Using narrative to integrate anti-oppression into interprofessional collaborative practice competencies.

Many institutions of higher education have designed curricula for health professions learners based on the Interprofessional Education Collaborative (IPEC) core competencies for interprofessional collaborative practice. As part of a periodic cycle of revision, in 2023, IPEC released revised competencies that, for the first time, explicitly embedded concepts of anti-oppressive practice. Curriculum designers seeking to revise their interprofessional learning activities to map onto the new competencies can benefit from the experience of a health professions graduate school in Boston, MA. Since 2021, faculty members and experts in justice, equity, diversity, and inclusion have revamped a required interprofessional education curriculum to include anti-oppression competencies. They targeted narrative elements of the courses like a common reading, case studies, and simulation scenarios for revision. By using narrative to introduce anti-oppression competencies like recognizing bias, analyzing systems of power, and intervening to mitigate microaggressions, course designers encouraged learners to cultivate reflection about their relationship to the care team, the patient, and the community.

Accounting for agency in structural competency.

To emphasize to learners how factors outside individual control impact health, scholars introduced the concept of structural competency. Structural competency refers to the development of analytical skills that reveal the larger societal context beyond the patient-clinician interaction that shapes health outcomes. The growing adoption of structural competency curricula, however, has revealed that prelicensure and early career health professionals can feel overwhelmed by the mismatch between the wide scale of entrenched problems and the limited scope of their therapeutic skills. In this Reflections paper, I draw on theories from Giddens, Bourdieu, and Foucault to restore a role for individual agency in promoting health. Conceiving of structure and agency as mutually constituting suggests that structures are human-made and can be vulnerable to challenge. Structures, however, disperse power to such an extent that people internalize their rules and discipline themselves to follow them without explicit enforcement. It is precisely in those local sites of power that health professions learners and educators can intervene to interrupt the reproduction of structures harmful to health. As I demonstrate with an example from a reproductive health emergency, being structurally competent may also include contesting agreed upon norms at the level of the learning and clinical environments rather than only macro-level societal forces. Rewriting norms within health professions education and clinical practice is not necessarily a simpler task, but it provides learners and educators with more accessible targets for action.

Answering the Call: Experiences of Implementing Antiracist Interventions in Health Care.

Since 2020, when the Covid-19 pandemic and police violence against Black Americans made undeniably visible inequities in health outcomes based on race, health professionals have issued calls for their colleagues to practice antiracism. Yet few studies have qualitatively described the experiences of health professionals who have implemented antiracist interventions to identify the factors that make them successful. I conducted semi-structured interviews with 51 health professionals and administrators who had introduced changes in their clinical practices explicitly to address health inequities based on race. The interventions focused on removing barriers to access for patients who lack the linguistic, economic, or cultural resources to navigate a complicated health care system. Interprofessional collaboration, leadership support, and community trust facilitated the success of the interventions. Restrictive insurance reimbursement policy was the most cited barrier. The experiences of these health professionals illustrate possibilities for implementing antiracist interventions at the point of care.

Defusing Land Mines: Keywords About Race in Nursing Education.

BACKGROUND: The call for nurse educators to facilitate conversations about racism with learners has become inescapable. Yet, nurse educators in the United States indicate they feel unprepared or uncomfortable leading classroom conversations about race. METHOD: Keyword analysis maps the multiple meanings of vocabulary, creating a common foundation for productive dialogue. Selection of keywords is subjective, but each keyword must meet three criteria: a term that is in common use, definitions that change according to time and perspective, and use that illuminates larger phenomena. RESULTS: Five keywords when teaching about racism are Caucasian, colorblind, diversity, reverse racism, and underrepresented minority. Each keyword carries connotations that may be perceived as upholding egalitarian ideals without acknowledging the pernicious mechanisms of racism itself. CONCLUSION: Familiarity with keywords provides educators with solid ground for engaging in often ambiguous and troubling dialogues about racism. [J Nurs Educ. 2022;61(7):408-412.].

