Retrospective review of atrial fibrillation in Standardbred racehorses at a tertiary care facility in Atlantic Canada.

Atrial fibrillation (AF) is the most clinically relevant cardiac arrhythmia identified in the Standardbred racehorse. However, there is limited literature regarding athletic ability in Standardbred racehorses following AF conversion. To investigate this issue, the objectives of this review were to: i) determine the success rate in using quinidine sulphate to treat AF in a population of hospitalized equine patients in Atlantic Canada between January 2008 and December 2019; and ii) measure return to athletic ability (using racetrack earnings and top-3 finishes) following cardioversion with quinidine sulphate in a population of Standardbred racehorses. Overall, 73% (16/22) of AF instances in this study were successfully treated with enteral quinidine sulphate. No significant difference was detected in racetrack earnings or number of top-3 finishes for each horse that raced at least 5 times pre- and post-conversion. Key clinical message: To the authors' knowledge, this is the first published review to assess the athletic ability of Standardbred racehorses following cardioversion with enteral quinidine sulphate. Based on the current information, it does not appear that treatment of AF with quinidine sulphate affects future athletic performance in horses that achieved cardioversion.

Examen rétrospectif de la fibrillation auriculaire chez des chevaux de course Standardbred dans un établissement de soins tertiaires au Canada Atlantique. La fibrillation auriculaire (FA) est l'arythmie cardiaque la plus cliniquement pertinente identifiée chez le cheval de course Standardbred. Cependant, il existe peu de littérature concernant la capacité athlétique des chevaux de course Standardbred après la conversion de l'FA. Pour étudier cette question, les objectifs de cette revue étaient de : i) déterminer le taux de réussite de l'utilisation du sulfate de quinidine pour traiter la FA dans une population de patients équins hospitalisés au Canada Atlantique entre janvier 2008 et décembre 2019; et ii) mesurer le retour à la capacité athlétique (en utilisant les gains en hippodrome et les trois premiers résultats) après une cardioversion avec du sulfate de quinidine dans une population de chevaux de course Standardbred. Dans l'ensemble, 73 % (16/22) des cas de FA dans cette étude ont été traités avec succès avec du sulfate de quinidine entérale. Aucune différence significative n'a été détectée dans les revenus de l'hippodrome ou le nombre de classements parmi les trois premiers pour chaque cheval ayant couru au moins cinq fois avant et après la conversion.Message clinique clé :À la connaissance des auteurs, il s'agit de la première revue publiée évaluant la capacité athlétique des chevaux de course Standardbred après une cardioversion avec sulfate de quinidine entérale. Sur la base des informations actuelles, il ne semble pas que le traitement de la FA avec du sulfate de quinidine affecte les performances sportives futures des chevaux ayant cardioversion réussie.(Traduit par Dr Serge Messier).

Musculoskeletal injuries in Standardbred racehorses on Prince Edward Island.

A study of musculoskeletal injuries in Standardbred racehorses on Prince Edward Island was conducted to determine the incidence and risk factors for injury. Monthly information was collected from 10 trainers and 153 Standardbred horses over a 12-month period. Seventeen new injuries were identified in pacers, representing a horse level incidence risk of 23% and an incidence rate of injury of 2.19 per horse-month at risk. Forty-one percent of the injuries occurred during a race, 53% during training and 6% during jogging. Fourteen horses had experienced a previous injury and 3 of these horses experienced a new injury during the study period. Potential risk factors for injury were the speed at which the horse was trained, previous injury, and the conformational fault of offset knees.

Blessures musculosquelettiques chez des chevaux de course Standardbred à l'Île-du-Prince-Édouard. Une étude des blessures musculosquelettiques chez des chevaux de course Standardbred à l'Île-du-Prince-Édouard a été menée pour déterminer l'incidence et les facteurs de risque de blessures. Des informations mensuelles ont été recueillies auprès de 10 entraîneurs et de 153 chevaux Standardbred sur une période de 12 mois. Dix-sept nouvelles blessures ont été identifiées chez les trotteurs, représentant un risque d'incidence au niveau du cheval de 23 % et un taux d'incidence de blessures de 2,19 par cheval-mois à risque. Quarante et un pour cent des blessures sont survenues pendant une course, 53 % pendant l'entraînement et 6 % pendant le jogging. Quatorze chevaux avaient déjà subi une blessure et trois de ces chevaux ont subi une nouvelle blessure au cours de la période d'étude. Les facteurs de risque potentiels de blessure étaient la vitesse à laquelle le cheval a été entraîné, les blessures antérieures et le défaut de conformation des genoux décalés.(Traduit par Dr Serge Messier).

