Exploring differences in and factors influencing self-efficacy for competence in interprofessional collaborative practice among health professions students.

The value of health care delivered via effective interprofessional teams has created an imperative for interprofessional education (IPE) and interprofessional collaborative practice (ICP). To inform IPE strategies, we investigated differences in perceived self-efficacy (SE) for competence in ICP among health professions students. The study data were collected between 2015 and 2019 from students from 13 different health professions programmes (N = 3,497) before an annual institutional interprofessional programme. Students completed the IPECC-SET-27, a validated instrument evaluating perceived SE for competence in ICP, and rated their 1) amount of previous contact with, and 2) perceived understanding of, the role of different health professions. Students in different health professions education programmes were compared using parametric statistics. Regression analyses explored factors influencing SE for competence in ICP. Findings revealed significant differences in perceived SE for competence in ICP between programmes (p < .05). Specifically, health information management/health informatics, dentistry, medicine, and nursing students expressed relatively higher SE, whereas physical therapy and occupational therapy students expressed relatively lower SE. Perceived understanding of the role of health professions (p < .01) and gender (p < .01) contributed significantly to predicting perceived SE for competence in ICP, while the amount of previous contact with other health professions did not (p = .42). The findings highlight the value of designing IPE with consideration of specific learner needs.

Let's Not Reinvent the Wheel: Using Communities of Learning and Practice to Address SDOH and Advance Health Equity.

BACKGROUND: Despite advances in knowledge and science, evidence indicates that health care disparities and inequities continue to exist across diverse populations. Educating and training the next generation of health professionals to focus on addressing social determinants of health (SDOH) and advancing health equity is a key priority. This aim requires educational institutions, communities, and educators to strive for change in health professions education, to attain the goal of creating transformative educational systems that better meet the public health needs of the 21st Century. PURPOSE AND OUTCOMES: Communities of practice (CoPs) are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly. The National Collaborative for Education to Address Social Determinants of Health (NCEAS) CoP is focused on integrating SDOH into the formal education of health professionals. The NCEAS CoP is one model to replicate how health professions educators can work together for transformative health workforce education and development. The NCEAS CoP will continue to advance health equity by sharing evidence-based models of education and practice that address SDOH and help build and sustain a culture of health and well-being through sharing models for transformative health professions education. CONCLUSIONS: Our work is an example that shows we can build partnerships across communities and professions, thereby freely sharing ideas and curricular innovations that address the systemic inequities that continue to fuel persistent health disparities and inequities, and contribute to moral distress and burnout of our health professionals.

Challenges of interprofessional geriatric practice in home care settings: an integrative review.

This integrative review identified challenges for interprofessional home care and provided recommendations for improving geriatric home care. A search of six databases identified 982 articles; 11 of them met the review's eligibility criteria and were included in the review. Quality appraisal of the included studies was performed using two tools (Critical Appraisal Skills Program for Qualitative Research and Mixed Methods Appraisal Tool), and their overall methodological quality was found to be satisfactory. After applying D'Amour et al.'s framework, four "challenge" themes emerged: (1) lack of sharing, (2) lack of partnership, (3) limited resources and interdependency, and (4) power issues. Recommendations included providing practical multidisciplinary training guided by a standardized model, establishing streamlined communication protocols and a communication platform reflecting the actual needs of users by involving them in its design, and asking interprofessional team members to commit to home care planning and to cultivate a collaborative culture and organizational support.

Instrument Refinement for Measuring Self-Efficacy for Competence in Interprofessional Collaborative Practice: Development and Psychometric Analysis of IPECC-SET 27 and IPECC-SET 9.