Disrupting Bias Without Trainings: The Effect of Equity Advocates on Faculty Search Committees.

Many institutions of higher education have implemented workshops for hiring committee members to familiarize them with the pernicious effects of implicit bias and how to counteract them. Unfortunately, the enthusiasm for implicit bias trainings is not matched by the evidence for their effectiveness. Recognizing the difficulty of removing entrenched biases and the potential for trainings to backfire, we introduced the role of equity advocate (EA) at one institution. EAs are trained volunteer faculty and staff members who serve on search committees outside their home departments to identify behaviors and judgments that might have a disparate racial effect in hiring. We conducted focus groups to document the perspectives of both EAs and non-EA search committee members who completed a cycle of academic hiring. Search committee members credited EAs with helping to mitigate bias by questioning their assumptions and introducing standardized tools for evaluating candidates. By contrast, EAs reported a more contentious relationship with the rest of the search committee and expressed less confidence that the process was free from bias. Both groups agreed that the EAs added valuable race-conscious equitable practices, and untrained committee members identified ways they could apply the lessons of bias reduction in other parts of their professional roles. Our study provides evidence for how to engage all faculty and staff members in sustainable, equity-minded efforts.

Expanding Global Rehabilitation Services through International Academic-Community Partnerships.

Background: More than one billion people worldwide live with a disability, yet rehabilitation professionals are scarce in low- and middle-income countries. Attempts to expand access to rehabilitation services have encountered barriers on multiple levels: limited resources on the systemic level, hierarchies on the professional level, and cultural stigma on the community level. Objectives: We sought to determine if an academic-community partnership could overcome multiple levels of barriers to expand services for people with disabilities. Methods: Toward an All-Inclusive Jordan incorporates community-based rehabilitation with prelicensure health professions education to address the three primary levels of barriers to rehabilitation services in low- and middle-income countries. The yearlong curriculum includes formal training, research, and advocacy with graduate students from the United States and health professions students and community members in Palestinian refugee camps near Amman, Jordan. Findings: After two cycles of the program, 14 Jordanian volunteers have partnered with 20 graduate students from the United States. They have delivered over 300 direct rehabilitation sessions, conducted ten workshops with mothers of children with disabilities, and trained 12 community-based rehabilitation workers in the refugee camps. Conclusions: The academic-community partnership model builds on the evidence base for the success of community-based rehabilitation services in low- and middle-income countries. Its components address barriers on multiple levels to create a sustainable expansion of services to people with disabilities.

Onramp to Scholarship: Putting Clinical Faculty Members on the Path to Academic Productivity.

Many faculty members in the health professions who come from a clinical background lack the research experience to produce original scholarship. Most faculty development programs focus on supporting individual projects, which helps faculty members who are already pursuing an intellectual question to locate useful resources. Those programs provide limited benefit, however, to faculty members without an identified academic project. An independent, health sciences graduate school designed and implemented a solution to create scholarship groups in which early career faculty members joined ongoing projects led by an experienced investigator. Groups presented internally at a midyear check-in and an end of the academic year poster session. Of the four groups launched in September 2017, three pursued systematic reviews or analyses of existing data. At the end of 9 months, all 4 groups had drafted a manuscript for peer review. Collectively, members of the group had made five poster presentations at national or international conferences and hosted one continuing education workshop. The experience suggests that collaborative projects are a viable form of faculty development to enhance scholarly productivity. Borrowing from the postdoctoral model of scientific mentoring, early career faculty members sacrifice some autonomy of intellectual pursuits in exchange for expert guidance. Senior investigators invest time in coaching novice researchers in exchange for additional intellectual labor and perspectives.

Competent in any context: An integrated model of interprofessional education.

