Evaluating an interprofessional education curriculum: A theory-informed approach.

BACKGROUND: This paper retrospectively reports on an evaluation framework applied to a local interprofessional education (IPE) curriculum design. The theoretically informed IPE curriculum spans the undergraduate health and social care programmes of over 10 professions as a curriculum theme. The teaching design and its impact were informed by psycho-social and learning theories. AIMS: This meta-analysis is presented to share the importance of longitudinal IPE, whole curriculum evaluation for comparisons and to advance our understandings of what works and why. METHOD: The meta-analysis used the Presage, Process and Product conceptual framework outlined by Biggs in 1993, and the Kirkpatrick in 1996, evaluation outcome model. Data are shared on the final overall learning from evaluating the teaching and the outcomes from students, teachers, practitioners, patients and carers. RESULTS: The evaluation highlighted cyclical issues relating to students experiences, facilitators abilities and highlights the challenges of learning in practice which was highly praised by students. The problems and challenges were solved through the application of theory to illuminate our understandings. CONCLUSION: We lament at missed opportunities for the application of theoretically informed research questions that still require to be addressed. However, we share this framework as having offered a complete and comprehensive evaluation process.

A systematic review of how studies describe educational interventions for evidence-based practice: stage 1 of the development of a reporting guideline.

BACKGROUND: The aim of this systematic review was to identify which information is included when reporting educational interventions used to facilitate foundational skills and knowledge of evidence-based practice (EBP) training for health professionals. This systematic review comprised the first stage in the three stage development process for a reporting guideline for educational interventions for EBP. METHODS: The review question was 'What information has been reported when describing educational interventions targeting foundational evidence-based practice knowledge and skills?'MEDLINE, Academic Search Premier, ERIC, CINAHL, Scopus, Embase, Informit health, Cochrane Library and Web of Science databases were searched from inception until October - December 2011. Randomised and non-randomised controlled trials reporting original data on educational interventions specific to developing foundational knowledge and skills of evidence-based practice were included.Studies were not appraised for methodological bias, however, reporting frequency and item commonality were compared between a random selection of studies included in the systematic review and a random selection of studies excluded as they were not controlled trials. Twenty-five data items were extracted by two independent reviewers (consistency > 90%). RESULTS: Sixty-one studies met the inclusion criteria (n = 29 randomised, n = 32 non-randomised). The most consistently reported items were the learner's stage of training, professional discipline and the evaluation methods used (100%). The least consistently reported items were the instructor(s) previous teaching experience (n = 8, 13%), and student effort outside face to face contact (n = 1, 2%). CONCLUSION: This systematic review demonstrates inconsistencies in describing educational interventions for EBP in randomised and non-randomised trials. To enable educational interventions to be replicable and comparable, improvements in the reporting for educational interventions for EBP are required. In the absence of a specific reporting guideline, there are a range of items which are reported with variable frequency. Identifying the important items for describing educational interventions for facilitating foundational knowledge and skills in EBP remains to be determined. The findings of this systematic review will be used to inform the next stage in the development of a reporting guideline for educational interventions for EBP.

A Delphi survey to determine how educational interventions for evidence-based practice should be reported: stage 2 of the development of a reporting guideline.

BACKGROUND: Undertaking a Delphi exercise is recommended during the second stage in the development process for a reporting guideline. To continue the development for the Guideline for Reporting Evidence-based practice Educational interventions and Teaching (GREET) a Delphi survey was undertaken to determine the consensus opinion of researchers, journal editors and educators in evidence-based practice (EBP) regarding the information items that should be reported when describing an educational intervention for EBP. METHODS: A four round online Delphi survey was conducted from October 2012 to March 2013. The Delphi panel comprised international researchers, educators and journal editors in EBP. Commencing with an open-ended question, participants were invited to volunteer information considered important when reporting educational interventions for EBP. Over three subsequent rounds participants were invited to rate the importance of each of the Delphi items using an 11 point Likert rating scale (low 0 to 4, moderate 5 to 6, high 7 to 8 and very high >8). Consensus agreement was set a priori as at least 80 per cent participant agreement. Consensus agreement was initially calculated within the four categories of importance (low to very high), prior to these four categories being merged into two (<7 and ≥7). Descriptive statistics for each item were computed including the mean Likert scores, standard deviation (SD), range and median participant scores. Mean absolute deviation from the median (MAD-M) was also calculated as a measure of participant disagreement. RESULTS: Thirty-six experts agreed to participate and 27 (79%) participants completed all four rounds. A total of 76 information items were generated across the four survey rounds. Thirty-nine items (51%) were specific to describing the intervention (as opposed to other elements of study design) and consensus agreement was achieved for two of these items (5%). When the four rating categories were merged into two (<7 and ≥7), 18 intervention items achieved consensus agreement. CONCLUSION: This Delphi survey has identified 39 items for describing an educational intervention for EBP. These Delphi intervention items will provide the groundwork for the subsequent consensus discussion to determine the final inclusion of items in the GREET, the first reporting guideline for educational interventions in EBP.