Assessing competence in interprofessional collaborative practice (ICP) among health professions students is a high priority. This cross-sectional study built on the authors' prior work that led to the development of the 38-item Interprofessional Education Collaborative Competency Self Efficacy Tool (IPECC-SET), an instrument to evaluate health professions students' self-efficacy in interprofessional collaborative competency, and addressed two primary questions. First, could a unidimensional scale based on the IPEC competencies and assessing perceived self-efficacy for competence in ICP and be constructed? Second, could a shorter version of that instrument still meet criteria for unidimensionality and retain the ability to separate students in distinct levels of perceived self-efficacy for competence in ICP? Study participants were two cohorts of students from 11 health professions programs participating in an institutional interprofessional immersion event in 2015 and 2016. Statistical stepwise analyses were conducted using a Rasch rating scale model. The original 38 IPECC-SET items did not meet the criteria to generate a valid unidimensional measure of self-efficacy for competence in ICP, but could be condensed into a 27-item scale that met all set criteria for unidimensionality, with an explained variance of 61.2% and a separation index of 3.02. A shorter, 9-item scale demonstrated a separation index of 2.21. The nine items included also demonstrated a relatively equivalent range (54.93-45.65) as compared to the 27-item scale (57.26-46.16). Findings confirm empirically the conceptual suggestion from our earlier work that the four dimensions in the original IPEC competencies contribute to a shared underlying construct: perceived competence in interprofessional collaboration. Given the emphasis on ICP, psychometrically sound instruments are needed to evaluate the effectiveness of educational efforts to promote competency for ICP. Based on the findings from this study, both the IPECC-SET 27 and IPECC-SET 9 can be used to measure perceived self-efficacy for competence in ICP.

Development and validation of a tool to assess self-efficacy for competence in interprofessional collaborative practice.

Although interprofessional education and collaborative practice have gained increasing attention over the past five decades, development of rigorous tools to assess related competencies is still in infancy. The purpose of this study was to develop an instrument to evaluate health professions students' self-efficacy in interprofessional collaborative competency and to assess the instrument's psychometric properties. We developed a new instrument based on the Interprofessional Education Collaborative's (IPEC) Core Competencies for Interprofessional Collaborative Practice. In a cross-sectional study design, 660 students from 11 health programmes at an urban university in the Midwest USA completed the Interprofessional Education Collaborative Competency Self Efficacy Tool (IPECC-SET). Rasch analysis evaluated the following: (1) functioning of the instrument; (2) fit of items within each subscale to a unidimensional construct; (3) person-response validity; (4) person-separation reliability; and (5) differential item functioning in relation to gender and ethnicity. After removing seven items with suboptimal fit, each subscale demonstrated high internal validity. Two items demonstrated differential item functioning (DIF) for "Gender" and none for "Race/Ethnicity." Our findings provide early evidence of IPECC-SET as a valid measure of self-efficacy for interprofessional competence for health professions students. Additional research is warranted to establish external validity of the new instrument by conducting studies across institutions.

Trauma informed care in medicine: current knowledge and future research directions.

Traumatic events (including sexual abuse, domestic violence, elder abuse, and combat trauma) are associated with long-term physical and psychological effects. These events may influence patients' health care experiences and engagement in preventative care. Although the term trauma-informed care (TIC) is widely used, it is not well understood how to apply this concept in daily health care practice. On the basis of a synthesis of a review of the literature, the TIC pyramid is a conceptual and operational framework that can help physicians translate TIC principles into interactions with patients. Implications for clinical practice and future research are discussed in this article.

Long-Term Impacts on Clinical Practice Along the HIV Care Continuum: Addressing Workforce Gaps Through a Clinician Scholars Program.

The Clinician Scholars Program (CSP) was designed to expand the HIV care workforce by improving the clinical capacity of clinicians in underserved areas. This evaluation assessed program participants' long-term practice changes and system changes. The year-long program combined mentoring, training, and on-site clinical observation. Qualitative interviews (N = 46) were conducted with Scholars at least 2 years following CSP, supplemented by a 2023 survey. Multiple coders analyzed transcripts using open coding. Thematic analysis explored practice changes and efforts to move patients along the HIV care continuum. Findings indicate positive long-term impacts of CSP regarding the HIV care continuum and care system engagement. Over 90% of Scholars remained working in HIV care, with 75% maintaining or increasing patient loads and 72% making changes to their clinical practice. This training model appears to enhance care along the HIV care continuum and may be adaptable to other contexts that address complex chronic conditions.

Is Academic Medicine Prepared to Teach About the Intersection of Childhood Experiences and Health? An Exploratory Survey of Faculty.