While most graduate health professions programs in the United States have accepted the Interprofessional Education Collaborative's core competencies for collaborative practice, there is no consistent way to integrate the competencies into courses of study already crowded with uniprofessional competencies. A potential negative effect of treating interprofessional education as an add-on is that learners will not engage deeply with the competencies required to work effectively in health care teams. To design an integrated model, one institution adopted a theory from the management literature that frames professional competence as a way of being, not simply a body of knowledge to master. Viewing competence as a way of being ensures that learners can act collaboratively in any context. The model, called IMPACT Practice, provides multiple settings where learners can practice the competencies and make connections to their uniprofessional studies. By embedding the interprofessional competencies into all programs of study, learners come to see collaboration as a core element of what it means to be an effective health professional.

Getting on the same page: an interprofessional common reading program as foundation for patient-centered care.

A primary goal of interprofessional education is to produce clinicians who practice collaboratively to provide patient-centered care. This exploratory study evaluated whether students' attitudes about a literary account of an illness experience endured after a year of professional and clinical education and if students applied lessons learned from a common reading to the delivery of patient centered care. Six focus groups were completed with health professions students and five main themes emerged from the focus group data. Themes include: Seeing family members as stakeholders; Establishing common ground with peers and the larger reason for graduate school; Applying lessons to clinical practice that see the patient as a person; Experiencing an emotional connection with a story and its characters; and Taking alternative perspectives/stepping into the shoes of the patient. Study results are discussed in relation to the interprofessional education literature, with implications for educators and interprofessional curricula also presented. We conclude that a common reading program may provide an effective means for developing health professions students' knowledge and attitudes in the tenets of patient-centered collaborative care. It has the potential to build community through shared intellectual experience, facilitating meaningful reflection and perspective-taking in interprofessional learners.

Seven Dirty Words: Hot-Button Language That Undermines Interprofessional Education and Practice.

An increasingly common goal of health professions education is preparing learners to collaborate with the full range of members on a health care team. While curriculum developers have identified many logistical and conceptual barriers to interprofessional education, one overlooked factor threatens to undermine interprofessional education and practice: language. Language reveals the mental metaphors governing thoughts and actions. The words that faculty members and health care providers use send messages that can-consciously or not-undermine explicit lessons about valuing each member of the care team. Too often, word choices make visible hierarchies in health care that may contradict overt messages about collaboration.In this Perspective, the author draws on his experience as an outsider coming to academic medicine, noticing that certain words triggered negative responses in colleagues from different professions. He reflects on some of the most charged (or hot-button) words commonly heard in health care and educational settings and suggests possible alternatives that have similar denotations but that also have more collaborative connotations. By exploring seven of these dirty words, the author intends to raise awareness about the unintended effects of word choices. Changing exclusionary language may help promote the adoption of new metaphors for professional relationships that will more easily facilitate interprofessional collaboration and reinforce the formal messages about collaborative practice aimed at learners.

Recognizing and Reckoning With Unconscious Bias: A Workshop for Health Professions Faculty Search Committees.

INTRODUCTION: As part of national efforts to reduce disparities in access to care, health professions schools have committed to increasing the proportion of faculty members from underrepresented minority groups. Responsibility for recruiting and vetting candidates for faculty positions, however, tends to rest in decentralized search committees that may receive no training in the science of human judgment. Simply as a product of living in a stratified culture, we form unthinking stereotypes about certain groups of people. Fortunately, when people become sensitized to their unconscious biases, they can minimize cognitive errors. METHODS: This 2-hour workshop is designed to introduce health professions faculty search committee members to the concept of unconscious bias and to spur reflection on how it can influence the decisions they make. In small-group activities, participants create and test materials that can facilitate their efforts to hire qualified candidates. RESULTS: Search committee members who attended the workshop consistently rated it somewhat or very helpful in carrying out their roles. At one institution, the proportion of faculty members from underrepresented minority groups has increased each year that the workshop has been implemented. DISCUSSION: The modules follow the work flow of a typical search process and are generalizable to any health professions department. While the challenge of diversifying the faculty involves many factors external to a university, calling search committee members' attention to unconscious bias is a strategy that faculty affairs officers can control.

A design thinking approach to evaluating interprofessional education.

