health. Sex- and gender-based comparisons can inform research on disease mechanisms and the development of new therapeutics as well as enhance scientific rigor and reproducibility. This review will assist basic researchers, clinical investigators, as well as epidemiologists, population, and social scientists by providing an annotated bibliography of currently available resource tools on how to consider sex and gender as independent variables in research design and methodology. These resources will assist investigators applying for funding from the National Institutes of Health since all grant applicants will be required (as of January 25, 2016) to address the role of sex as a biological variable in vertebrate animal and human studies.

Self-reported physical health associations of traumatic events in medical and dental outpatients: a cross-sectional study.

The purpose of this cross-sectional study was to understand the prevalence and severity of health-related sequelae of traumatic exposure in a nonpsychiatric, outpatient sample.Self-report surveys were completed by patients seeking outpatient medical (n = 123) and dental care (n = 125) at a large, urban academic medical center.Results suggested that trauma exposure was associated with a decrease in perceptions of overall health and an increase in pain interference at work. Contrary to prediction, a history of interpersonal trauma was associated with less physical and emotional interference with social activities. A history of trauma exposure was associated with an increase in time elapsed since last medical visit. Depression and anxiety did not mediate the relationship between trauma history and medical care.Based on these results, clinical and research implications in relation to the health effects of trauma are discussed. The results suggest that routine screening for traumatic events may be important, particularly when providers have long-term relationships with patients.

Identifying elements of patient-centered care in underserved populations: a qualitative study of patient perspectives.

Patient-centered care is an important goal in the delivery of healthcare. However, many patients do not engage in preventive medical care. In this pilot study, we conducted twenty in depth, semi-structured qualitative interviews at the University of Illinois at Chicago Health Sciences campus in a four month time frame. Many patients were underserved and underinsured, and we wanted to understand their experiences in the healthcare system. Using content analysis, several themes emerged from the interview data. Participants discussed the need for empathy and rapport with their providers. They identified provider behaviors that fostered a positive clinical relationship, including step-by step explanations of procedures, attention to body language and clinic atmosphere, and appropriate time management. Participants identified cost as the most common barrier to engaging in preventive care and discussed children and social support as motivating factors. A long-term relationship with a provider was an important motivator for preventive care, suggesting that the therapeutic alliance was essential to many patients. Conversely, many participants discussed a sense of dehumanization in the healthcare system, reporting that their life circumstances were overlooked, or that they were judged based on insurance status or ethnicity. We discuss implications for provider training and healthcare delivery, including the importance of patient-centered medical homes.