INTRODUCTION: Childhood experiences affect health across the lifespan. Evidence-based strategies targeting early-life stress are emerging. Nevertheless, faculty physicians' preparation to incorporate this science into practice has not been well studied. This study explores medical faculty knowledge and beliefs, timing and route of knowledge acquisition, perceived relevance and application of study topics, and characteristics associated with concept mastery. METHODS: The authors developed and administered an exploratory survey to faculty from six departments at two medical schools. The team analyzed responses using quantitative and qualitative methods. RESULTS: Eighty-one (8.8%) eligible faculty completed the survey. Of respondents, 53 (65.4%) achieved high knowledge, 34 (42.0%) high beliefs, and 42 (59.1%) high concept exposure question scores, but only 6 (7.4%) through a formal route. Although 78 (96.8%) respondents indicated that survey concepts are relevant, only 18 (22.2%) reported fully incorporating them in their work, and 48 (59.2%) identified the need for additional coaching. Respondents reporting full incorporation were significantly more likely to attain high concept exposure scores (17 respondents, 94.4%, versus 25 respondents, 39.7%, P < .001). Quantitative and qualitative analysis highlighted limited respondent awareness of trauma prevalence among health care workers, lack of familiarity with interventions, and time and resource challenges addressing childhood adversity. DISCUSSION: Although survey respondents had some familiarity with study concepts and perceived their relevance, most are not fully applying them. Results suggest that exposure to study concepts is associated with full incorporation. Therefore, intentional faculty development is essential to prepare faculty to include this science in practice.

Training future health providers to care for the underserved: a pilot interprofessional experience.

INTRODUCTION: Interprofessional teamwork is essential for effective delivery of health care to all patients, particularly the vulnerable and underserved. This brief communication describes a pilot interprofessional learning experience designed to introduce medicine and pharmacy students to critical health issues affecting at-risk, vulnerable patients and helping students learn the value of functioning effectively in interprofessional teams. METHODS: With reflective practice as an overarching principle, readings, writing assignments, a community-based immersion experience, discussion seminars, and presentations were organized to cultivate students' insights into key issues impacting the health and well-being of vulnerable patients. A written program evaluation form was used to gather students' feedback about this learning experience. RESULTS: Participating students evaluated this learning experience positively. Both quantitative and qualitative input indicated the usefulness of this learning experience in stimulating learners' thinking and helping them learn to work collaboratively with peers from another discipline to understand and address health issues for at-risk, vulnerable patients within their community. DISCUSSION: This pilot educational activity helped medicine and pharmacy students learn the value of functioning effectively in interprofessional teams. Given the importance of interprofessional teamwork and the increasing need to respond to the health needs of underserved populations, integrating interprofessional learning experiences in health professions training is highly relevant, feasible, and critically needed.

Hypertension: Are Current Guidelines Inclusive of Sex and Gender?

Background: Hypertension (HTN) accounts for one in five deaths of American women. Major societies worldwide aim to make evidence-based recommendations for HTN management. Sex- or gender-based differences exist in epidemiology and management of HTN; in this study, we aimed to assess sex- and gender-based language in major society guidelines. Materials and Methods: We reviewed HTN guidelines from four societies: the American College of Cardiology (ACC), the American College of Emergency Physicians (ACEP), the European Society of Cardiology (ESC), and the Eighth Joint National Committee (JNC8). We quantified the sex- and gender-based medicine (SGBM) content by word count in each guideline as well as identified the gender of guideline authors. Results: Two of the four HTN guidelines (ACC, ESC) included SGBM content. Of these two guidelines, there were variations in the quantity and depth of content coverage. Pregnancy had the highest word count found in both guidelines (422 words in ACC and 1,523 words in ESC), which represented 2.45% and 3.04% of the total words in each guideline, respectively. There was minimal coverage, if any, of any other life periods. The number of women authors did not impact the SGBM content within a given guideline. Conclusions: Current HTN management guidelines do not provide optimal guidance on sex- and gender-based differences. Inclusion of sex, gender identity, hormone therapy, pregnancy and lactation status, menopause, and advanced age in future research will be critical to bridge the current evidence gap. Guideline writing committees should include diverse perspectives, including cisgender and transgender persons from diverse racial and ethnic backgrounds.

Challenges to Interprofessional Education: will e-Learning be the Magical Stick?

