Unpacking interactions among student teams in a practice-based IPE setting: a qualitative evaluation study.

In many healthcare settings, teams change composition regularly, so healthcare students must be trained to function effectively in dynamic teams before entering the workforce. Interprofessional clinical rotations provide an ideal venue for learners to practice these skills, but little is known about how student teams interact in such settings. In this qualitative observational evaluation, learners from multiple health professions at a single institution participated in scheduled clinics in low-income housing communities for older adults. Interprofessional student teams met with program participants for care coordination, health and wellness assessments, and assistance in setting and achieving health goals; team composition changed from week-to-week. A purposive sample was selected from video-recorded encounters between student teams and their program participants. The aim of this study was to explore team interactions and document learner behaviors. Two researchers independently reviewed discrete segments of each video, recorded their observations and reflections, and then the team discussed, categorized, and identified relevant examples of both effective and ineffective behaviors. Four major themes were observed: inclusiveness, leadership, joy of practice, and sharing of clinical knowledge. Students demonstrated both positive and negative examples of behaviors that aligned with each theme. Understanding how students behave on teams in dynamic settings where patient care is taking place can help educators establish practice-based interprofessional education models that better prepare learners to function effectively and strategies that may improve team interactions.

Are primary care providers' nutrition care and food insecurity screening practices associated with their perceptions of team-based care?

BACKGROUND: Screening for food insecurity (FI) and providing nutrition care are important management strategies for chronic diseases, but rates are low. Aspects of team-based care and providers' nutrition competence may help inform interventions to improve these services. The objectives of this study were to describe US primary care providers' FI screening and nutrition care practices (counselling, referrals, and time spent counselling) and test for associations with scored measures of their perceptions of team-based care (care continuity, patient-centredness, coordination with external providers and resources) and nutrition competence (confidence counselling and attitudes towards nutrition). METHODS: Cross-sectional online survey data of primary care providers were described and analysed for associations using Wilcoxon rank sum tests. RESULTS: Of provider respondents (N = 92), 35% (n = 32) worked in clinics that screen for FI and had higher team perceptions (P = 0.006) versus those who do not. Those who reported counselling >30% patients about nutrition (57%, n = 52) and referring >10% patients to nutrition professionals (24%, n = 22) had significantly better attitudes towards nutrition (P = 0.013 and P = 0.04, respectively) compared with those with lower counselling and referral rates. Half (n = 46) of the providers reported spending >3-min counselling each patient about nutrition and had higher patient-centred care (P = 0.004) and nutrition competence (P < 0.001) compared with those who spent less time counselling. CONCLUSION: Providers in clinics that screen for FI had higher overall perceptions of team-based care, but their nutrition competence was not significantly different. Meanwhile, reported more time counselling was associated with a culture of patient-centredness. Promoting team-based care may be a mechanism for improving FI screening and nutrition care.

Interprofessional education and collaborative practice in Kuwait: attitudes and perceptions of health sciences students.

Interprofessional education (IPE) prepares health students to become collaboration-ready healthcare professionals. Assessing students' baseline attitudes toward IPE and collaborative practice is essential to inform development of IPE curricula. Kuwait University Health Sciences Center (HSC) is early in its IPE journey but is planning to join the broader global movement toward IPE. A cross-sectional survey was conducted to explore the attitudes of HSC students from Faculties of Medicine, Dentistry, Pharmacy, and Allied Health Sciences toward collaborative practice and IPE at early and late stages of study. A total of 770 students completed the survey (81.1% response rate). Students expressed positive attitudes toward interprofessional healthcare teams and IPE (median [IQR] overall attitudes were rated 4.0 [1.0] and 4.0 [2.0], respectively, on a scale of 5). Overall attitudes toward both scales were significantly more positive among pharmacy students than students from other faculties (p < .001). Final-year students reported more positive attitudes toward healthcare teams than early- and middle-year students, while early- and final-year students expressed more positive attitudes toward IPE than middle-year students (p < .001). There were no significant differences in overall attitudes between female and male students toward the two scales (p > .05). These findings have implications for engaging students from different professions in IPE initiatives.

Validity evidence and use of the IPEC Competency Self-Assessment, Version 3.

