"Building Your Neurology Acumen": A Flipped Classroom Approach for Internal Medicine Residents.

Globally, internal medicine (IM) residents often feel they lack the knowledge and skills to approach patients presenting with neurologic issues. We conducted a multiple method needs assessment to determine the feasibility of a novel neurology flipped classroom (FC) curriculum for internal medicine residents. Our primary findings include participants: (1) finding neurology a useful rotation; (2) feeling uncomfortable with the neurological examination; and (3) endorsing flipped classroom as a potential alternative but with significant barriers. Our findings elucidate upon the various extrinsic/intrinsic motivators for resident education and illustrate the need to re-examine the way in which neurology is being taught to off-service residents.

A behavioural study of obedience in health professional students.

Interprofessional Education and Collaborative Practice (IPECP) is a field of study suggested to improve team functioning and patient safety. However, even interprofessional teams are susceptible to group pressures which may inhibit speaking up (positive deviance). Obedience is one group pressure that can inhibit positive deviance leading to negative patient outcomes. To examine the influence of obedience to authority in an interprofessional setting, an experimental simulated clinical scenario was conducted with Respiratory Therapy (RT) (n = 40) and Advanced Care Paramedic (ACP) (n = 20) students. In an airway management scenario, it was necessary for students to challenge an authority, a senior anesthesiologist, to prevent patient harm. In a 2 × 2 design cognitive load and an interventional writing task designed to increase positive deviance were tested. The effect of individual characteristics, including Moral Foundations, and displacement of responsibility were also examined. There was a significant effect for profession and cognitive load: RT students demonstrated lower levels of positive deviance in the low cognitive load scenario than students in other conditions. The writing task did not have a significant effect on RT or ACP students' behaviour. The influence of Moral Foundations differed from expectations, In Group Loyalty was selected as a negative predictor of positive deviance while Respect for Authority was not. Displacement of responsibility was influential for some participants thought not for all. Other individual variables were identified for further investigation. Observational analysis of the simulation videos was conducted to obtain further insight into student behaviour in a compliance scenario. Individual differences, including experience, should be considered when providing education and training for positive deviance. Simulation provides an ideal setting to use compliance scenarios to train for positive deviance and for experimentation to study interprofessional team behaviour.

A case of validity evidence for the Interprofessional Attitudes Scale.

Numerous measures have been developed for the assessment of interprofessional attitudes, including the Interprofessional Attitudes Scale (IPAS). The purpose of this study was to assess, and contribute to, the validity evidence for the IPAS. The IPAS was used in a three-year longitudinal study to collect data from first year health professionals. Three forms of assessment were conducted to accrue validity evidence for the IPAS: Exploratory Factor Analysis, Item Analysis, and analysis using Item Response Theory. Data was collected from 337 participants over three years. Separately, and cumulatively, the Exploratory Factor Analysis, Item Analysis and analysis using Item Response Theory identified issues with the content, response process, internal structure, and consequential validity of the IPAS. The outcomes of the present study call into question the use of the IPAS, and other measures, for the assessment of interprofessional attitudes. The present study contributes several pieces of evidence to the validity of the IPAS and the reevaluation of the use of attitude assessment in interprofessional education.

Longitudinal evaluation of attitudes to interprofessional collaboration: time for a change?

Longitudinal evaluation of interprofessional programming is necessary to understand the impact of interprofessional education (IPE) for collaborative practice. Attitude is one measure of intended behavior. The Interprofessional Attitude Scale (IPAS) was developed as an improved measure to examine the readiness for interprofessional education and collaborative practice. As a means to pilot a protocol for a longitudinal comprehensive evaluation of an interprofessional program with 13 health professional programs in 6 health science faculties, the IPAS was administered over a 3-year period to three cohorts of students. The results of the IPAS indicated no significant differences detected across the 3 years. Although there was a significant difference on the Patient Centredness subscale for Cohorts 2 and 3 the effect size was small. Previous experience in an interprofessional course was a predictor of more positive patient centeredness attitudes, but other IPE experience and years of education were not predictors of any interprofessional attitudes. Students from the Medicine & Dentistry (M&D) faculty ranked significantly lower on the teamwork roles and responsibilities subscale compared to the other faculties, except Rehabilitation Medicine (RM). However, once the outliers in RM were removed, there was a significant difference on this subscale between RM and M&D. This paper outlines the challenges with using the IPAS as part of a comprehensive program evaluation and identifies issues with longitudinal data collection for evaluation with large student cohorts.

