The applicability of interprofessional education for collaborative people-centered practice and care to health plans and workforce issues: A thematic global case review.

Background: This article focuses on a growing, global recognition of the importance of the field of interprofessional education for person-centered collaborative practice (IPECP) expressed through high-level policy and accreditation decisions/actions taking place in 5 countries. Policy decisions are used to motivate strategies related to IPECP that align with national health plans, and workforce issues. Methods: Using a collective of representative stories from around the globe, a grouping of case studies were developed to illustrate different approaches and challenges to IPECP implementation. Results: Institutions from countries of various income levels face many similar challenges in the execution, delivery, and sustainability of IPECP. All programs face issues of financing, of preparing faculty, of developing and organizing curricula, and of bridging between campus and community. Discussion: Policies are being developed that promote a global approach to the inclusion of IPECP in the accreditation and regulation of postsecondary institutions and health service organizations, in keeping with WHO National Health Workforce Accounts. Policies developed promote and demonstrate the benefits of IPECP through remote emergency learning methods. The policies also build national systems for IPECP as an integral part of continuing professional development and lifelong learning. The organization of interprofessional research programs and the increasing publication of their results of such programs will lead to a clearer understanding of the efficacy of the field of IPECP. To ensure sustainability, stakeholders and policymakers should continue to foster policies that facilitate IPECP.

The development of interprofessional education and collaborative practice in Latin America and the Caribbean: preliminary observations.

The Pan-American Health Organization (PAHO) and World Health Organization have encouraged countries across Latin America and the Caribbean (LAC) to incorporate interprofessional education and collaborative practice (IPECP) into policies on the health workforce, and support policymakers in expanding its use. PAHO recommend countries to promote the development of interprofessional teams in integrated health services networks using IPECP. The creation of the Regional Network for Interprofessional Education in the Americas, the mobilization of a series of IPECP regional meetings, and the development of national IPECP action plans are the most promising results achieved thus far. This report describes the process of implementing IPECP in LAC countries as an innovative initiative in interprofessional health policy.

Accreditation as a driver of interprofessional education: the Canadian experience.

BACKGROUND: The purpose of this study was to (1) explore evidence provided by Canadian health and social care (HASC) academic programs in meeting their profession-specific interprofessional education (IPE)-relevant accreditation standards; (2) share successes, exemplars, and challenges experienced by HASC academic programs in meeting their IPE-relevant accreditation standards; and (3) articulate the impacts of IPE-relevant accreditation standards on enabling interprofessional learning to the global HASC academic community. METHODS: Profession-specific (bilingual, if requested) surveys were developed and emailed to the Deans/Academic Program Directors of eligible academic programs with a request to forward to the individual who oversees IPE accreditation. Responses were collated collectively and by profession. Open-ended responses associated with our first objective were deductively categorized to align with the five Accreditation of Interprofessional Health Education (AIPHE) standards domains. Responses to our additional questions associated with our second and third objectives were inductively categorized into themes. RESULTS/DISCUSSION: Of the 270 HASC academic programs surveyed, 30% (n = 24) partially or completely responded to our questions. Of the 106 IPE-relevant standards where evidence was provided, 62% (n = 66) focused on the Educational Program, 88% of which (n = 58) were either met or partially met, and 47% (n = 31) of which focused on practice-based IPE. Respondents cited various exemplars and challenges in meeting IPE-relevant standards. CONCLUSIONS: The overall sentiment was that IPE accreditation was a significant driver of the IPE curriculum and its continuous improvement. The array of exemplars described in this paper may be of relevance in advancing IPE implementation and accreditation across Canada and perhaps, more importantly, in countries where these processes are yet emerging.

Factors Causing Variation in World Health Organization Surgical Safety Checklist Effectiveness-A Rapid Scoping Review.

INTRODUCTION: This review was conducted to determine what factors might be responsible for prejudicing the outcomes after the implementation of a World Health Organization Surgical Safety Checklist (WHO SSC), grouping them appropriately and proposing strategies that enable the SSC a more helpful and productive tool in the operating room. METHODS: It was a rapid scoping review conducted as per Preferred Reporting Items for Systematic Review and Meta-analyses extension guidelines for scoping reviews (PRISMA-Scr). Comprehensive search on MEDLINE and Embase was carried out, to include all relevant studies published during last 5 years. Twenty-seven studies were included in analysis. The barriers to SSC implementation were classified into 5 main groups, with further subdivisions in each. RESULTS: The results of review revealed that there are 5 major barriers to SSC at the following levels: organizational, checklist, individual, technical, and implementation. Each of these major barriers, on further evaluation, was found to have more than one contributing factors. All these factors were analyzed individually. CONCLUSIONS: This rapid scoping review has consolidated data, which may pave the way for experts to further examine steps that might be taken locally or globally in order that the WHO SSC to successfully achieve all its desired goals.

