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Definition of Interprofessional Education (IPE) from CAIPE

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Definition of Interprofessional Education (IPE) from CAIPE

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"Occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care." (Barr, 2002)

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Centre for the Advancement of Interprofessional Education

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Centre for the Advancement of Interprofessional Education

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CAIPE is a community of practice whose members are dedicated to a collaborative future. CAIPE works nationally and internationally to generate, synthesise and translate evidence for best practice in interprofessional education and collaborative practice.

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Interprofessional Education (IPE) involves learning alongside professionals from various healthcare disciplines. It's designed to foster collaboration and improve patient care outcomes.

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Sunitha Zechariah, 1, 2,* Benjamin E. Ansa, 1, 3,* Stephanie W. Johnson, 1, ⁴ Amy M. Gates, 1, ⁵ and Gianluca De Leo 1, ⁶

Abstract

Qualified and competent healthcare professionals working in a collaborative team environment is a prerequisite for high quality patient care. In order to be successful in the healthcare working environment, medical students need to be exposed to interprofessional learning early in their education. A single stage online survey was administered to medical students to evaluate their attitudes and perceptions of interprofessional education (IPE) and whether prior exposure to IPE increased their appreciation for interprofessional collaboration. The results suggest that irrespective of prior exposure to IPE, medical students appreciated the importance of interprofessional education and collaboration. Medical students showed a strong interest in attending interprofessional courses in other disciplines. Time constraints, scheduling conflicts, and communication emerged as barriers to IPE. Medical students embraced IPE and welcomed the opportunity to learn with other disciplines. Clinical case studies and simulations were identified as potential methods to integrate with other healthcare disciplines. The positive attitude and perceptions of the medical students toward interprofessional education and collaboration warrants the inclusion of related courses in medical curricula, as this may further increase students' potentials in becoming effective healthcare providers.

Keywords: interprofessional, education, collaboration, healthcare, medical students, attitudes, behaviors, perceptions

1. Introduction

Interprofessional Education (IPE), an essential pedagogical approach in healthcare education, is deemed crucial in equipping healthcare professionals to deliver safe, high quality, and optimal patient care [ 1]. IPE is the engagement of two or more healthcare professions in an integrated learning environment in an effort to foster collaboration and improve health [ 2]. IPE fosters interprofessional collaboration (IPC), which is often recognized for nurturing a collaborative team approach, resulting in an improved quality of patient care, decreased length of hospital stay, reduced costs of care, and fewer medical errors [ 3]. Additionally, a systematic review by Reeves et al. [ 4] showed improved patient outcomes, better clinical processes, and enhanced patient satisfaction when IPC is utilized.

IPC, on the other hand, is a process where multiple individuals from diverse backgrounds collaborate to deliver the best possible care to their patients [ 2]. Wheelan et al. [ 5] noted that improved healthcare outcomes for intensive care unit patients is dependent upon teamwork and collaboration among healthcare providers. The Committee on Quality Health Care in America [ 6] stated that providing opportunities for interdisciplinary training is vital for reinventing healthcare, with an increased focus on evidence-based practice. Asmirajanti et al. [ 7] reviewed clinical care pathways with IPC and found that while clinical care pathways need active engagement and collaboration to yield positive results from healthcare providers, the optimization of care needs to be implemented within the realm of a multidisciplinary team. To achieve such well-functioning, collaborative interprofessional teams, it is fundamental to expose students to interprofessional learning during their medical training [ 8]. Embedding a strong IPE foundation and interprofessional learning opportunities within healthcare education is therefore paramount, as has long been emphasized by the World Health Organization (WHO) [ 9, 10], specifically for medical students [ 11, 12, 13]. IPE is indispensable for medical students, as they typically assume the lead role in patient care when they commence their medical practice. This level of responsibility requires medical students to function with the necessary team and communication skills, along with a healthy respect for their fellow healthcare team members [ 14].