A multi-method exploratory study of health professional students' experiences with compliance behaviours.

BACKGROUND: Research in healthcare, including students as participants, has begun to document experiences with negative compliance, specifically conformity and obedience. There is a growing body of experimental and survey literature, however, currently lacking is a direct measure of the frequency at which health professional students have negative experiences with conformity and obedience integrated with psychological factors, the outcomes of negative compliance, and students' perceptions. METHODS: To develop empirical knowledge about the frequency of negative compliance and student perceptions during health professional education a multi-methods survey approach was used. The survey was administered to health professional students across ten disciplines at four institutions. RESULTS: The results indicated students regularly experience obedience and conformity and are influenced by impression management and displacement of responsibility. Moral distress was identified as a consistent negative outcome. Student self-reported experiences aligned with the empirical findings. CONCLUSIONS: The findings of the present study demonstrate the pervasiveness of experiences with negative compliance during health professional's education along with some attendant psychological factors. The findings have educational and practical implications, as well as pointing to the need for further integration of social and cognitive psychology in explaining compliance in healthcare. The results are likely generalizable to a population level however replication is encouraged to better understand the true frequency of negative compliance at a health professional population level.

Taking the classroom to camp: The facilitators' role in creating an impactful interprofessional experiential learning opportunity.

A case study approach was used to describe faculty facilitators' perspectives on the creation and implementation of an interprofessional experiential learning opportunity for students at an aphasia camp. The facilitators serendipitously created an interprofessional experiential learning opportunity for speech-language pathology, occupational therapy, and physical therapy students volunteering at the aphasia camp. During focus groups several weeks after the camp, students discussed the interprofessional nature of their camp experiences and stated they had learned more about collaborative practice while volunteering at the aphasia camp than they had in any interprofessional course work, simulation experience, or clinically based fieldwork they had previously engaged in. The students spoke very highly of the facilitators' creation of the interprofessional experience. The interviewer, an interprofessional educator, wanted to know what the 'magic' was from the facilitators. Facilitators were asked to document their teaching philosophies and reflections and participate in a group interview. Three key themes emerged: educational philosophy, the environment, and facilitator characteristics. The facilitators created an environment where there was a balance between providing structure and clear expectations, with a flexible learning space where students could make mistakes yet feel supported. It was within this psychologically safe learning space that students had autonomy over many camp activities and opportunities to experiment and problem solve. The results from the study were compared to the characteristics of experiential learning. The article concludes with a summary of facilitators' characteristics that led to an impactful interprofessional experiential learning experience.

The Healthcare Environment: A Perfect Ecosystem for Growing Shame.

The expression "shame and blame" has often been used to describe the culture within healthcare when a mistake is made. There has been little exploration, however, on the shame healthcare professionals experience after a mistake. Based on an original grounded theory study on the psychological impact of mistakes on health professionals, this article explores why the healthcare environment is a perfect ecosystem for growing shame, how individuals are coping or not coping with the negative effects of this powerful emotion and what might be done at the system, organizational and team level to mitigate these negative effects.

Assessment of Resident Physicians' Communicator and Collaborator Competencies by Interprofessional Clinicians: A Mixed-Methods Study.