Protocol for development of the guideline for reporting evidence based practice educational interventions and teaching (GREET) statement.

BACKGROUND: There are an increasing number of studies reporting the efficacy of educational strategies to facilitate the development of knowledge and skills underpinning evidence based practice (EBP). To date there is no standardised guideline for describing the teaching, evaluation, context or content of EBP educational strategies. The heterogeneity in the reporting of EBP educational interventions makes comparisons between studies difficult. The aim of this program of research is to develop the Guideline for Reporting EBP Educational interventions and Teaching (GREET) statement and an accompanying explanation and elaboration (E&E) paper. METHODS/DESIGN: Three stages are planned for the development process. Stage one will comprise a systematic review to identify features commonly reported in descriptions of EBP educational interventions. In stage two, corresponding authors of articles included in the systematic review and the editors of the journals in which these studies were published will be invited to participate in a Delphi process to reach consensus on items to be considered when reporting EBP educational interventions. The final stage of the project will include the development and pilot testing of the GREET statement and E&E paper. OUTCOME: The final outcome will be the creation of a Guideline for Reporting EBP Educational interventions and Teaching (GREET) statement and E&E paper. DISCUSSION: The reporting of health research including EBP educational research interventions, have been criticised for a lack of transparency and completeness. The development of the GREET statement will enable the standardised reporting of EBP educational research. This will provide a guide for researchers, reviewers and publishers for reporting EBP educational interventions.

A top-down approach impedes the use of theory? Interprofessional educational leaders' approaches to curriculum development and the use of learning theory.

International policy has emphasized the development of interprofessional education (IPE) to reinforce interprofessional practice. This study explored the extent to which IPE initiatives in the UK are based on sound theoretical frameworks. Findings from semi-structured interviews with lead IPE curriculum developers at eight higher education institutions are presented which identified curriculum developers' developmental approaches to IPE. The findings reveal a notable lack of explicit theoretical basis for models of IPE. In many cases, senior managers determined the institutional approach to IPE which academic staff then needed to deliver. Curriculum developers reported adopting a largely practical approach to IPE curriculum development. However, questioning that focused on learning and teaching methods revealed that a range of learning theories was used implicitly. The significance of these findings is discussed with recommendations to inform future curriculum development of IPE initiatives.

Testing theory in interprofessional education: social capital as a case study.

Theory is essential to understand our interprofessional educational (IPE) practice. As a discipline, IPE has moved from being widely atheoretical to having a plethora of theories imported from the psychosocial disciplines that have utility to understand, articulate and improve IPE practice and evaluation. This paper proposes that when taking this deductive approach to theoretical development in IPE, a greater focus must now be placed on the rigorous testing of these theories within the IPE context. It synthesizes two approaches to achieving this, using the social capital theory as a case study, and focuses on the first two stages of this synthesis: first, the identification of the concepts and propositions that make up a theory within the study context and second, the value-based judgments made by the researcher and other stakeholders on the utility of these propositions. The interprofessional student group is chosen as a possible exemplar of a social network and theory-derived concepts and propositions are identified and classified within this context. With a focus on physical network characteristics, validation of these propositions with a sample of IPE educationalists is described. We present a range of propositions specifically related to the size and mix of IPE student groups, the frequency and level with which students participate in these as well as some of the existing evidence that have explored these propositions to date. Refined propositions and the way forward in the future application and empirical testing of social capital theory in IPE are presented.