To guide interprofessional education (IPE), a variety of frameworks have been suggested for defining competency in interprofessional practice, but competency-based assessment remains challenging. One self-report measure developed to facilitate competency-based assessment in IPE is the IPEC Competency Self-Assessment. It was originally described as a 42-item measure constructed on the four domains defined by the Interprofessional Education Collaborative (IPEC) Expert Panel. Response data, however, identified only two factors labeled Interprofessional Interaction and Interprofessional Values. In this study, we tested a revised 19-item, two-factor scale based on these prior findings with a new sample (n = 608) and found good model fit with three items not loading on either factor. This led to a 16-item instrument, which was then tested with an additional sample (n = 676). Internal consistency was high, and scores for both subscales showed variance based on prior healthcare experience. The interprofessional interaction subscale was primarily comprised of items from the Teams and Teamwork domain, with one item each based on competencies from the Interprofessional Communication and Values/Ethics domains; and scores varied by year of enrollment. The interprofessional values subscale was comprised solely of items from the Values/Ethics domain. Scores for both subscales were strongly correlated with scores from the Interprofessional Socialization and Valuing Scale. This study further establishes the validity, reliability, and usability of an assessment tool based on interprofessional competency. The findings also suggest the constructs underlying the subscales may be affected differently by experience and training. Additional study using longitudinal data is needed to test this hypothesis.

Interprofessional education and collaborative practice in Kuwait: attitudes and barriers from faculty.

Interprofessional education (IPE) has been adopted in many educational systems to prepare students in the health professions for team-based practice, but its implementation is still limited in many countries. In preparation for the introduction of IPE within Kuwait University Health Sciences Center, a cross-sectional survey was conducted to explore the attitudes of faculty members (academic staff/academic support staff) toward collaborative practice and IPE, their training needs, and perceived barriers to implementing IPE. Two hundred and ten individuals completed the survey (60% response rate). Respondents expressed positive attitudes toward interprofessional healthcare teams, IPE, and interprofessional learning in the academic setting (median [IQR] overall attitude for each scale was 4.0 [1.0] on a scale of 5). Overall attitudes were significantly more positive among assistant professors, females, and faculty members with ≤ 10 years of experience (p < .05). Most respondents (91.9%) indicated willingness to be trained to implement IPE, with small-group learning as the preferred teaching method (85.7%). A longitudinal curriculum was less popular than discrete IPE experiences. The top reported barriers to implementing IPE were leadership challenges (86.6%), curriculum challenges (82.4%), teaching challenges (81.4%), and resistance to change (80.5%). These findings have implications for developing strategies to engage faculty in effective IPE initiatives internationally.

Perceived influence of power distance, psychological safety, and team cohesion on team effectiveness.

Interprofessional education needs a stronger theoretical basis informed by the challenges facing collaboration across professions. This study explores the impact of power distance (perception of role hierarchy), on team effectiveness as mediated by team cohesion and psychological safety (believe one can speak up without the fear of negative consequences). Furthermore, it tests for differences between medical and nursing students in these concepts. Final-year medical and nursing students completed a paper survey on study constructs at the end of a three-session, 6-h interprofessional critical care simulation activity. Two hundred and forty-three (76% response rate) retrospective surveys found the relationship between power distance and perceived team effectiveness was mediated by perceptions of team cohesion and psychological safety, suggesting these concepts influence desired interprofessional collaboration. There were no differences between medical and nursing students on study variables. While interprofessional training typically focuses on general attitudes toward interprofessional collaboration and on the acquisition and demonstration of knowledge and skills, these findings suggest important team concepts underlying effective collaboration may include perceptions of psychological safety and power distance. These concepts can be key drivers of cohesion and effectiveness during interprofessional simulation exercises and may be targets for future interventions.

Interprofessional practice in different patient care settings: A qualitative exploration.

Increasing interprofessional practice is seen as a path to improved quality, decreased cost, and enhanced patient experience. However, little is known about how context shapes interprofessional work and how interventions should be crafted to account for a specific setting of interprofessional practice. To better understand, how the work of interprofessional practice differs across patient care settings we sought to understand the social processes found in varying work contexts to better understand how care is provided. A case study design was used in this study to yield a picture of patient care across three different settings. Qualitative analysis of teams from three healthcare settings (rehabilitation, acute care, and code team) was conducted, through the use of ten in-depth semi-structured interviews. Interview data from each participant were analyzed via an inductive content analysis approach based upon theories of work and teams from organisational science, a framework for interprofessional practice, and competencies for interprofessional education. The work processes of interprofessional practice varied across settings. Information exchange was more physician-centric and decision-making was more physician dominant in the non-rehabilitation settings. Work was described as concurrent only for the code team. Goal setting varied by setting and interpersonal relationships were only mentioned as important in the rehabilitation setting. The differences observed across settings identify some insights into how context shapes the process of interprofessional collaboration and some research questions that need further study.

Outcomes of Introducing Early Learners to Interprofessional Competencies in a Classroom Setting.