Although IPE is not a new concept in the medical profession, it has gained momentum recently, as the Association of American Medical Colleges (AAMC) and Institute of Medicine (IOM) have endorsed it to be an integral component of medical education, with the AAMC listing it as one of its strategic initiatives in medical training [ 15]. Harden [ 14] recommends introducing IPE in medical education early in the training. His review rationalizes that the early introduction of IPE will shape young minds and instill the appropriate attitude toward other healthcare professionals before any biases are developed. Despite the mounting needs for IPE in the medical curriculum, only 38% of surveyed medical schools within the United States offer it as part of their formal or informal curricula [ 16], demonstrating inadequacies in IPE provision and the training of medical students. One possible challenge encountered in incorporating IPE in medical and other health professions' educational curricula is the lack of structured competencies integrating various disciplines. The IPEC Expert Panel addressed this concern and developed four core interprofessional competencies, i.e., ethics, communication, roles and responsibilities, and teams/teamwork, to enhance collaboration among healthcare professionals in order to improve health outcomes [ 8].

The extent of IPE offered in medical education and the receptiveness of medical students to engage in interprofessional learning are well known to directly influence their eagerness to participate in IPC and assimilation [ 17]. A longitudinal study conducted at a private university in the United States explored student attitudes toward IPE [ 18]. This study surveyed medical, nursing, and physician assistant (PA) students in their first year of training and again in their third year. The results demonstrated that medical students had a less positive attitude toward IPE compared to nursing and PA students. Conversely, Ahmed and colleagues [ 19] report a high level of IPE readiness among their first year medical students at the National University of Singapore compared to their first year nursing, pharmacy, and dentistry students. The differences noted in these studies invoke the need to explore the perceptions of medical students. Hence, this study aimed to evaluate the attitudes and perceptions of a sample of medical students undergoing training in the United States toward IPE and IPC in healthcare teamwork and patient care.

2. Materials and Methods

2.1. Study Population

Study participants were recruited in partnership with the American Medical Student Association (AMSA) [ 20]. AMSA is a United States-based, independent membership organization consisting of medical and premedical students, interns, and residents. Only medical students trained within the United States and listed in the AMSA registry were included in this study.

2.2. Survey Design

A 34-item, single-stage survey was developed utilizing previously published instruments [ 21, 22, 23] along with survey questions created by the authors to tailor to medical students. Questions included empirical, Likert scale, and qualitative/open-ended questions. The survey was designed through the Qualtrics platform (Qualtrics, Provo, UT); it consisted of three sections: (1) Basic demographic information (age, gender, race, year of medical school), (2) attitudes and perceptions regarding interprofessional education and collaboration, and (3) qualitative/open-ended responses regarding barriers and opportunities for IPE.

In addition, the survey tested the medical students' general IPE knowledge. Using the WHO's definition of IPE [ 2], the participants were provided with an option to agree or disagree with the definition based on their knowledge level. Participants were then asked to rank the four core IPEC competencies (Ethics, Communication, Roles/Responsibilities, and Teams and Teamwork) in the order of importance, with 1 being the most important and 4 the least. Each ranking order could only be assigned once. To measure changes in understanding or opinion that may have developed as the survey progressed, the definitions for each of the four core IPEC competencies were provided at the end of the survey, and the students were asked to rank the competencies again in order to identify any changes in their views.

2.3. Data Collection

The anonymous survey link generated from Qualtrics was emailed electronically by AMSA to medical students receiving training in the United States, and included in AMSA membership database ( n = 7771). The survey remained available for 6 weeks from the initial email distribution. Unfortunately, AMSA was unable to send reminder emails during the study period.

2.4. Statistical Analysis

The statistical data analysis was conducted using SPSS version 25 (IBM SPSS, Inc., Armonk, NY, USA). Descriptive statistics were utilized to examine the medical students' current IPE exposure. Medical students who received IPE within their curriculum as a core component, as an elective, or both, were coded together and categorized as 'IPE received', while those who never received any form of IPE within their curriculum were categorized as 'No IPE received'. The frequency of responses to questions about attitudes and perceptions toward IPE coursework, IPC in patient care, and IPC toward healthcare team, were calculated. An independent samples t-test was performed to determine statistically significant differences between the means of attitudes and perceptions of medical students who received IPE and those who never received it within their program. Scores were assigned to each of the Likert Scale ratings with a range of '1' to '5'. "Strongly disagree" was scored as '1' and "strongly agree" was scored as '5'. Statistical significance was set at the level of p < 0.05. TagCrowd (San Francisco, CA, USA), an online application for creating word clouds, was used to visualize open-ended responses to questions regarding barriers and opportunities for IPE.

2.5. Ethical Considerations

The Institutional Review Board at Augusta University approved this study (IRB# 1151240-2).