The COVID-19 crisis silver lining: interprofessional education to guide future innovation.

Globally, the advent and rapid spread of the COVID-19 virus has created significant disruption to health professions education and practice, and consequently interprofessional education, leading to a model of learning and practicing where much is unknown. Key questions for this ongoing evolution emerge for the global context leading to reflections on future directions for the interprofessional education field and its role in shaping future practice models. Health professions programs around the world have made a dramatic shift to virtual learning platforms in response to closures of academic institutions and restrictions imposed on learners accessing practice settings. Telemedicine, slow to become established in many countries to date, has also revolutionized practice in the current environment. Within the state of disruption and rapid change is the awareness of a silver lining that provides an opportunity for future growth. Key topics explored in this commentary include reflection on the application of existing competency frameworks, consideration of typology of team structures, reconsideration of theoretical underpinnings, revisiting of core dimensions of education, adaptation of interprofessional education activities, and the role in the future pandemic planning. As an international community of educators and researchers, the authors consider current observations relevant to interprofessional education and practice contexts and suggest a response from scholarship voices across the globe. The current pandemic offers a unique opportunity for educators, practitioners, and researchers to retain what has served interprofessional education and practice well in the past, break from what has not worked as well, and begin to imagine the new.

Compliance with the Code of Practice for the Care and Handling of Equines on 50 horse farms in Prince Edward Island.

The objective of this study was to determine the proportion of horse farms on Prince Edward Island, Canada that comply with the requirements of the Code of Practice for the Care and Handling of Equines (Code). An investigator performed on-farm assessments while administering a questionnaire to owners of 50 horse farms. The percentage of farms in compliance with specific requirements in the Code ranged from 20% to 100% per requirement. The largest areas of non-compliance regarding facilities and housing were the lack of the ability to segregate sick or injured animals and the lack of an emergency action plan. It was determined that 72% of farms were in compliance with body condition scores and 54% reported to have taken corrective action when required. Farm owners who were aware of the Code were more likely to have good quality air in their barns as well as an emergency action plan in place.

L'objectif de la présente étude était de déterminer la proportion de fermes équines sur l'Île-du-Prince-Édouard, Canada qui se conforme aux exigences du Code de pratiques pour les soins et la manipulation des chevaux (Code). Un enquêteur effectua des évaluations à la ferme tout en procédant à un questionnaire auprès des propriétaires de 50 fermes équines. Le pourcentage de fermes en conformité avec des exigences spécifiques du Code variait de 20 % à 100 % selon l'exigence. Les secteurs les plus importants de nonconformité en regard des facilités et de logement étaient l'absence de la capacité à isoler les animaux malades ou blessés et l'absence d'un plan d'action d'urgence. Il fut déterminé que 72 % des fermes étaient en conformité pour les pointages d'état de chair et 54 % rapportèrent d'avoir pris les actions correctives lorsque requises. Les propriétaires de ferme qui étaient au courant du Code étaient plus susceptibles d'avoir un air de bonne qualité dans leurs fermes ainsi qu'un plan d'action d'urgence en place.(Traduit par Dr Serge Messier).

Bedside nurses' roles in discharge collaboration in general internal medicine: Disconnected, disempowered and devalued?

Collaboration among nurses and other healthcare professionals is needed for effective hospital discharge planning. However, interprofessional interactions and practices related to discharge vary within and across hospitals. These interactions are influenced by the ways in which healthcare professionals' roles are being shaped by hospital discharge priorities. This study explored the experience of bedside nurses' interprofessional collaboration in relation to discharge in a general medicine unit. An ethnographic approach was employed to obtain an in-depth insight into the perceptions and practices of nurses and other healthcare professionals regarding collaborative practices around discharge. Sixty-five hours of observations was undertaken, and 23 interviews were conducted with nurses and other healthcare professionals. According to our results, bedside nurses had limited engagement in interprofessional collaboration and discharge planning. This was apparent by bedside nurses' absence from morning rounds, one-way flow of information from rounds to the bedside nurses following rounds, and limited opportunities for interaction with other healthcare professionals and decision-making during the day. The disconnection, disempowerment and devaluing of bedside nurses in patient discharge planning has implications for quality of care and nursing work. Study findings are positioned within previous work on nurse-physician interactions and the current context of nursing care.