Phenomenon: As we move toward competency-based medical education, greater emphasis is being placed on assessing a more comprehensive skill set, including the ability to communicate and collaborate effectively in the workplace. Nonphysician members on interprofessional (IP) teams have valuable perspectives on actual resident performance and are often not adequately engaged in the provision of feedback to residents. Based on the educational theories of collaborative evaluation and social constructivism, this research examined the ability of IP clinicians to provide feedback to residents. The aim of this study was to examine IP clinicians' perceptions of their ability to provide formative feedback, through their observations and assessments of developmental pediatric residents, compared to physician supervisors on the rotation, and to qualitatively explore potential barriers to the feedback process from their perspective. APPROACH: This explanatory, sequential mixed-methods design study first examined which and how many of the CanMEDS Communicator and Collaborator training objectives (N = 40) were considered to be observable and assessable by IP clinicians and physicians. A comparison of the mean number of objectives that were observed and practically assessed by (a) each group (IP clinicians vs. physicians) and (b) clinical service teams during the core developmental pediatrics rotations, were examined using independent t tests. Second, a thematic qualitative analysis of focus groups was used to develop a contextual understanding of the factors that influenced this process. Data were analyzed using three levels of open coding and descriptive qualitative analysis techniques. FINDINGS: Physicians reported they could observe (M = 33.3, SD = 5.2, 83.3%) and assess (M = 31.5, SD = 7.3, 79%) a larger number of objectives compared to the IP clinician group (M = 24.7, SD = 8.6, 61.8% and M = 20.3, SD = 10.6, 51%, respectively). There were no differences between the clinical service teams (i.e., preschool/school-age and pediatric rehabilitation). The objective that was most observable and assessable by the IP clinicians was "Demonstrates a respectful attitude towards other colleagues and members of an interprofessional team." Four themes identified by the IP clinicians provided more in-depth qualitative information: (a) assessment requires more than simple observation, (b) assumptions and indirect observation influence assessment, (c) clinic culture and structure shapes observation and assessment, and (d) specific assessment criteria are required by IP clinicians. Insights: IP clinicians have the desire and ability to provide formative feedback to residents. Formalized processes with specific evaluation criteria would facilitate meaningful feedback from IP clinicians in the assessment of residents as they journey toward competence.

Launching first-year health sciences students into collaborative practice: Highlighting institutional enablers and barriers to success.

Developing and sustaining a comprehensive interprofessional education (IPE) curriculum infused throughout health science programmes at large post-secondary institutions requires not only champions within each program but also collaboration across professional programmes and strong support at an institutional level. The purpose of this article is twofold. First, it reports on the development of an interprofessional learning pathway, an institutional curricular model, and the pathway launch, an introductory learning experience within the context of a large post-secondary institution. The interprofessional curricular model provides a framework to connect the IPE that was previously fragmented across faculties and professional programmes into a scaffolded coherent pathway. The launch exposes students to the principles and competencies of collaborative practice. Second, it explores the dual role of enablers and barriers to IPE within the context of one institution's 20-year experience of developing and delivering. In examining the elements that have sustained the institution's IPE programming, it is highlighted how the seemingly positive elements (e.g., IPE champions and strong university support from central administration) have also served as hindrances within the academy potentially threatening the sustainability and institutionalisation of IPE. We anticipate that this curricular model and learning experiences will provide mechanisms to sustain and foster IPE.

Developing a culture of safety: Exploring students' perceptions of errors in an interprofessional setting.

Healthcare has a long tradition of silence around mistakes that cause or have the potential to cause harm to a patient, and there is evidence that this culture may be present from the beginning of a health professional's training. The purpose of this pilot study was to examine a team of interprofessional students' interactions with a preceptor in a simulation environment. The debriefing explored the students' reactions and assisted them with how to manage similar situations in the future to improve patient safety. The results showed that the students felt powerless to stop the simulated preceptor from doing harm to the patient, or to even question the preceptor's unsafe actions. Recommendations for educators include incorporating discussions and interprofessional training about handling mistakes into the curriculum, in the context of patient safety.

Interprofessional learning objectives for health team simulations.

Interprofessional health team simulations are often developed using learning objectives that relate to competency statements. Educators then assume these learning objectives are relevant to students participating in the simulation. However, evaluating the link between learning objectives and outcomes is often difficult in authentic simulation environments with multiple human factors. This article suggests one process for revising learning objectives based on review of the simulation, the debriefing, and the student feedback on reported learning. Implications for curriculum integration are discussed.

An inter-institutional collaboration: transforming education through interprofessional simulations.

An inter-institutional partnership of four post-secondary institutions and a health provider formed a learning community with the goal of developing, implementing and evaluating interprofessional learning experiences in simulation-based environments. The organization, education and educational research activities of the learning community align with the institutional and instructional reforms recommended by the Lancet Commission on Health Professional Education for the 21st century. This article provides an overview of the inter-institutional collaboration, including the interprofessional simulation learning experiences, instructor development activities and preliminary results from the evaluation.

Effect of teaching tools in spatial understanding in health science education: a systematic review.