PROBLEM: Although interprofessional practice is important for improving healthcare delivery, there is little evidence describing interprofessional education (IPE) outcomes beyond changes in attitudes and knowledge of prelicensure learners. More rigorous evaluation of early IPE is needed to determine its impact on teaching interprofessional collaborative practice and providing a solid foundation for applying collaborative skills in the clinical environment. INTERVENTION: First-year students (N = 679) in 7 health professions programs participated in a 4-session series focusing on professional roles and responsibilities, teams and teamwork, and the healthcare system. Interprofessional teams of 5-6 students, from at least 3 professions, were assembled for the duration of the series and created a team charter during their first session to guide their work. Each subsequent session included a brief lecture and interactive exercises. Faculty facilitators from the participating programs provided support to students during the sessions. As a culminating project, each team created a short video depicting a barrier to interprofessional collaboration. Students evaluated the performance of their team members using a web-based peer assessment survey. A course evaluation with an embedded validated attitudinal scale was used to assess changes in student perceptions about IPE. A sample of videos were also scored by 2 faculty using a rubric linked to course expectations. CONTEXT: This educational offering took place on the health sciences campus of a large, mid-Atlantic research university with more than 3,200 clinical learners in schools of allied health professions, dentistry, medicine, nursing, and pharmacy. It was the first interprofessional activity for most of the learners. OUTCOME: There were 555 students who participated in some or all of the sessions. Comments indicated that students enjoyed interacting with their peers and prefer activities allowing them to apply content to their profession over lectures. The assessment measures revealed a disconnect between student ratings targeting interprofessional socialization and faculty ratings targeting the products of their teamwork. Although students provided positive feedback to their teammates through peer assessment, and the attitudinal scale showed a small but significant increase in positive attitudes toward IPE, the videos they created did not demonstrate a deep understanding of barriers to interprofessional practice. LESSONS LEARNED: This large-scale IPE activity for early learners supported progress toward interprofessional socialization, but student learning was inconsistently demonstrated in teamwork products. Course planners should augment self- and peer-reported interprofessional socialization measures with faculty-generated behavioral outcome assessments. Such triangulation produces a more robust data set to inform decisions about curricular revisions and development.

Nurse-physician collaboration in an academic medical centre: The influence of organisational and individual factors.

Ineffective physician-nurse collaboration has been recognised to adversely impact patient and organisational outcomes, and some studies suggest an underlying factor may be that nurses and physicians have different perceptions of interprofessional collaboration (IPC). The objectives of this study were to evaluate for a difference in the perception of IPC between physicians and nurses and to explore potential contributing factors at the individual and organisational levels to any observed difference. Data including measures of perceptions of IPC were collected from a convenience sample of resident physicians (n = 47), attending physicians (n = 18), and nurses (n = 54) providing care for internal medicine patients in a large tertiary care academic medical centre. Regression analysis revealed significantly lower perceptions of IPC scores for nurses in comparison to the scores of both the resident and attending physician groups (p = .0001 for both). Although demographic and workload factors also differed by profession, only profession and workload remained significant in regression analysis. Given the known relationships between effective physician-nurse collaboration and superior patient and organisational outcomes, better defining the individual and organisational predictors of IPC scores may support development of more effective interventions targeting improvements in IPC.

Refinement of the IPEC Competency Self-Assessment survey: Results from a multi-institutional study.

Effective interprofessional practice requires interprofessional education that facilitates learners' achievement of competency in the interprofessional domains. Unfortunately, educators currently have a limited number of tools to identify the level of competency of their learners. Previous investigations by some of the authors described the initial characteristics of a tool based on the Competencies for Interprofessional Collaborative Practice. Building on this work, this study describes a multi-institutional, three-part study refining this tool. The series of studies further established the validity, reliability, and usability of the assessment tool. Based on the data derived from this study, we created a shorter, more easily utilised version of the tool that retains previous psychometric strengths. This article describes a tool that consists of two domains, one linked to interprofessional interaction and one linked to interprofessional values. It is believed that this assessment tool may help educators define competence in interprofessional practice and guide assessment of both programmes and learners.

An exploratory study of an assessment tool derived from the competencies of the interprofessional education collaborative.