Interprofessional simulation education to enhance teamwork and communication skills among medical and nursing undergraduates using the TeamSTEPPS® framework.

BACKGROUND: Learning in silos during the undergraduate years results in ineffective collaborative practice leading to adverse events. Simulation training using the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS)® framework has been shown to be effective in enhancing teamwork skills among healthcare professionals. This study aims to evaluate an interprofessional simulation education (IPSE) module for undergraduate medical and nursing students on teamwork and communication skills using the TeamSTEPPS® framework. METHODS: An IPSE module was developed by an interprofessional team of faculty. A convenient sample of medical and nursing undergraduate interns participated in trauma simulation scenarios before and after a didactic session on interprofessional education (IPE) and TeamSTEPPS® 2.0. The pre-post performance was assessed by faculty and pre-post self-assessment of the IPSE training and interprofessional education collaborative (IPEC) competencies by the participants. Quantitative data were analysed using a paired t-test of the mean scores and analysis of variance. The themes that emerged from audio recordings of the debriefing, and written reflections of the participants, yielded data for qualitative thematic analysis. RESULTS: The scores of team performance, self-assessment of IPSE training, and IPEC competencies revealed statistically significant values. Themes that emerged included the need for IPSE in the curriculum, impact of structured tools for communication on patient safety, and awareness of the roles and responsibilities in interprofessional teamwork. A survey conducted two weeks after completion of the module showed positive feelings among participants about interprofessional collaboration. CONCLUSION: The study specifically assessed the effectiveness of an IPSE module based on TeamSTEPPS® guidelines in improving communication and teamwork skills among medical and nursing undergraduates.

Emergency skills learning on video (ESLOV): A single-blinded randomized control trial of teaching common emergency skills using self-instruction video (SIV) versus traditional face-to-face (FTF) methods.

BACKGROUND: Self-instruction video (SIV) has been widely explored as a teaching mode for cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED), but not with other basic emergency skills. AIM: To evaluate the effectiveness of SIV in teaching other basic emergency skill in comparison with traditional face-to-face (FTF) methods. METHODS: Participants were randomized into SIV and FTF groups. Each group was assigned to learn basic airway management (BAM), cervical collar application (CCA), manual cardiac defibrillation (MCD), and emergency extremity splinting (EES) skills. Confidence level was assessed using questionnaires, and skills performances were assessed using calibrated-blinded assessors through an Objective Structured Clinical Examination (OSCE). RESULTS: Forty-five participants took part in the assessment exercises. There were no significant differences between both groups, on all four skill categories. The mean OSCE-score of an individual category between the FTF-group vs. the SIV-group were as follows: BAM (10.23 ± 1.04 vs. 10.04 ± 1.49; p = 0.62); CCA (7.86 ± 4.39 vs. 7.13 ± 4.12; p = 0.57); MCD (8.24 ± 0.89 vs. 7.58 ± 1.14; p = 0.39); EES (5.43 ± 2.11 vs. 4.63 ± 2.30; p = 0.23). The composite mean score for the FTF-group was 6.85, and for the SIV-group was 6.20 (p < 0.05). There was no significant different in the level of confidence for both groups. CONCLUSION: SIV is as effective as FTF in teaching and learning basic emergency skills.

The coming of age for interprofessional education and practice.

Interprofessional education for collaborative practice is an important innovation globally and in US health professions education. The recent spotlight on interprofessional education in the United States was launched by a series of reports in the US Institute of Medicine's Quality Chasm series. They raised concerns over medical errors and health care quality as significant sources of morbidity and mortality in the United States and proposed health professions' education for patient-centered, team-based care as one means to address these concerns. Starting in 2007, binational, biennial conferences on interprofessional education have been held to synergize interprofessional education developments in the United States and Canada. In 2011, Collaborating Across Borders III, in Tucson, Arizona, drew 750 participants from 11 countries. The conference focused on interprofessional competency frameworks; strategies for preparing students for interprofessional practice; tailoring of learning environments for interprofessional education; and developing policy, infrastructure, culture, and faculty leadership for interprofessional education.

Engine or Boat Anchor? The Health Professional Training Establishment in HHR Innovation.

Educational institutions have largely failed to provide innovative responses to emerging health human resources (HHR) needs. Reasons include the prevailing ratio policy, which simply increases the supply of professionals; university funding protocols; a guild structure that isolates health professions rather than integrating them; and current credentialing for entry to practice, which both controls and further balkanizes the professions. Providing integrated health services will require (a) embedding interprofessional education and collaborative practice in accreditation requirements, (b) coordinating educational programs via intergovernmental committees and (c) embedding interprofessional collaborative learning in clinical training.

A WHO report: framework for action on interprofessional education and collaborative practice.

This article summarizes the key features of the World Health Organization's Framework for Action on Interprofessional Education and Collaborative Practice. The Framework is a call for action to policy-makers, decision-makers, educators, health workers, community leaders, and global health advocates to move toward embedding interprofessional education and collaborative practice in all of the services they deliver.