PURPOSE: In Egypt, the main challenges to interprofessional education (IPE) implementation are complexity of the required curricular design, the attitudinal barriers between professions, and the needed resources. Action research work was planned and implemented to identify alternative solutions to overcome barriers to IPE in the local Egyptian context. METHODS: -An 8-week e-learning elective course was developed, implemented, and evaluated. A mixed group of 30 nursing and medical students was enrolled voluntarily in the course. Female to male ratio was 3:2. Four faculty members were assigned to manage the course. Based on the EMRO-WHO guidelines, ethics content was selected and organized. A closed Facebook group was created and utilized as the e-learning platform. Facilitated large-group and case-based discussions were the main instructional methods. Scoring of mixed small group assignments was the main assessment tool. Course evaluation was conducted using the Interprofessional Socialization and Valuing Scale (ISVS) and an Online-Course Evaluation Questionnaire (OCEQ). RESULTS: ISVS results revealed that students' perception of ability, comfort and value in working with others, were all positive. The OCEQ provided additional evidence regarding the satisfaction of students with the Facebook group as a learning platform. Assignment submission rate was 90%. Success rate of small group assignments (scores ≥ 60%) was 100%. Response rate to the open online discussions was 63%. Through peer evaluation as well as direct observation of online discussions, there was evidence of distinct contributions by females and by medical students compared to nursing students. CONCLUSION: As evidenced by the students' perception and performance, our IPE distance learning experience was valuable. Motivation of medical students as well as females was evident. IPE is a challenging process. The elective approach and using DL can offer solutions. Conducting relevant practical sessions as well as sustainability of this IPE e-learning experience remain key challenges.

Contributions of US Medical Schools to Primary Care (2003-2014): Determining and Predicting Who Really Goes Into Primary Care.

BACKGROUND AND OBJECTIVES: Schools of medicine in the United States may overstate the placement of their graduates in primary care. The purpose of this project was to determine the magnitude by which primary care output is overestimated by commonly used metrics and identify a more accurate method for predicting actual primary care output. METHODS: We used a retrospective cohort study with a convenience sample of graduates from US medical schools granting the MD degree. We determined the actual practicing specialty of those graduates considered primary care based on the Residency Match Method by using a variety of online sources. Analyses compared the percentage of graduates actually practicing primary care between the Residency Match Method and the Intent to Practice Primary Care Method. RESULTS: The final study population included 17,509 graduates from 20 campuses across 14 university systems widely distributed across the United States and widely varying in published ranking for producing primary care graduates. The commonly used Residency Match Method predicted a 41.2% primary care output rate. The actual primary care output rate was 22.3%. The proposed new method, the Intent to Practice Primary Care Method, predicted a 17.1% primary care output rate, which was closer to the actual primary care rate. CONCLUSIONS: A valid, reliable method of predicting primary care output is essential for workforce training and planning. Medical schools, administrators, policy makers, and popular press should adopt this new, more reliable primary care reporting method.

Entrustable Professional Activity Utilization: A CERA Study of Family Medicine Residency Program Directors.

BACKGROUND AND OBJECTIVES: Entrustable professional activities (EPAs) is a novel assessment framework in competency-based medical education. While there are published pilot reports about utilization and validation of EPAs within undergraduate medical education (UME), there is a paucity of research within graduate medical education (GME). This study aimed to explore the landscape of EPAs within family medicine GME, particularly related to the understanding of EPAs, extent of utilization, and benefits and challenges of EPAs implementation as an assessment framework within family medicine residency programs (FMRPs) in the United States. METHODS: A cross-sectional survey, as part of the 2017 Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) Family Medicine Residency Program (FMRP) Director omnibus online survey was conducted in fall, 2017. ACGME-accredited FMRP directors were invited by email to participate. RESULTS: The survey response rate was 53.1% (267/503). Overall, 90.1% (237/263) of FMRP directors were aware of EPAs as an assessment framework and 82.8% (197/238) understood the principles of EPAs, but 39.9% (95/238) were not confident in utilizing EPAs. Only 15.1% (36/238) of FMRP directors reported currently employing EPAs as an assessment tool. Identified benefits of EPAs use included increased transparency and congruence of expectations between learners and FRMP as well as facilitation for formative feedback. Identified barriers of EPA incorporation included difficulty integrating EPAs into the current assessment framework and faculty development. CONCLUSIONS: While EPAs are well recognized and understood by FMRP directors, there is significant lack of utilization of this assessment framework within FMRP in the United States.