Linking the outcomes from interprofessional education to improvements in patient care has been hampered by educational assessments that primarily measure the short-term benefits of specific curricular interventions. Competencies, recently published by the Interprofessional Education Collaborative (IPEC), elaborate overarching goals for interprofessional education by specifying desired outcomes for graduating health professions students. The competencies define a transition point between the prescribed and structured educational experience of a professional degree program and the more self-directed, patient-oriented learning associated with professional practice. Drawing on the IPEC competencies for validity, we created a 42-item questionnaire to assess outcomes related to collaborative practice at the degree program level. To establish the usability and psychometric properties of the questionnaire, it was administered to all the students on a health science campus at a large urban university in the mid-Atlantic of the United States. The student responses (n = 481) defined four components aligned in part with the four domains of the IPEC competencies. In addition, the results demonstrated differences in scores by domain that can be used to structure future curricula. These findings suggest a questionnaire based on the IPEC competencies might provide a measure to assess programmatic outcomes related to interprofessional education. We discuss directions for future research, such as a comparison of results within and between institutions, and how these results could provide valuable insights about the effect of different curricular approaches to interprofessional education and the success of various educational programs at preparing students for collaborative practice.

Empowering Student Antiracist Work to Overcome Inertia in Academic Health Centers.

The national struggles for social justice that have dominated headlines since 2020 are reflected in the challenges academic health centers are confronting as they strive to become more antiracist. One of the largest challenges for these institutions may be the inertia of the status quo. While faculty may have become accustomed to a status quo that perpetuates inequity, students provide perspectives that can disrupt this inertia and lead to positive change. Students, however, face barriers to antiracist work, including power gradients (i.e., different amounts of power people possess according to their position in a hierarchy) and a need to be accepted as part of the physician profession. In this article, the authors examine these challenges to student antiracist advocacy. They identify student empowerment, faculty allyship, and sustainability as essential principles for student antiracist work. They suggest this work could be operationalized through sequential student-led task forces focused on addressing the most pressing antiracist issues. The authors further recommend an approach to professionalism and development of a physician professional identity based on the values of antiracism rather than on existing norms. With this foundation, students may be able to engage in antiracist work, build professional identities that are more antiracist, and become physicians who can ensure a more just health care environment for their patients and communities.

Learning Through Listening: A Scoping Review of Podcast Use in Medical Education.

PURPOSE: To improve understanding of podcast use in medical education by examining current research on descriptive attributes and educational outcomes, highlighting implications of the current evidence base for educational practices, and identifying research gaps to guide future investigation. METHOD: The authors conducted a scoping review, searching PubMed and Embase databases in June-July 2020 for English-language studies of audio-only medical education podcast use in undergraduate, graduate, and continuing medical education. The authors excluded studies without original data or with nonphysician data that could not be separated from physician data. From included studies, the authors extracted data regarding descriptive outcomes (e.g., podcast use, content areas, structure) and educational outcomes (classified using Kirkpatrick's 4 levels of evaluation). RESULTS: Of 491 unique articles, 62 met inclusion criteria. Descriptive outcomes were reported in 44 studies. Analysis of these studies revealed podcast use has increased over time, podcasts are a top resource for resident education, and podcasts are being incorporated into formal medical curricula. Educational outcomes were reported in 38 studies. The 29 studies that assessed learner reaction and attitudes to podcasts (Kirkpatrick level 1) showed learners value podcasts for their portability, efficiency, and combined educational and entertainment value. The 10 studies that assessed knowledge retention (Kirkpatrick level 2) showed podcasts to be noninferior to traditional teaching methods. The 11 studies that assessed behavior change (Kirkpatrick level 3) showed improved documentation skills in medical students and self-reported practice change in residents and practicing physicians after listening to podcasts. None of the studies reported system change or patient outcomes (Kirkpatrick level 4). CONCLUSIONS: Future research should focus on the optimal structure of podcasts for learning, higher-level outcomes of podcasts, and the implementation of podcasts into formal curricula. Podcasts may prove to be essential tools for disseminating and implementing the most current, evidence-based practices.

Changes in Physician Telemedicine Use during COVID-19: Effects of Practice Setting, Demographics, Training, and Organizational Policies.

Telemedicine use increased during the COVID-19 pandemic, but uptake was uneven and future use is uncertain. This study, then, examined the ability of personal and environmental variables to predict telemedicine adoption during the COVID-19 pandemic. A total of 230 physicians practicing in the U.S. completed questions concerning personal and environmental characteristics, as well as telemedicine use at three time points: pre-pandemic, during the pandemic, and anticipated future use. Associations between use and characteristics were determined to identify factors important for telemedicine use. Physicians reported that telemedicine accounted for 3.72% of clinical work prior to the pandemic, 46.03% during the pandemic, and predicted 25.44% after the pandemic ends. Physicians within hospitals reported less increase in telemedicine use during the pandemic than within group practice (p = 0.016) and less increase in use at hospitals compared to academic medical centers (p = 0.027) and group practice (p = 0.008). Greater telemedicine use was associated with more years in practice (p = 0.009), supportive organizational policies (p = 0.001), organizational encouragement (p = 0.003), expectations of greater patient volume (p = 0.003), and perceived higher quality of patient care (p = 0.032). Characteristics such as gender, number of physicians, and level of telemedicine training were not significant predictors. Organizations interested in supporting physicians to adopt telemedicine should encourage its use and create policies supporting its use. More senior physicians had a greater degree of telemedicine uptake, while training programs did not predict use, suggesting that efforts to develop telemedicine competency in younger physicians may be ineffective and should be re-examined.