The status of interprofessional education in Canada.

This article describes the history and development of interprofessional education (IPE) in Canada from its conceptual beginnings in the 1960s to today. The status of IPE in Canada is viewed in relation to the broader international movements for IPE and collaborative healthcare. The current goals and principles of the Canadian Interprofessional Health Collaborative are reviewed, and the future of IPE is considered in light of these goals.

Role of educational institutions in identifying and responding to emerging health human resources needs.

The healthcare system continues to evolve, requiring innovation to promote patient-centred, fiscally responsible healthcare delivery. This evolution includes changes to the skills and competencies required of the health human resources (HHR), both regulated and unregulated, who are central supports to healthcare delivery. This has become a priority agenda item at the international, national, provincial, regional and local levels. This paper describes the system factors that drive the emergence of HHR skill and competency needs, and explores the roles of various institutions in the identification of and response to HHR needs. Educational institutions play an important role in responding to emerging HHR needs. Their actual response to HHR skill and competency needs will ultimately depend on the risk posed to the organizations of either addressing, or not addressing, these needs. These decisions are complex and are balanced against strategic, operational and educational risks, benefits and realities within each given educational institution. Educational institutions - through their linkages with the workplace, industry, professional organizations and government - have a unique view and understanding of many facets of the complexity of HHR planning. This paper proposes that educational institutions play a pivotal role as levers in a more coordinated response to emerging HHR needs and, as such, should be intimately involved in comprehensive HHR planning.

Interprofessional learning in the trenches: fostering collective capability.

The greatest resource for improving interprofessional learning and practice is the knowledge, wisdom, and energy of professionals who adapt to challenging situations in their everyday work. We call collective capability the ability of a group of professionals to balance two interdependent levels of organization of practice: what professionals know and what they do collectively over time. Organizing what professionals know links the relational value--caring for patients--to the knowledge value of practice. Organizing what professionals do includes human and organizational factors that facilitate collective work and learning: technical skills for care delivery, institutional support, and a complex mix of emotional, ethical and moral factors involved in social decision-making. Performance gaps can result from a lack of an integrated knowledge framework or from a disembodied knowledge that is not anchored in practice. Opportunities for continuous learning can be seized by documenting the source of the performance gap, and providing the relevant resources to establish the balance between the organization of knowledge and the organization of work.

Abraham Flexner and the roots of interprofessional education.

This paper explores the culture underlying the practices of physicians and other health care providers in the 20th century and implications for interprofessional education for collaborative practice in the 21st century. Today's practice of medicine flows from the 1920s work of Dr. Abraham Flexner recommending that North American medical schools introduce rigor and consistency in teaching, moving them from private, for-profit, somewhat ad hoc institutions to university affiliation employing physicians dedicated to teaching and research. The education of physicians and other providers was transformed by Flexner's work. However, a sequela has been the "stovepiping" of professions, in both their education and their practices, with minimal interaction among professions, and provider- or system-centric care rather than patient-centric care. The result has been learning environments that lack sympathy for interprofessional education and its concomitant of learning and working together.

Student leadership in interprofessional education: benefits, challenges and implications for educators, researchers and policymakers.

Context Interprofessional collaboration is gaining increasing prominence as a team-based approach to health care delivery that synergistically maximises the strengths of each health professional to enhance patient care, decrease medical errors and optimise efficiency. The often neglected role that student leaders have in preparing their peers, as the health professionals of the future, for collaboration in health care should not be overlooked. Objective This paper offers the foundational arguments supporting the integral role that student leadership in interprofessional education (IPE) can play and its comparative advantages. Methods Evidence from previous literature and the National Health Science Students' Association in Canada was reviewed and a questionnaire on student-initiated IPE was administered among Canada's top student leaders in this area. Results Student leadership is essential to the success of IPE because it enhances students' willingness to collaborate and facilitates the longterm sustainability of IPE efforts. Student-initiated IPE, a subset of student leadership, is particularly important to achieving the aforementioned goals and offers a number of benefits, comparative advantages and associated challenges. Conclusions Successful student leadership in IPE will yield significant benefits for everyone in the years to come. However, it requires the support of educators, researchers and policymakers in fostering an enabling environment that will facilitate the efforts and contributions of student leaders.

Interprofessional learning and higher education structural barriers.

Structural changes need to be made within universities such that interprofessional education for patient-centred collaborative practice becomes a responsibility that crosses faculty jurisdictions and is accepted as the responsibility of all associated health and human service programs. In communities, the patient or client is the centre of professional attention requiring care that goes beyond the skill and scope of any one profession. Notions about collaboration inform and drive interprofessional education and should lead to sustainable system changes within centres of advanced education that ensure a permanent place for interprofessional education in all health and human service programs. This chapter explores the many barriers to achieving this goal, and offers insights into their removal from one university's experience.