Background: The concept of spatial orientation is integral to health education. Students studying to be healthcare professionals use their visual intelligence to develop 3D mental models from 2D images, like X-rays, MRI, and CT scans, which exerts a heavy cognitive load on them. Innovative teaching tools and technologies are being developed to improve students' learning experiences. However, the impact of these teaching modalities on spatial understanding is not often evaluated. This systematic review aims to investigate current literature to identify which teaching tools and techniques are intended to improve the 3D sense of students and how these tools impact learners' spatial understanding. Methods: The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were followed for the systematic review. Four databases were searched with multiple search terms. The articles were screened based on inclusion and exclusion criteria and assessed for quality. Results: Nineteen articles were eligible for our systematic review. Teaching tools focused on improving spatial concepts can be grouped into five categories. The review findings reveal that the experimental groups have performed equally well or significantly better in tests and tasks with access to the teaching tool than the control groups. Conclusion: Our review investigated the current literature to identify and categorize teaching tools shown to improve spatial understanding in healthcare professionals. The teaching tools identified in our review showed improvement in measured, and perceived spatial intelligence. However, a wide variation exists among the teaching tools and assessment techniques. We also identified knowledge gaps and future research opportunities.

Contexte: Le concept d'orientation spatiale fait partie intégrante de l'enseignement des professions de la santé. Les étudiants utilisent leur intelligence visuelle pour se représenter mentalement en 3D des images en 2D comme des radiographies, de l'IRM et des coupes tomodensitométriques, ce qui constitue une lourde charge cognitive. On développe actuellement des technologies et des outils pédagogiques innovants pour améliorer l'expérience d'apprentissage des étudiants. Cependant, l'impact de ces ressources pédagogiques sur la perception spatiale est rarement évalué. L'objectif de cette revue systématique de la littérature était de recenser les outils et techniques pédagogiques destinés à améliorer la perception 3D des apprenants et d'évaluer les effets de ces outils sur leur perception spatiale. Méthodes: Suivant les lignes directrices PRISMA, nous avons consulté quatre bases de données avec des termes de recherche multiples, analysé les articles recensés en fonction de critères d'inclusion et d'exclusion, et évalué leur qualité. Résultats: Dix-neuf articles correspondaient aux critères d'inclusion. Les outils pédagogiques axés sur l'amélioration de la perception spatiale peuvent être regroupés en cinq catégories. L'examen a révélé que les résultats obtenus par les groupes expérimentaux ayant utilisé l'outil pédagogique pour effectuer les tests et les tâches demandés sont aussi bons ou significativement meilleurs que les résultats obtenus par les groupes témoins. Conclusion: Notre revue de la littérature visant à recenser et catégoriser les outils pédagogiques disponibles a montré que ces derniers améliorent la perception spatiale, notamment l'intelligence spatiale mesurée et perçue, des professionnels de la santé. Toutefois, il existe une grande variation entre les divers outils pédagogiques et techniques d'évaluation. Nous avons également relevé des lacunes dans nos connaissances et des pistes de recherche future.

Empowering Patients With a Shared Communication Tool: A Patient-Oriented Multimethods Pilot Study.

Not all patients feel empowered to take on the expanding role as active members in their healthcare journey. Healthcare services must shift attention to supporting patients and families in this emerging role. This support includes providing communication tools designed for patients and families to empower them to speak up. Two Plan-Do-Study-Act (PDSA) cycles were conducted to test a communication tool, the Jargon Alert!/WAIT card, with patients/families and providers in a Canadian rehabilitation hospital. After the first PDSA cycle, feedback from patients/families (n = 24), and providers (n = 4), informed modifications. The new Question Alert! card was retested in the same clinics. Patients/families (n = 13) reported the new card was a valuable tool enabling them to ask questions, although not all patients or family members expressed the need to use the card. The participating providers (n = 4) thought the Question Alert! card was helpful for quieter patients or family members who normally shy away from asking questions. The shared communication tool designed with patients improved the patient-centered experience and empowered patients/families to be more involved in their care.

A cross-institutional examination of readiness for interprofessional learning.