A sociological exploration of the tensions related to interprofessional collaboration in acute-care discharge planning.

Patient discharge is a key concern in hospitals, particularly in acute care, given the multifaceted and challenging nature of patients' healthcare needs. Policies on discharge have identified the importance of interprofessional collaboration, yet research has described its limitations in this clinical context. This study aimed to extend our understanding of interprofessional interactions related to discharge in a general internal medicine setting by using sociological theories to illuminate the existence of, and interplay between, structural factors and microlevel practices. An ethnographic approach was employed to obtain an in-depth insight into healthcare providers' perspectives, behaviours, and interactions regarding discharge. Data collection involved observations, interviews, and document analysis. Approximately 65 hours of observations were undertaken, 23 interviews were conducted with healthcare providers, and government and hospital discharge documents were collected. Data were analysed using a directed content approach. The findings indicate the existence of a medically dominated division of healthcare labour in patient discharge with opportunities for some interprofessional negotiations; the role of organizational routines in facilitating and challenging interprofessional negotiations in patient discharge; and tensions in organizational priorities that impact an interprofessional approach to discharge. The findings provide insight into the various levels at which interventions can be targeted to improve interprofessional collaboration in discharge while recognizing the organizational tensions that challenge an interprofessional approach.

A scoping review of interprofessional education within Canadian nursing literature.

The purpose of this scoping review is to examine the nature of the interprofessional education (IPE) discussion that the Canadian nursing profession is having within the Canadian peer-reviewed nursing literature. An electronic database search of CINAHL was conducted using a modified Arksey & O'Malley scoping review framework. Peer-reviewed, English-language articles published in Canadian nursing journals from January 1981 to February 2016 were retrieved. Articles were included if they discussed IPE, or described an educational activity that met our conceptual definition of IPE. A total of 88 articles were screened, and 11 articles were eligible for analysis. Analysis revealed that this body of literature does not seem to be purposefully engaging Canadian nurses in a critical discourse about the role of IPE. The majority of articles located were reflective or commentaries. At the time of this review, there was a paucity of theoretically informed empirical research articles on IPE in the nursing literature. While IPE may be viewed by some critical scholars as a means of shifting the control of healthcare delivery traditionally held by medicine to other professions, our results suggest that this may not be the case in the Canadian nursing profession.

Medical Residents and Interprofessional Interactions in Discharge: An Ethnographic Exploration of Factors That Affect Negotiation.

BACKGROUND: Interprofessional collaboration is an important aspect of patient discharge from a general internal medicine (GIM) unit. However, there has been minimal empirical or theoretical research that has examined interactions that occur between medical residents and other healthcare professionals in the discharge process. This study provides insight into the social processes that shape and characterize such interactions. OBJECTIVE: To explore factors that shape interactions between medical residents and other healthcare professionals in relation to patient discharge, and to examine the opportunities for negotiations about discharge between these professional groups. DESIGN: A qualitative ethnographic approach using observations, interviews and documentary analysis. PARTICIPANTS AND SETTING: Healthcare professionals working in a GIM unit in Canada. APPROACH: Sixty-five hours of observations were undertaken in a range of settings (e.g. interprofessional rounds, medical and nursing rounds, nursing station) in the unit over a 17-month period. A maximum variation sampling approach was used to identify healthcare professionals working in the unit. Twenty-three interviews were completed, recorded and transcribed verbatim. A directed content approach using theories of medical dominance and negotiated order was used to analyze the data. KEY RESULTS: The organization of clinical work in combination with clinical teaching influenced interprofessional interactions and the quality of discharge in this GIM unit. While organizational activities (orientation and rounds) and individual activities (e.g. role modeling, teaching) supported negotiations between medical residents and other healthcare professionals around discharge, participants had varied perspectives about their effectiveness. CONCLUSIONS: This study illuminates social factors and processes that require attention in order to address challenges with interprofessional collaboration and discharge in GIM. These findings have implications for medical education, workplace learning, patient safety and quality improvement.

Nurse practitioner interactions in acute and long-term care: an exploration of the role of knotworking in supporting interprofessional collaboration.