The complex challenge of evaluating the impact of interprofessional education (IPE) on patient and community health outcomes is well documented. Recently, at the Radcliffe Institute for Advanced Study in the United States, leaders in health professions education met to help generate a direction for future IPE evaluation research. Participants followed the stages of design thinking, a process for human-centred problem solving, to reach consensus on recommendations. The group concluded that future studies should focus on measuring an intermediate step between learning activities and patient outcomes. Specifically, knowing how IPE-prepared students and preceptors influence the organisational culture of a clinical site as well as how the culture of clinical sites influences learners' attitudes about collaborative practice will demonstrate the value of educational interventions. With a mixed methods approach and an appreciation for context, researchers will be able to identify the factors that foster effective collaborative practice and, by extension, promote patient-centred care.

Do health professions graduate programs increase diversity by not requiring the graduate record examination for admission?

PURPOSE: Seeking to increase the diversity of the health care workforce, prominent national commissions have called on health professions graduate schools to deemphasize standardized tests in admissions. Have programs that do not require standardized tests observed an increase in students from under-represented minority groups? METHODS: The websites of the centralized application services for occupational therapy, physical therapy, physician assistant studies, and speech-language pathology programs were reviewed, and programs were identified that do not require the Graduate Record Examination (GRE) for admissions. Representatives were then invited to participate in a hypothesis-generating interview. The transcripts were coded using grounded theory to identify emerging themes. STUDY SAMPLE: Faculty and administrators with admissions responsibilities representing 30 graduate programs in the health professions participated. RESULTS: Fewer than one-third of programs in each health profession surveyed do not require the GRE for admission. While test-optional programs attract students who might otherwise not apply to graduate school, the lack of a GRE requirement does not automatically increase the representation of under-represented minority students in the matriculated class. The programs most successful in meeting their diversity goals also engage in deliberate recruitment activities.

In and out of the curriculum: an historical case study in implementing interprofessional education.

Although international reports have called for making interprofessional education an integral part of health professions education, most interprofessional learning activities remain voluntary and occur a single time. Barriers to implementing comprehensive interprofessional education come from forces both internal and external to institutions. Understanding the historical context for how one graduate health professions school attempted to overcome these barriers will provide a longitudinal perspective that may assist other institutions with their interprofessional education efforts. The case of the Massachusetts General Hospital Institute of Health Professions shows that, despite being founded with a mission to educate students from different professions together, interprofessional education does not emerge naturally. An analysis of archival documents, academic catalogs and oral history interviews revealed that early attempts focused on requiring students to take common courses. Later, the faculty created voluntary interprofessional learning activities. Neither approach achieved its intended goals until the Institute developed deliberate strategies to counter the internal and external barriers to integrating interprofessional education. This historical case study suggests that sustainable interprofessional education initiatives require both an organizational home and a permanent place in the curriculum.

'Uncrunching' time: medical schools' use of social media for faculty development.

PURPOSE: The difficulty of attracting attendance for in-person events is a problem common to all faculty development efforts. Social media holds the potential to disseminate information asynchronously while building a community through quick, easy-to-use formats. The authors sought to document creative uses of social media for faculty development in academic medical centers. METHOD: In December 2011, the first author (P.S.C.) examined the websites of all 154 accredited medical schools in the United States and Canada for pages relevant to faculty development. The most popular social media sites and searched for accounts maintained by faculty developers in academic medicine were also visited. Several months later, in February 2012, a second investigator (C.W.S.) validated these data via an independent review. RESULTS: Twenty-two (22) medical schools (14.3%) employed at least one social media technology in support of faculty development. In total, 40 instances of social media tools were identified--the most popular platforms being Facebook (nine institutions), Twitter (eight institutions), and blogs (eight institutions). Four medical schools, in particular, have developed integrated strategies to engage faculty in online communities. CONCLUSIONS: Although relatively few medical schools have embraced social media to promote faculty development, the present range of such uses demonstrates the flexibility and affordability of the tools. The most popular tools incorporate well into faculty members' existing use of technology and require minimal additional effort. Additional research into the benefits of engaging faculty through social media may help overcome hesitation to invest in new technologies.