This paper examines the readiness for and attitudes toward interprofessional (IP) education in students across four diverse educational institutions with different educational mandates. The four educational institutions (research-intensive university, baccalaureate, polytechnical institute and community college) partnered to develop, deliver and evaluate IP modules in simulation learning environments. As one of the first steps in planning, the Readiness for Interprofessional Learning Scale was delivered to 1530 students from across the institutions. A confirmatory factor analysis was used to expand upon previous work to examine psychometric properties of the instrument. An analysis of variance revealed significant differences among the institutions; however, a closer examination of the means demonstrated little variability. In an environment where collaboration and development of learning experiences across educational institutions is an expectation of the provincial government, an understanding of differences among a cohort of students is critical. This study reveals nonmeaningful significant differences, indicating different institutional educational mandates are unlikely to be an obstacle in the development of cross-institutional IP curricula.

Home care and technology: a case study.

Health care aides (HCAs) are the backbone of the home care system and provide a range of services to people who, for various reasons related to chronic conditions and aging, are not able to take care of themselves independently. The demand for HCA services will increase and the current HCA supply will likely not keep up with this increasing demand without fundamental changes in the current environment. Information and communication technology (ICT) can address some of the workflow challenges HCAs face. In this project, we conducted an ethnographic study to document and analyse HCAs' workflows and team interactions. Based on our findings, we designed an ICT tool suite, integrating easily available existing and newly developed (by our team) technologies to address these issues. Finally, we simulated the deployment of our technologies, to assess the potential impact of these technological solutions on the workflow and productivity of HCAs, their healthcare teams and client care.

Conformity, obedience, and the Better than Average Effect in health professional students.

Background: Compliance, through conformity and obedience to authority, can produce negative outcomes for patient safety, as well as education. To date, educational interventions for dealing with situations of compliance or positive deviance have shown variable results. Part of the challenge for education on compliance may result from disparities between learners' expectations about their potential for engaging in positive deviance and the actual likelihood of engaging in positive deviance. More specifically, students may demonstrate a Better Than Average Effect (BTAE), the tendency for people to believe they are comparatively better than the average across a wide range of behaviours and skills. Methods: Four vignettes were designed and piloted using cognitive interviews, to investigate the BTAE. Conformity and obedience to authority were each addressed with two vignettes. The vignettes were included in a survey distributed to Canadian health professional students across multiple programs at several different institutions during the Winter 2019 semester. Self-evaluation of behaviour was investigated using a one-sample proportion test. Demographic data were investigated using logistic regression to identify predictors of the BTAE. Results: Participants demonstrated the BTAE for expected behaviour compared to peers for situations of conformity and obedience to authority. Age, sex, and program year were identified as potential predictors for exhibiting the BTAE. Conclusions: This study demonstrated that health professional students expect that they will behave better than average in compliance scenarios. Health professional students are not exempt from this cognitive bias in self-assessment. The results have implications for education on compliance, positive deviance, and patient safety.

Contexte: La conformité, par le biais du respect des normes et de l'obéissance à l'autorité, peut avoir des effets négatifs tant pour la sécurité des patients que pour l'éducation des médecins. À ce jour, les interventions éducatives portant sur la conformité ou la déviance positive se sont soldées par des résultats mitigés. Une des difficultés auxquelles se heurte l'enseignement de la conformité provient de l'écart entre les attentes des apprenants quant à la possibilité d'appliquer la déviance positive et la probabilité qu'ils adoptent réellement ce comportement. Plus précisément, les étudiants peuvent faire preuve de supériorité illusoire, c'est-à-dire la tendance à se croire supérieur à la moyenne des gens par rapport à un éventail de comportements et d'habiletés. Méthodes: Quatre vignettes, deux sur la conformité et deux sur l'obéissance à l'autorité, ont été conçues et mises à l'essai dans le cadre d'entretiens cognitifs afin d'étudier la présence du phénomène de supériorité illusoire. Les vignettes faisaient partie d'une enquête menée auprès d'étudiants de différents programmes en sciences de la santé offerts par divers établissements canadiens au cours de la session d'hiver 2019. L'auto-évaluation du comportement a été examinée à l'aide d'un test de proportion pour échantillon unique. Les données démographiques ont été étudiées à l'aide d'une régression logistique pour identifier les prédicteurs de la supériorité illusoire. Résultats: L'effet de supériorité illusoire par rapport aux pairs était présent chez les participants en ce qui concerne le comportement qu'on attend d'eux dans des situations en lien avec la conformité et l'obéissance à l'autorité. L'âge, le sexe et l'année de formation ont été repérés comme prédicteurs potentiels de la manifestation de supériorité illusoire. Conclusions: Cette étude montre que les étudiants en sciences de la santé s'attendent à avoir un comportement supérieur à la moyenne dans les situations où la conformité est en jeu. Ils ne sont pas exempts de ce biais cognitif dans leur auto-évaluation. Les résultats obtenus ont des implications pour l'éducation en matière de conformité, de déviance positive et de sécurité des patients.