IN-2-THEORY--Interprofessional theory, scholarship and collaboration: a community of practice.

Theoretical awareness is essential in the development and delivery of effective interprofessional education and collaborative practice (PECP). The objective of this paper was to explain the origins and purpose of an international network, IN-2-THEORY--interprofessional theory, scholarship and collaboration: a community of practice (CoP) that aims to build theoretical rigor in IPECP. It explains why the network is viewed as a CoP and lays out the way forward for the community based on the principles for developing a CoP outlined by Wenger, McDermott, and Snyder (2002).

Evidence shaped health professional education: can we talk about a new paradigm?

This commentary accompanies the publication of several Best Evidence Medical Education systematic reviews together with invited discussion papers on issues of key importance to evidence shaped health professional education. The reviews and papers signify positive developments for the still very young movement where practitioners and policy makers use evidence to help their decision making in health professional education. They provide this commentary with exemplar material to highlight some key points about the process of education systematic review and some of the conceptual and methodological issues presently being discussed by colleagues interested in taking the evidence shaped education movement in a forward direction. These include the need for more funded reviews, greater commitment to question-driven research (primary and secondary) and further debate about power, evidence and change. It is hoped that this will lead to a broader debate, a widening of interest and a deepening of scholarship related to evidence shared health professional education.

Theoretical insights into interprofessional education: AMEE Guide No. 62.

In this Guide, we support the need for theory in the practice of interprofessional education and highlight a range of theories that can be applied to interprofessional education. We specifically discuss the application of theories that support the social dimensions of interprofessional learning and teaching, choosing by way of illustration the theory of social capital, adult learning theory and a sociological perspective of interprofessional education. We introduce some of the key ideas behind each theory and then apply these to a case study about the development and delivery of interprofessional education for pre-registration healthcare sciences students. We suggest a model that assists with the management of the numerous theories potentially available to the interprofessional educator. In this model, context is central and a range of dimensions are presented for the reader to decide which, when, why and how to use a theory. We also present some practical guidelines of how theories may be translated into tangible curriculum opportunities. Using social capital theory, we show how theory can be used to defend and present the benefits of learning in an interprofessional group. We also show how this theory can guide thinking as to how interprofessional learning networks can best be constructed to achieve these benefits. Using adult learning theories, we explore the rationale and importance of problem solving, facilitation and scaffolding in the design of interprofessional curricula. Finally, from a sociological perspective, using Bernstein's concepts of regions and terrains, we explore the concepts of socialisation as a means of understanding the resistance to interprofessional education sometimes experienced by curriculum developers. We advocate for new, parallel ways of viewing professional knowledge and the development of an interprofessional knowledge terrain that is understood and is contributed to by all practitioners and, importantly, is centred on the needs of the patient or client. Through practical application of theory, we anticipate that our readers will be able to reflect and inform their current habitual practices and develop new and innovative ways of perceiving and developing their interprofessional education practice.

Theoretical insights into interprofessional education.

This article argues for the need for theory in the practice of interprofessional education. It highlights the range of theories available to interprofessional educators and promotes the practical application of these to interprofessional learning and teaching. It summarises the AMEE Guides in Medical Education publication entitled Theoretical Insights into Interprofessional Education: AMEE Guide No. 62, where the practical application of three theories, social capital, social constructivism and a sociological perspective of interprofessional education are discussed in-depth through the lens of a case study. The key conclusions of these discussions are presented in this article.

What is evidence? Reflections on the AMEE symposium, Vienna, August 2011.

In this article, we present a summary of the discussion from the symposium on 'what is evidence', which took place at the AMEE conference in 2011. A panel of five academics and clinicians, plus the chair, considered the nature of evidence, in particular in relation to the 'evidence' in the best evidence medical education reviews. Evidence has multiple meanings depending on context and use, and this reflects the complex and often chaotic world in which we work and research.

Interprofessional staff development: changing attitudes and winning hearts and minds.