3. Results

3.1. Demographics

A total of 98 medical students responded to the survey. Only surveys completed to their entirety ( n = 69) were included in the analyses. Table 1 shows the demographic distribution of the survey respondents.

Table 1

Variable

n = 69

%

Gender

Age in Years

Ethnic Background

Year in medical school

The majority of respondents were 20-29 years old ( n = 59, 85.5%), predominantly male ( n = 42, 61%), and white ( n = 48, 69.5%). A slightly higher percentage of respondents were year 3 medical students ( n = 22, 31.8%), followed by year 1 students ( n = 17, 24.6%), and an equal percentage of year 2 and year 4 medical students ( n = 15, 21.7%). A large number of respondents ( n = 52, 75.4%) reported receiving IPE infused within their curriculum as a core component, as an elective, or both. Almost one in every four subjects ( n = 17, 24.6%) indicated not receiving any form of IPE within their curriculum.

The total number of credit hours received varied among the medical students who had received IPE within their curriculum. Among these, 19 students (25.7%) received one credit; 9 (13%) received two credits; 10 (14.5%) received three credits, and 14 (20.3%) received four credit hours. Of those who were offered IPE, 31 students (44.9%) agreed that the amount of IPE offered in their curriculum promoted interprofessional collaboration and practice.

Among the medical students who received IPE, a majority ( n = 42, 80.7%) reported being engaged with nursing students compared to any other disciplines, including advanced practice nurses/nurse practitioners, dietitians/nutritionists, occupational therapists, pharmacists, physical therapists, physician assistant, respiratory therapists, social workers, and/or speech-language pathologists. The least engaged discipline reported was respiratory therapy ( n = 6, 11.5%).

Clinical simulation was found to be the preferred IPE method of learning ( n = 43, 82.7%) among the medical students who had received IPE, followed by informal clinical experience ( n = 36, 69.2%) when compared to other options including case studies, integrated classes, core and elective coursework, optional conferences, and training.

Of those who reported never receiving IPE, 16 students (94%) desired IPE to be part of their course curriculum, of which 10 (59%) preferred a core course while 6 (35%) preferred optional training. Clinical simulation was also the preferred method of IPE among those who had never received IPE ( n = 14, 82.3%), followed by multidisciplinary conferences as their second choice of learning method ( n = 11, 65%). Among the medical students who never received IPE, 7 (41.1%) favored a curriculum that included IPE four or more times to promote interprofessional collaboration and practice.

3.2. Attitudes

The attitudes of the medical students toward interprofessional education and collaboration was examined to detect any differences between having prior exposure to IPE within their medical curriculum compared to no previous exposure to IPE. Each of the individual items demonstrating their attitudes and perceptions toward IPE coursework, IPC in patient care, and IPC with a healthcare team is discussed in detail below and is presented in Table 2 a-c.

Table 2

( a)

Strongly Agree

Agree

Neither

Disagree

Strongly Disagree

n (%)

n (%)

n (%)

n (%)

n (%)

( b)

Strongly Agree

Agree

Neither

Disagree

Strongly Disagree

n (%)

n (%)

n (%)

n (%)

n (%)

( c)

Strongly Agree

Agree

Neither

Disagree

Strongly Disagree

n (%)

n (%)

n (%)

n (%)

n (%)

3.2.1. Attitudes Toward IPE Coursework

A majority of the medical students indicated a strong interest in attending IPE coursework with other disciplines ( n = 57, 82.6%, strongly agreed and agreed combined). There was strong consensus on attending the IPE coursework with nursing students, i.e., n = 61, 88.4% either agreed or strongly agreed, followed by allied health professionals ( n = 57, 82.6%), and nursing practitioners and physician assistants ( n = 53, 76.8%). About 77% ( n = 53) strongly agreed or agreed that medical students would benefit from working on group projects with students from other healthcare professions. Nearly 90% ( n = 62, 89.9%) of medical students agreed that IPE with other disciplines improves interprofessional communication. Similarly, 84% ( n = 58) agreed that integrated learning with students from other disciplines helps medical students to become effective healthcare team members. There was a high level of agreement ( n = 66, 95.7% strongly agreed and agreed) among the medical students that interprofessional learning would aid in understanding their own professional limitations. As expected, medical students strongly disagreed or disagreed ( n = 40, 52.1%) that clinical problem solving could only be learned effectively when taught within their individual department or school. However, a majority remained neutral or disagreed ( n = 54, 78.2%) that healthcare students require interprofessional learning to increase their ability in understanding clinical problems.