Professional Identity Formation in HIV Care: Development of Clinician Scholars in a Longitudinal, Mentored Training Program.

INTRODUCTION: The Clinician Scholars Program is designed to improve the capacity and quality of HIV care by training clinicians in underserved areas. A mentoring approach is used to deliver individualized educational opportunities over the course of a year focused on preparing clinicians to provide high-quality patient-centered HIV care. Evaluation of the program has illustrated increases in knowledge, skills, and practice behavior, yet critical domains remain unexplored, particularly the potential for the program to affect professional identity formation and networking between individual clinicians. METHODS: Qualitative exit interviews (N = 50) were conducted over 4 years of the Clinician Scholars Program. Interviews were transcribed and analyzed using an open-coding process with multiple coders. Interrater reliability was assessed. Themes related to professional development and networking emerged. RESULTS: Thematic analysis revealed changes in several professional development domains, including self-efficacy, HIV care clinician identity, and career development. In addition, clinicians began to develop key connections with mentors, other clinicians, and health systems-gaining a foundation in the HIV care community, enabled and strengthened by growth in professional confidence and competence within the clinician's care context. DISCUSSION: Evaluations of clinical training programs often focus on knowledge and skill gains without addressing professional identity development and place within the care community. This study illustrates that a longitudinal clinician training program has the potential to influence professional identify development, particularly affect how clinicians view themselves as a resource in the HIV care community and begins to facilitate necessary connections to other clinicians and the wider care system.

Impact of exercise (walking) on blood pressure levels in African American adults with newly diagnosed hypertension.

OBJECTIVES: To determine whether the encouragement of walking an extra 30 minutes a day decreases blood pressure in adult African Americans with newly diagnosed hypertension. DESIGN: Randomized controlled study. PARTICIPANTS AND SETTING: A total of 19 African American adults with newly diagnosed hypertension from an urban family medicine office were randomly assigned to intervention and control groups. INTERVENTION: The intervention group was advised to walk an extra 30 minutes per day. The control group was not given this advice. All subjects used pedometers to record the number of daily steps. MAIN OUTCOME MEASURE: Change in systolic and diastolic blood pressure in the intervention and control groups after six months of trial, controlling for age and body mass index. RESULTS: At the end of six months, a mixed analysis of covariance did not reveal a significant group-by-time interaction for systolic blood pressure. However, positive effects of walking were evidenced; adjusted mean systolic blood pressure dropped by 9.0% for those in the intervention group and 2.33% for those in the control group. Similarly, adjusted mean diastolic pressure dropped by 7.42% for the intervention group and remained essentially unchanged for the control group (P = .08) CONCLUSIONS: The findings of this study indicate that walking an extra 30 minutes a day is associated with lower mean blood pressure among adult African Americans with newly diagnosed hypertension.

Impacts of Longitudinal Mentorship to Strengthen the HIV Workforce: Qualitative Evidence of Changes in Clinicians' Knowledge, Attitudes, and Practice.

The Clinician Scholars Program at the Midwest AIDS Training and Education Center strengthens the workforce by increasing knowledge and skills related to HIV prevention and care. The 1-year individualized training program for minority-serving clinicians includes intensive mentoring and networking. Qualitative exit interviews (N = 50) conducted over 4 years demonstrate the effectiveness of the training, including changes at the individual and systems levels. Findings show that almost all graduates reported improvements in knowledge, two-thirds reported changes in empathic capacity and cultural competence, and nearly three-quarters reported changes in clinical practice. Scholars indicated improvements in knowledge and practice of HIV prevention, including pre-exposure prophylaxis and managing medications and comorbidities. A third of the Scholars reported improvements in their clinical practices related to linking and retaining patients in HIV care, which demonstrated positive movement along the HIV care continuum, a key focus area of the National HIV AIDS Strategy.

Implementing visual cervical cancer screening in Senegal: a cross-sectional study of risk factors and prevalence highlighting service utilization barriers.