As more educators are involved in interprofessional education (IPE) it is important to consider how participation affects those who are sceptical about IPE. We report a prospective study in which the attitudes of 13 educators, unfamiliar with IPE, were compared before and after facilitating their first IPE. Their views, obtained as personal stories, were analysed through cognitive dissonance theory. Prior to teaching, all novice educators had concerns about IPE. Post-facilitation all were more positive about the value and meaning of IPE.

Conducting a best evidence systematic review. Part 1: From idea to data coding. BEME Guide No. 13.

This paper outlines the essential aspects of conducting a systematic review of an educational topic beginning with the work needed once an initial idea for a review topic has been suggested through to the stage when all data from the selected primary studies has been coded. It draws extensively on the wisdom and experience of those who have undertaken systematic reviews of professional education, including Best Evidence Medical Education systematic reviews. Material from completed reviews is used to illustrate the practical application of the review processes discussed. The paper provides practical help to new review groups and contributes to the debate about ways of obtaining evidence (and what sort of evidence) to inform policy and practice in education.

The effectiveness of interprofessional education: key findings from a new systematic review.

Over the past decade systematic reviews of interprofessional education (IPE) have provided a more informed understanding of the effects of this type of education. This paper contributes to this literature by reporting an update of a Cochrane systematic review published in this journal ten years ago (Zwarenstein et al., 1999 ). In updating this initial review, our current work involved searches of a number of electronic databases from 1999-2006, as well as reference lists, books, conference proceedings and websites. Like the previous review, only studies which employed randomized controlled trials, controlled-before and-after-studies and interrupted time series studies of IPE, and that reported validated professional practice and health care outcomes, were included. While the first review found no studies which met its inclusion criteria, the updated review located six IPE studies. This paper aims to add to the ongoing development of evidence for IPE. Despite some useful progress being made in relation to strengthening the evidence base for IPE, the paper concludes by stressing that further rigorous mixed method studies of IPE are needed to provide a greater clarity of IPE and its effects on professional practice and patient/client care.

Learning in interprofessional teams: AMEE Guide no 38.

This guide is for health and social care professionals who teach or guide others' learning before and after qualification, in formal courses or the workplace. It clarifies the understanding of interprofessional learning and explores the concept of teams and team working. Illustrated by examples from practice, the practicalities of effective interprofessional learning are described, and the underlying concepts of patient-centred care, excellent communication, development of capacity and clarity of roles that underpin this explored.

Assessing competence in veterinary medical education: where's the evidence?

A systematic review of the literature was carried out to determine the evidence for the reliability and validity of the assessment methods used in veterinary medical education. The review followed the approach used by the Best Evidence Medical Education (BEME) group. This process has established baseline data on published evidence and found that a relatively small number of articles exist relating to assessment specific to veterinary medical education. These articles include a number of general discussion papers, employer observations on graduate competence, and descriptions of methods to assess particular attributes--in particular, clinical skills. However, only five of the papers retrieved in this comprehensive search provide evidence relating to evaluation of the assessment method itself. There is a need for more research on assessment of clinical competence in veterinary medical education.

Evidence-informed education in the health care science professions.

The use of evidence to inform the practice and policy of professional education in the health care sciences is taking on an increasingly important role alongside the use of more traditional types of knowledge. It is an addition to the repertoire in this and many professions that draw on social-science discipline knowledge. In the field of health care science professional education, the Best Evidence Medical Education Collaboration (BEME) leads the movement toward evidence-informed practice. It is a movement not without controversy, and lively debate on epistemological and practical issues is in progress. With publication of the first BEME Reviews in 2005, this debate will be extended. We can expect energetic and healthy commentaries on both the review process and the substantive findings. All this will make a valuable contribution to an important aspect of professional education practice and policy that is here to stay.

Cancer fatigue and its impact on patients: knowledge within the cancer care team.

Previous papers reported on the magnitude of fatigue as a problem for cancer patients and the growing recognition by patients, carers and health care professionals of the impact of cancer fatigue on quality of life. This paper presents findings from a United Kingdom survey of the knowledge of cancer fatigue and its impact on patients amongst cancer nurses, radiographers, haematologists and oncologists. We discuss how the context and chronology of care may influence differences in this knowledge between cancer care team members. Future directions for collaborative care, further research and interprofessional education are outlined.