3.2.2. Attitudes Toward IPC in Patient Care

Exploring the IPC patient care attitudes of medical students who had prior exposure to IPE compared to those who never received IPE showed that the medical students strongly agreed ( n = 60, 87%, strongly agreed and agreed combined) that IPC increases the healthcare team's ability to understand clinical problems. Similarly, there was a high level of agreement that the interprofessional approach to patient care is more efficient, i.e., n = 58, 84.1% strongly agreed and agreed, and results in treating patients as a whole person ( n = 56, 81.2% strongly agreed and agreed). A strong agreement, almost reaching statistical significance ( p = 0.05), was evident for patients ultimately benefitting if healthcare professionals worked together to solve patient problems ( n = 66, 95.7%, strongly agreed and agreed). Equally, a solid level of agreement was seen for the 'give and take' among team members helping providers make better patient care decisions ( n = 60, 87%, strongly agreed and agreed). Strong agreement was also indicated for team members understanding the roles of other healthcare professionals when observations were exchanged as a multi-disciplinary team ( n = 64, 92.8%, strongly agreed and agreed). There were no statistically significant differences in attitudes toward IPC for patient care, irrespective of whether they had previous IPE exposure.

3.2.3. Attitudes Toward IPC with Healthcare Team

Analyzing the IPC healthcare team attitudes and perceptions of medical students who had prior exposure to IPE compared to those who had never received IPE revealed a statistically significant difference ( p = 0.003) in their belief that healthcare teams need to trust and respect each other for effective interprofessional collaboration ( n = 67, 97.1%, strongly agreed and agreed). There were no other statistically significant differences noted; however, positive agreements were displayed for all areas of IPC attitudes toward healthcare team. Medical students strongly agreed that IPC helps healthcare professionals to think positively about the healthcare team ( n = 57, 82.6%, strongly agreed and agreed). Equally strong agreement was seen with communication skills being critical for the healthcare team for improved patient outcomes ( n = 69, 95.7%, strongly agreed and agreed). Medical students also agreed that IPC allows healthcare professionals to understand their role limitations ( n = 63, 91.3%, strongly agreed and agreed) and that team meetings foster communication among members of different disciplines ( n = 63, 87%), strongly agreed and agreed). Responses for the question 'working in an interprofessional environment keeps health professionals enthusiastic and interested in their jobs' varied, with 60.9% agreeing ( n = 42) and 34.7% ( n = 24) disagreeing with this statement. Similarly, mixed responses were seen for 'working in an interprofessional manner requires additional time' ( n = 36, 52.2%, strongly agreed and agreed & n = 33, 47.8%, strongly disagreed and disagreed). Respondents also had a similarly varied responses for the statement 'for IPC to be effective, members of the healthcare team must work within their scope of practice' ( n = 49, 71%, strongly agreed and agreed, while n = 20, 29%, strongly disagreed and disagreed). A high level of agreement was noted with the hypothesis that training to work on interprofessional teams is critical to the future of medicine ( n = 60, 86.9%, strongly agreed and agreed).

Overall, using an independent t-test to examine the differences in the means between the group of medical students who had prior exposure to IPE compared to those with no exposure to IPE, demonstrated one statistically significant difference between their attitudes toward the notion that healthcare teams need to trust and respect each other for effective interprofessional collaboration. There were no other significant differences noted.

3.3. IPE Definition and Ranking of IPEC Competencies

An overwhelming majority of the medical students ( n = 68, 98.6%) agreed with the WHO's (2010) definition of IPE. Figure 1 shows the overall initial ranking and re-ranking of the importance of interprofessional education competencies. Responses are stacked as a bar graph, with each bar showing the total number of responses for each of the competencies. The initial ranking and reranking pattern of the competencies were similar, with communication being ranked as the competency of highest importance, and roles and responsibilities being ranked as the least important in both the initial ranking and re-ranking.

3.4. Interprofessional Barriers and Opportunities

A word cloud for IPE barriers is shown in Figure 2 a. The word size provides a visual representation of the frequency with which the word was repeated in the survey responses. Actual frequencies are indicated in parentheses adjacent to each word. Time constraints ( n = 15) emerged as the topmost barrier to IPE, followed by scheduling conflicts ( n = 7) and communication ( n = 7). Figure 2 b displays word clouds for IPE opportunities. IPE with clinical cases ( n = 12) was the top opportunity identified by the medical students, followed by simulation ( n = 4) and communication ( n = 4).