BACKGROUND: Senegal ranks 15th in the world in incidence of cervical cancer, the number one cause of cancer mortality among women in this country. The estimated participation rate for cervical cancer screening throughout Senegal is very low (6.9% of women 18-69 years old), especially in rural areas and among older age groups (only 1.9% of women above the age of 40 years). There are no reliable estimates of the prevalence of cervical dysplasia or risk factors for cervical dysplasia specific to rural Senegal. The goals of this study were to estimate the prevalence of cervical dysplasia in a rural region using visual inspection of the cervix with acetic acid (VIA) and to assess risk factors for cervical cancer control. PATIENTS AND METHODS: We conducted a cross-sectional study in which we randomly selected 38 villages across the Kédougou region using a three-stage clustering process. Between October 2013 and March 2014, we collected VIA screening results for women aged 30-50 years and cervical cancer risk factors linked to the screening result. RESULTS: We screened 509 women; 5.6% of the estimated target population (9,041) in the region. The point prevalence of cervical dysplasia (positive VIA test) was 2.10% (95% confidence interval [CI]: 0.99-3.21). Moreover, 287 women completed the cervical cancer risk factor survey (56.4% response rate) and only 38% stated awareness of cervical cancer; 75.9% of the screened women were less than 40 years of age. CONCLUSION: The overall prevalence of dysplasia in this sample was lower than anticipated. Despite both overall awareness and screening uptake being less than expected, our study highlights the need to address challenges in future prevalence estimates. Principally, we identified that the highest-risk women are the ones least likely to seek screening services, thus illustrating a need to fully understand demand-side barriers to accessing health services in this population. Targeted efforts to educate and motivate older women to seek screenings are needed to sustain an effective cervical cancer screening program.

Current Status of Family Medicine Faculty Development in Sub-Saharan Africa.

BACKGROUND AND OBJECTIVES: Reducing the shortage of primary care physicians in sub-Saharan Africa requires expansion of training programs in family medicine. Challenges remain in preparing, recruiting, and retaining faculty qualified to teach in these pioneering programs. Little is known about the unique faculty development needs of family medicine faculty within the sub-Saharan African context. The purpose of this study was to assess the current status and future needs for developing robust family medicine faculty in sub-Saharan Africa. The results are reported in two companion articles. METHODS: A cross-sectional study design was used to conduct a qualitative needs assessment comprising 37 in-depth, semi-structured interviews of individual faculty trainers from postgraduate family medicine training programs in eight sub-Saharan African countries. Data were analyzed according to qualitative description. RESULTS: While faculty development opportunities in sub-Saharan Africa were identified, current faculty note many barriers to faculty development and limited participation in available programs. Faculty value teaching competency, but institutional structures do not provide adequate support. CONCLUSIONS: Sub-Saharan African family physicians and postgraduate trainee physicians value good teachers and recognize that clinical training alone does not provide all of the skills needed by educators. The current status of limited resources of institutions and individuals constrain faculty development efforts. Where faculty development opportunities do exist, they are too infrequent or otherwise inaccessible to provide trainers the necessary skills to help them succeed as educators.

Future of Family Medicine Faculty Development in Sub-Saharan Africa.

BACKGROUND AND OBJECTIVES: High-quality family medicine education is needed in sub-Saharan Africa to facilitate the future growth of primary care health systems. Current faculty educators recognize the value of dedicated teacher training and ongoing faculty development. However, they are constrained by inadequate faculty development program availability and institutional support. METHODS: A cross-sectional study design was used to conduct a qualitative needs assessment comprised of 37 in-depth, semi-structured interviews of individual faculty trainers from postgraduate family medicine training programs in eight sub-Saharan African countries. Data were analyzed according to qualitative description. RESULTS: Informants described desired qualities for a family medicine educator in sub-Saharan Africa: (1) pedagogical expertise in topics and perspectives unique to family medicine, (2) engagement in self-directed, lifelong learning, and (3) exemplary character and behavior that inspires others. Informant recommendations to guide the development of faculty development programs include: (1) sustainability, partnership, and responsiveness to the needs of the institution, (2) intentional faculty development must begin early and be supported with high-quality mentorship, (3) presumptions of teaching competence based on clinical training must be overcome, and (4) evaluation and feedback are critical components of faculty development. CONCLUSIONS: High-quality faculty development in family medicine is critically important to the primary care workforce in sub-Saharan Africa. Our study describes specific needs and recommendations for family medicine faculty development in sub-Saharan Africa. Next steps include piloting and evaluating innovative models of faculty development that respond to specific institutional or regional needs.