Learner Drawings of Interprofessional Education and Collaborative Practice: An Exploratory, Arts-Based Interview Study.

Interprofessional education and collaborative practice (IPECP) is a concept that supports the theory-to-practice transition of health professional students. Aligning with the global research priorities on building the science and scholarship through innovative evidence-informed strategies, the benefits of understanding stakeholder perspectives, notably learners, were considered an asset for this project. Informed by intergroup contact theory, this exploratory case study sought to gain insight into what perspectives and experiences rehabilitation medicine students encounter throughout their program that impacted their collaborative learning and practice experiences. The aim of this exploratory case study was to gain insight into learner perspectives in order to better inform how interprofessional education and practice is both taught and applied. The analysis of the drawings and interviews resulted in three themes: 1) Situate your client as an active member of the team; 2) Share professional perspectives across your team; and 3) Create team supports that are context specific. A thematic model using client engagement, team connectedness, and context-specific support was offered to describe how the emerging themes contribute to the socialization of health professionals within IPECP. In such a way, this study contributes to the body of literature by focusing on the student perspective. Additionally, it aims to contribute to methods used in interprofessional interview-based literature by using unique learner-driven drawings to elicit personal reflections of collaborative learning. The findings resulted in understanding the social impacts involving client engagement, team connectedness, and context-specific support.

Technology Acceptance and Usability of a Mobile App to Support the Workflow of Health Care Aides Who Provide Services to Older Adults: Pilot Mixed Methods Study.

BACKGROUND: Health care aides are unlicensed support personnel who provide direct care, personal assistance, and support to people with health conditions. The shortage of health care aides has been attributed to recruitment challenges, high turnover, an aging population, the COVID-19 pandemic, and low retention rates. Mobile apps are among the many information communication technologies that are paving the way for eHealth solutions to help address this workforce shortage by enhancing the workflow of health care aides. In collaboration with Clinisys EMR Inc, we developed a mobile app (Mobile Smart Care System [mSCS]) to support the workflow of health care aides who provide services to older adult residents of a long-term care facility. OBJECTIVE: The purpose of this study was to investigate the technology acceptance and usability of a mobile app in a real-world environment, while it is used by health care aides who provide services to older adults. METHODS: This pilot study used a mixed methods design: sequential mixed methods (QUANTITATIVE, qualitative). Our study included a pre- and post-paper-based questionnaire with no control group (QUAN). Toward the end of the study, 2 focus groups were conducted with a subsample of health care aides (qual, qualitative description design). Technology acceptance and usability questionnaires used a 5-point Likert scale ranging from disagree (1) to agree (5). The items included in the questionnaires were validated in earlier research as having high levels of internal consistency for the Unified Theory of Acceptance and Use of Technology constructs. A total of 60 health care aides who provided services to older adults as part of their routine caseloads used the mobile app for 1 month. Comparisons of the Unified Theory of Acceptance and Use of Technology constructs' summative scores at pretest and posttest were calculated using a paired t test (2-tailed). We used the partial least squares structural regression model to determine the factors influencing mobile app acceptance and usability for health care aides. The α level of significance for all tests was set at P≤.05 (2-tailed). RESULTS: We found that acceptance of the mSCS was high among health care aides, performance expectancy construct was the strongest predictor of intention to use the mSCS, intention to use the mSCS predicted usage behavior. The qualitative data support the quantitative findings and showed health care aides' strong belief that the mSCS was useful, portable, and reliable, although there were still opportunities for improvement, especially with regard to the mSCS user interface. CONCLUSIONS: Overall, these results support the assertion that mSCS technology acceptance and usability are high among health care aides. In other words, health care aides perceived that the mSCS assisted them in addressing their workflow issues.