4. Discussion

Interprofessional education (IPE) has increasingly become the impetus behind interprofessional collaboration (IPC) in patient care. Early exposure of students to IPE is required for a positive attitude toward IPC [ 24]. The results of our study suggest that irrespective of prior exposure to IPE, medical students appreciated the importance of IPE and IPC. This finding is similar to the results reported by Sytsma et al. [ 25]. In our study, medical students held a firm belief that healthcare teams need to trust and respect each other for effective interprofessional collaboration. They also believed strongly that patients would ultimately benefit when healthcare professionals collaborate to solve patient problems. However, it was interesting to note that some medical students had no opinion on the notion that interprofessional learning enhances their ability to understand clinical problems. This was also evident when ranking the importance of IPEC competencies, where the medical students elected roles and responsibilities as the least important competency during both the initial ranking and re-ranking. This affirms the need for continual emphasis on the various roles performed by other professional disciplines and the necessity to value the unique expertise brought by these professionals in order to provide wholesome patient care.

A large number of medical students ranked communication as the most important IPEC competency in both their initial ranking and subsequent re-ranking. This ranking concurred with previous studies [ 22, 26]. However, a recent study found that communication was ranked as least important among the nutrition program directors [ 23]. This discrepancy could be due to differences in how students perceive communication when compared to the faculty. Further studies exploring the differences in perception between students and faculty could be valuable.

The majority of the medical students indicated a strong interest in attending IPE coursework with other disciplines, as has been previously suggested by other studies [ 25]. Among those who had had prior exposure to IPE, many reported being engaged with nursing students. This finding is similar to a previous study by Vernon et al. [ 22]. In contrast, medical students with IPE had the least engagement with respiratory students. This indicates that most interprofessional experience occurs between medical and nursing students, and least between medical and respiratory therapy students, prompting the need to explore opportunities to integrate medical students with all disciplines.

Time constraints, scheduling conflicts, and communication emerged as the top three barriers to IPE, as perceived by the medical students. The topmost learning method and opportunity in IPE was identified as clinical case studies, followed by simulation and communication. Similar barriers and opportunities have been previously reported [ 1, 27, 28].

Study Limitations

One of the limitations of our survey is the low response rate; this could be attributed to AMSA's inability to send survey reminders after the initial email. Consequently, the results may not be representative of the medical student population in the United States. Although the roles of IPC and IPE in the improvement of patient health outcomes and healthcare team environments have long been established, low sample sizes constitute a major limitation of many studies [ 29, 30, 31]. More effort by researchers is required in creating awareness of the importance of IPE and IPC among healthcare students and professionals, and utilizing innovative means of encouraging potential study participants to respond to study invitations.

Another study limitation may be self-selection bias, whereby students who value IPE were more likely to respond to the survey. In addition, the survey did not capture the locations of the medical schools, such as cities/states. Geographic locations may influence students' perceptions toward IPE and IPC, and thereby, threaten the generalizability of the presented results.

5. Conclusions

Medical practice increasingly relies on interprofessional collaboration to provide high quality patient-centered care. Thus, incorporating IPE early into the medical educational curricula would ensure that medical professionals entering the workforce are well equipped to work in collaborative teams. In general, medical students recognize the significance of interprofessional education and collaboration. Their positive attitude and perceptions toward interprofessional learning and collaboration unlock the potential for medical students to become competent, collaborative healthcare providers in the future.

Acknowledgments

The authors would like to acknowledge AMSA for their assistance in disseminating the survey to the medical students.

Author Contributions

Conceptualization, S.Z., B.E.A., S.W.J., A.M.G. and G.D.L.; methodology, S.Z., B.E.A., S.W.J., A.M.G.; formal analysis, S.Z., B.E.A., S.W.J.; investigation, S.Z., B.E.A., S.W.J., A.M.G.; data curation, S.Z., B.E.A., S.W.J., A.M.G.; writing-original draft preparation, S.Z., B.E.A., S.W.J.; writing-review and editing, S.Z., B.E.A., S.W.J., A.M.G., and G.D.L.; supervision, G.D.L.; project administration, S.Z., B.E.A., S.W.J., A.M.G. and G.D.L.