BACKGROUND: Interprofessional care ensures high quality healthcare. Effective interprofessional collaboration is required to enable interprofessional care, although within the acute care  hospital setting interprofessional collaboration is considered suboptimal. The integration of nurse practitioner roles into the acute and long-term care settings is influencing enhanced care. What remains unknown is how the nurse practitioner role enacts interprofessional collaboration or enables interprofessional care to promote high quality care. The study aim was to understand how nurse practitioners employed in acute and long-term care settings enable interprofessional collaboration and care. METHOD: Nurse practitioner interactions with other healthcare professionals were observed throughout the work day. These interactions were explored within the context of "knotworking" to create an understanding of their social practices and processes supporting interprofessional collaboration. Healthcare professionals who worked with nurse practitioners were invited to share their perceptions of valued role attributes and impacts. RESULTS: Twenty-four nurse practitioners employed at six hospitals participated. 384 hours of observation provided 1,284 observed interactions for analysis. Two types of observed interactions are comparable to knotworking. Rapid interactions resemble the traditional knotworking described in earlier studies, while brief interactions are a new form of knotworking with enhanced qualities that more consistently result in interprofessional care. Nurse practitioners were the most common initiators of brief interactions. CONCLUSIONS: Brief interactions reveal new qualities of knotworking with more consistent interprofessional care results. A general process used by nurse practitioners, where they practice a combination of both traditional (rapid) knotworking and brief knotworking to enable interprofessional care within acute and long-term care settings, is revealed.

Development of a measure to assess healthcare providers' implementation of patient-centered care.

BACKGROUND: Patient-centered care (PCC) is a vaguely defined element of high-quality care, which precludes its consistent and precise operationalization. A conceptualization of PCC was derived from the literature and guided the development of an instrument to assess implementation of PCC by healthcare providers. The items of the instrument capture specific activities that reflect three components of PCC: holistic, collaborative, and responsive care. This paper reports on the measure's content and construct validity and reliability. METHODS: Content validity was evaluated in a sample of 11 nurse practitioners who rated the relevance of each items' content in reflecting the respective component of PCC. The content validity index (CVI) was estimated. Construct validity and internal consistency reliability were examined in a survey of 149 nurse practitioners employed in acute care institutions, using factor analysis and the KR-20 coefficient, respectively. RESULTS: The CVIs were 100% for the three subscales assessing the holistic, collaborative, and responsive care components of PCC. The items in each subscale loaded on one factor. The KR-20 coefficients were .66, .70, and .42, respectively. Overall, the majority (>70%) of respondents indicated performance of the activities comprising the three components of PCC. LINKING EVIDENCE TO ACTION: The PCC measure demonstrated acceptable psychometric properties. The low variance in responses, which is anticipated for instruments assessing fidelity of intervention implementation, accounts for the low reliability coefficients. Additional testing of the measure's psychometric properties in different groups of healthcare providers is warranted. The measure can be used to monitor healthcare providers' implementation of PCC in their usual practice.

Prevalence of Exercise-Induced Pulmonary Hemorrhage, Tracheal Mucus and Recurrent Laryngeal Neuropathy in Competitive Draft Pulling Horses.

Respiratory disease is common in the horse population and is often associated with poor performance in equine athletes. Despite their outstanding strength and aerobic capacity, little regard is given to draft horses and the respiratory disorders they may encounter when performing athletic activity. For this reason, the objectives of this study were: (1) to determine the prevalence of exercise-induced pulmonary hemorrhage (EIPH), tracheal mucus (TM) and recurrent laryngeal hemiplegia (RLH) in a population of competitive draft pulling horses, and (2) to determine if there was an association between horse weight, height, age, amount pulled, or competition placing with EIPH, TM or RLH in draft pullers. Results of this study identified EIPH in 26% of the study population, RLH in 32% and TM in 82% of participating horses; however, no risk factors were identified for the development of these problems in draft pulling horses.

Horse Housing on Prince Edward Island, Canada: Attitudes and Experiences Related to Keeping Horses Outdoors and in Groups.