Into the Storm: a Mixed Methods Evaluation of Reasons for Non-attendance of Appointments in the Free Clinic Setting.

Non-attendance of healthcare appointments impact individual health outcomes and the capacity and financial stability of clinics. While non-attendance of appointments has been associated with a variety of factors, interventions to increase attendance have had mixed success. The most widely used intervention, reminder systems like phone calls or text messages, generally improves attendance rates but is insufficient for many clinics as a sole intervention. This study of underresourced patients who did not attend appointments at two clinics for uninsured individuals describes the multifactorial, individualized, and interacting reasons for non-attendance among these methods: Forty-three patients were interviewed by phone within 3 weeks of missing a clinic appointment using a scripted interview based on the literature. Responses were coded and analyzed. For 57% of respondents, a competing priority such as work or caregiving was a reason for missing an appointment. Forgetting about the appointment was a barrier for 38% of participants despite reminder systems being in place. Contributions to non-attendance were identified through thematic analysis: emotional and physical exhaustion, prioritization of work over healthcare, unreliable transportation, financial stress, and being unaware of an appointment. These findings demonstrate the need to test multiple patient-centered interventions, particularly in the context of underresourced communities.

Notes from the Field: Evaluating a Budget-Based Approach to Peer Assessment for Measuring Collaboration Among Learners on Interprofessional Teams.

Assessing interprofessional skills poses challenges for health professions educators. While competency frameworks define the skills graduating students should possess, they do not provide guidance for assessment. This brief report explores validity evidence for use of peer assessment to assess learners and provide feedback for improvement. The context was an online learning experience for 477 fourth-year students from medicine, nursing, and pharmacy who worked together on small interprofessional teams to care for a virtual geriatric patient. At the end of each case unit, students were given a budget of points to allocate among teammates to assess their communication and interprofessional collaboration. Ratings were averaged to provide learners with feedback about their performance. Scores were normally distributed, did not demonstrate a leniency effect, were moderately correlated with ratings that preceptors assigned to students, and had smaller correlations with knowledge scores and other case activity measures. Findings support budget-based peer assessment as a valid and feasible approach for differentiating between students with high interprofessional competency and those who may be deficient. Further exploration should focus on the longitudinal effect of peer assessment, how it may influence individual learning and team dynamics, and whether it could be used for other assessment purposes.

A STEEEP Hill to Climb: A Scoping Review of Assessments of Individual Hospitalist Performance.

BACKGROUND: Although ensuring high-quality care requires assessment of individual hospitalist performance, current assessment approaches lack consistency and coherence. The Institute of Medicine's STEEEP framework for quality healthcare conceptualizes quality through domains of "Safe," "Timely," "Effective," "Efficient," "Equitable," and "Patient Centered." This framework may be applicable to assessing individual hospitalists. OBJECTIVE: This scoping review sought to identify studies that describe variation in individual hospitalist performance and to code this data to the domains of the STEEEP framework. METHODS: Via a systematic search of peer-reviewed literature that assessed the performance of individual hospitalists in the Medline database, we identified studies that described measurement of individual hospitalist performance. Forty-two studies were included in the final review and coded into one or more domains of the STEEEP framework. RESULTS: Studies in the Safe domain focused on transitions of care, both at discharge and within the hospital. Many studies were coded to more than one domain, especially Timely, Effective, and Efficient. Examples include adherence to evidence-based guidelines or Choosing Wisely recommendations. The Patient Centered domain was most frequently coded, but approaches were heterogeneous. No included studies addressed the domain Equitable. CONCLUSIONS: Applying the STEEEP framework to the published literature on assessment of individual hospitalist performance revealed strengths and weaknesses. Areas of strength were assessments of transitions of care and application of consensus guidelines. Other areas, such as equity and some components of safe practice, need development. All domains would benefit from more practical approaches. These findings should stimulate future work on feasibility of multidimensional assessment approaches.