Funding

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

References

1. Buring S.M., Bhushan A., Broeseker A., Conway S., Duncan-Hewitt W., Hansen L., Westberg S. Interprofessional Education: Definitions, Student Competencies, and Guidelines for Implementation. Am. J. Pharm. Educ. 2009;73:59. doi: 10.5688/aj730459. [[ PMC free article] [ PubMed] [ CrossRef] Google Scholar]

2. World Health Organization (WHO) Framework for Action on Interprofessional Education & Collaborative Practice. WHO; Geneva, Switzerland: 2010. WHO/HRH/HPN/10.3. [ Google Scholar]

3. Institute of Medicine . Health Professions Education: A Bridge to Quality. National Academies Press; Washington, DC, USA: 2003. [[ PubMed] Google Scholar]

4. Reeves S., Perrier L., Goldman J., Freeth D., Zwarenstein M. Interprofessional education: Effects on professional practice and healthcare outcomes (update) Cochrane Database Syst. Rev. 2013 doi: 10.1002/14651858.CD002213.pub3. [[ PMC free article] [ PubMed] [ CrossRef] Google Scholar]

6. Institute of Medicine . Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy Press; Washington, DC, USA: 2001. [[ PubMed] Google Scholar]

8. Interprofessional Education Collaborative . Expert Panel Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. Interprofessional Education Collaborative; Washington, DC, USA: 2011. [ Google Scholar]

9. WHO Study Group on Multiprofessional Education of Health Personnel . Learning Together to Work Together for Health. Volume 769. WHO; Geneva, Switzerland: 1988. pp. 1-72. Report of a WHO Study Group on Multiprofessional Education of Health Personnel: The Team Approach. [[ PubMed] Google Scholar]

10. Chen L., Evans D., Evans T., Sadana R., Stilwell B., Travis P., Van Lerberghe W., Zurn P. Working Together for Health: The World Health Report 2006. World Health Organization; Geneva, Switzerland: 2006. [ Google Scholar]

20. American Medical Student Association (AMSA) [(accessed on 23 February 2018)]; Available online: www.amsa.org

30. Pinto A., Lee S., Lombardo S., Salama M., Ellis S., Kay T., Davies R., Landry M.D. The Impact of Structured Inter-professional Education on Health Care Professional Students' Perceptions of Collaboration in a Clinical Setting. Physiother. Can. 2012;64:145-156. doi: 10.3138/ptc.2010-52. [[ PMC free article] [ PubMed] [ CrossRef] Google Scholar]

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Interprofessional Education and Collaboration in Healthcare: An Exploratory Study of the Perspectives of Medical Students in the United States

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Qualified and competent healthcare professionals working in a collaborative team environment is a prerequisite for high quality patient care. In order to be successful in the healthcare working environment, medical students need to be exposed to interprofessional ...

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IPE enhances communication, teamwork, and holistic understanding of patient care. It prepares healthcare providers to work collaboratively, ensuring comprehensive care for patients.

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Abstract

Background

To ensure high quality patient care an effective interprofessional collaboration between healthcare professionals is required. Interprofessional education (IPE) has a positive impact on team work in daily health care practice. Nevertheless, there are various challenges for sustainable implementation of IPE. To identify enablers and barriers of IPE for medical and nursing students as well as to specify impacts of IPE for both professions, the 'Cooperative academical regional evidence-based Nursing Study in Mecklenburg-Western Pomerania' (Care-N Study M-V) was conducted. The aim is to explore, how IPE has to be designed and implemented in medical and nursing training programs to optimize students' impact for IPC.

Methods

A qualitative study was conducted using the Delphi method and included 25 experts. Experts were selected by following inclusion criteria: (a) ability to answer every research question, one question particularly competent, (b) interdisciplinarity, (c) sustainability and (d) status. They were purposely sampled. Recruitment was based on existing collaborations and a web based search.

Results

The experts find more enablers than barriers for IPE between medical and nursing students. Four primary arguments for IPE were mentioned: (1) development and promotion of interprofessional thinking and acting, (2) acquirement of shared knowledge, (3) promotion of beneficial information and knowledge exchange, and (4) promotion of mutual understanding. Major barriers of IPE are the coordination and harmonization of the curricula of the two professions. With respect to the effects of IPE for IPC, experts mentioned possible improvements on (a) patient level and (b) professional level. Experts expect an improved patient-centered care based on better mutual understanding and coordinated cooperation in interprofessional health care teams. To sustainably implement IPE for medical and nursing students, IPE needs endorsement by both, medical and nursing faculties.