Limited research has assessed the "human dimension" of horse care. The aims of this study were to (1) understand horse owner attitudes toward horse welfare when kept outdoors versus indoors and in groups versus individually, (2) compare horse owner attitudes toward horse welfare with the ways in which they house their horses, and (3) explore horse owner reasons for and challenges with their horses' housing. Seventy-six horse owners in Prince Edward Island, Canada completed a questionnaire. Non-parametric tests and quantitative content analysis were used for data analysis. Consistent with the way horses were kept, most (82-96%) owners agreed that horses' physical health, mental well-being, and natural living were better when kept outdoors and in groups. Fewer (64-68%) participants agreed that the horses' standard of care was better when kept outdoors or in groups. Results show associations between owners whose attitudes suggest indoor and/or individual housing is better for horse welfare and keeping their horses indoors part-time and/or individually. Two overarching themes were developed from owners' responses regarding their reasons and challenges related to the ways in which horses were housed: horse-centered and owner-centered care. The results indicate that horse owners' choices about their horses' housing correspond to beliefs about improved horse welfare.

The challenge of achieving interprofessional collaboration: should we blame Nightingale?

The goal of implementing true interprofessional collaboration within the health care system seems to be elusive. The historical role of medicine as primary clinical leader and decision maker is particularly entrenched in the Western health care system. Florence Nightingale, the acknowledged founder of modern, Western nursing, is often blamed for the subservient role of nursing and other female-dominated health and social care professions. Is it fair to lay the blame on Nightingale? This paper seeks to place Nightingale in context and to revisit her own words to explore the Victorian world in which she worked as a social reformer. It argues that Nightingale made pragmatic compromises to gain acceptance for the new profession of nursing; that these compromises had unanticipated consequences that persist - but are not unchangeable.

Understanding interprofessional relationships by the use of contact theory.

The importance and necessity of interprofessional collaboration (IPC) present challenges for educators as they determine how best to achieve IPC through interprofessional education (IPE). Simulation-based teaching has been shown to enhance students' understanding of professional roles and promote positive attitudes toward team members; yet, empirical evidence providing direction on the conditions necessary to promote these positive outcomes is lacking. This study used a quasi-experimental design with a pre-/post-test to examine changes in undergraduate healthcare students' perceptions and attitudes toward IPC following their participation in an interprofessional simulation program. Allport's (1954) intergroup contact theory was used to help understand the nature of this IPE workshop and its reported outcomes. Participants included students in the final year of their respective programs (n = 84) such as pharmacy technician, paramedic, nursing and occupational therapy assistant/physical therapy assistant programs. These students were engaged in simulation exercises with interactive contact opportunities. Using the interdisciplinary education perceptions scale, statistically significant increases in positive attitudes in three of four sub-scales were found. An analysis of the structure and format of the workshop suggests that this IPE initiative fulfilled the key conditions suggested by intergroup contact theory. Attention to the key conditions provided by Allport's theory in the context of successful intergroup relationships may help provide direction for educators interested in planning IPE initiatives with student groups enrolled in various health programs.

Case report: Aquarium palytoxin induced keratoconjunctivitis.

PURPOSE: This case report describes the therapeutic management of a 61-year-old male who experienced aquarium coral keratoconjunctivitis caused by exposure to palytoxin and provides an additional resource to raise awareness and treat patients with ocular exposure to palytoxin. OBSERVATIONS: A 61-year-old male inadvertently touched his left eye while cleaning an aquarium. Within 24 hours, pain, redness and visual blurring was noted. After 48 hours his best corrected visual acuity was measured at 20/25 on the right eye and 20/200 on the left. A thick mucopurulent discharge was present with associated conjunctival edema. The corneal epithelium was denuded centrally and inferiorly with subepithelial infiltrates peripherally. The patient was treated with topical moxifloxacin (0.5%) drops 6x/day and prednisolone acetate (1%) 4x/day. He was seen for follow up 48 hours later with a significant improvement in discomfort. Vision had improved to 20/60 with resolution of conjunctival edema, partial corneal epithelialization and reduced erythema. Cultures for culture and sensitivity returned as normal. The patient's steroid regime was gradually tapered during reassessments at four and ten days by which time the left eye acuity had returned to 20/25 with no symptoms. Therapy was discontinued with the exception of artificial tears. The patient continued to do well at his 42-day follow-up appointment with persistent corneal epithelialization, absence of infiltrates and a stable visual acuity of 20/25 in the affected eye. His local optometrist confirmed that the acuity was consistent with measurements obtained prior to the insult. CONCLUSIONS: The combination of moxifloxacin eye drops and prednisolone acetate eye drops were effective in treating the patient's aquarium coral keratoconjunctivitis as after being treated the patient regained his baseline visual acuity in the affected eye (best corrected visual acuity of 20/25). IMPORTANCE: Currently, there are only a handful of case-reports published on ocular exposure to palytoxin. This case report will add to the literature by providing an additional resource for health care providers, in the treatment of patients with ocular exposure to palytoxin and increasing awareness to this rare condition.

Health Care Students' Perspectives on Artificial Intelligence: Countrywide Survey in Canada.

BACKGROUND: Artificial intelligence (AI) is no longer a futuristic concept; it is increasingly being integrated into health care. As studies on attitudes toward AI have primarily focused on physicians, there is a need to assess the perspectives of students across health care disciplines to inform future curriculum development. OBJECTIVE: This study aims to explore and identify gaps in the knowledge that Canadian health care students have regarding AI, capture how health care students in different fields differ in their knowledge and perspectives on AI, and present student-identified ways that AI literacy may be incorporated into the health care curriculum. METHODS: The survey was developed from a narrative literature review of topics in attitudinal surveys on AI. The final survey comprised 15 items, including multiple-choice questions, pick-group-rank questions, 11-point Likert scale items, slider scale questions, and narrative questions. We used snowball and convenience sampling methods by distributing an email with a description and a link to the web-based survey to representatives from 18 Canadian schools. RESULTS: A total of 2167 students across 10 different health professions from 18 universities across Canada responded to the survey. Overall, 78.77% (1707/2167) predicted that AI technology would affect their careers within the coming decade and 74.5% (1595/2167) reported a positive outlook toward the emerging role of AI in their respective fields. Attitudes toward AI varied by discipline. Students, even those opposed to AI, identified the need to incorporate a basic understanding of AI into their curricula. CONCLUSIONS: We performed a nationwide survey of health care students across 10 different health professions in Canada. The findings would inform student-identified topics within AI and their preferred delivery formats, which would advance education across different health care professions.

Interprofessional simulated learning: short-term associations between simulation and interprofessional collaboration.

BACKGROUND: Health professions education programs use simulation for teaching and maintaining clinical procedural skills. Simulated learning activities are also becoming useful methods of instruction for interprofessional education. The simulation environment for interprofessional training allows participants to explore collaborative ways of improving communicative aspects of clinical care. Simulation has shown communication improvement within and between health care professions, but the impacts of teamwork simulation on perceptions of others' interprofessional practices and one's own attitudes toward teamwork are largely unknown. METHODS: A single-arm intervention study tested the association between simulated team practice and measures of interprofessional collaboration, nurse-physician relationships, and attitudes toward health care teams. Participants were 154 post-licensure nurses, allied health professionals, and physicians. Self- and proxy-report survey measurements were taken before simulation training and two and six weeks after. RESULTS: Multilevel modeling revealed little change over the study period. Variation in interprofessional collaboration and attitudes was largely attributable to between-person characteristics. A constructed categorical variable indexing 'leadership capacity' found that participants with highest and lowest values were more likely to endorse shared team leadership over physician centrality. CONCLUSION: Results from this study indicate that focusing interprofessional simulation education on shared leadership may provide the most leverage to improve interprofessional care.

Simulated interprofessional education: an analysis of teaching and learning processes.

Simulated learning activities are increasingly being used in health professions and interprofessional education (IPE). Specifically, IPE programs are frequently adopting role-play simulations as a key learning approach. Despite this widespread adoption, there is little empirical evidence exploring the teaching and learning processes embedded within this type of simulation. This exploratory study provides insight into the nature of these processes through the use of qualitative methods. A total of 152 clinicians, 101 students and 9 facilitators representing a range of health professions, participated in video-recorded role-plays and debrief sessions. Videotapes were analyzed to explore emerging issues and themes related to teaching and learning processes related to this type of interprofessional simulated learning experience. In addition, three focus groups were conducted with a subset of participants to explore perceptions of their educational experiences. Five key themes emerged from the data analysis: enthusiasm and motivation, professional role assignment, scenario realism, facilitator style and background and team facilitation. Our findings suggest that program developers need to be mindful of these five themes when using role-plays in an interprofessional context and point to the importance of deliberate and skilled facilitation in meeting desired learning outcomes.