Conclusion

In conclusion, IPE promotes interprofessional cooperation between the medical and the nursing profession. Skills in interprofessional communication and roles understanding will be primary preconditions to improve collaborative patient-centered care. The impact of IPE for patients and caregivers as well as for both professions now needs to be more specifically analysed in prospective intervention studies.

Keywords: Interprofessional education, Education research, Education, medical, graduate, Education, nursing, Qualitative research

Background

A changing health care system with increasingly complex health needs of patients require innovative and efficient concepts of patient care. These concepts require key competencies, such as effective communication, teamwork and interprofessional collaboration between healthcare professionals [ 1, 2]. Interprofessional education (IPE), whereby students from several healthcare professions learn and work together [ 3, 4], has shown a positive impact on team work in daily health care practice [ 5] and is recommended for training programs of healthcare professionals [ 6- 8]. Several advantages of IPE have been reported: (a) increased mutual respect and trust [ 9, 10], (b) improved understanding of professional roles and responsibilities [ 10- 13], (c) effective communication [ 1, 7], (d) increased job satisfaction [ 11, 13, 14], and (e) positive impact on patient outcomes (e.g. decreased patient's length of hospital stay and a reduced number of medical errors) [ 8, 15, 16]. Previous studies have proven that students trained in an IPE approach have better interprofessional collaborative practice competencies compared to students without an IPE-training [ 8, 15, 17]. This can be attributed to students' more positive attitudes towards each other, a better understanding about each other's competencies, the ability to share knowledge and skills, and improved team identity [ 10, 13, 17]. Nevertheless, there are various challenges for sustainable implementation of IPE including (a) non-coordinated and strictly separate curricula of different health care professions, (b) an insufficient number of specifically qualified teaching staff and (c) limited financial resources of the institutions [ 9, 12, 18, 19]. As a result, most existing IPE courses are optional and only a few of them are sustainably implemented in the curricula of the health care professionals involved.

In Germany, IPE and research on the impact for interprofessional collaboration (IPC) in routine care is still in its iunfancy. First IPE activities concerned interprofessional communication in hospitals [ 20], interprofessional seminars in ethics [ 21], and interprofessional emergency management [ 22]. To support a sustainable implementation of IPE the GMA Committee - 'Interprofessional Education for the Health Care Professions' was founded in 2011. In its position statement, the committee developed recommendations to integrate interprofessional approaches into education for health professions and required continuous evaluation regarding outcomes of IPE [ 23]. In addition, the Advisory Council on the Assessment of Developments in the Health Care System emphasize in its report "Cooperation and Responsibility" in 2007 positive effects of IPE for IPC including a better mutual understanding and the acquisition of cooperative skills for all professions involved [ 24]. A better interaction between the different health care professions is a further positive effect that the GMA Committee stated [ 23].

To specify the impacts of IPE for medical and nursing students and to identify enablers and barriers of IPE, the Cooperative academical regional evidence-based Nursing Study in Mecklenburg-Western Pomerania (Care-N Study M-V) was conducted. A starting point of the study was the development of an academic nursing program [ 25]. The study evaluated (1) IPE acceptance between medical and nursing students, and four further research dimensions: (2) further development of academic nursing training, (3) identification of the task fields for graduates with bachelor degrees or master degrees in nursing, (4) specification of learning contents for academic bachelor and master training programs and (5) implications for health politics. The research dimensions comprised 25 research questions. A detailed study design and selected preliminary results were published elsewhere [ 25, 26].

Research dimension (1) IPE between medical and nursing students addressed the following research questions: (a) what are the enablers and barriers of IPE for nursing and medical students? (b) what are the expectations for the future impact of IPC between both professions?. The aim of the investigation is to explore, how IPE should be designed and implemented in medical and nursing training programs to optimize students' impact for IPC in routine care.

Methods

Design

The present analyses are based on data derived from the Care-N Study M-V, which was a qualitative study using the Delphi method (type: aggregation of ideas) and consisted of two qualitative semi-structured mailed questionnaires, and a group discussion. The details of the study have been described elsewhere [ 25].

Participants

To guide recruitment of experts for the study, inclusion criteria based on Häder 2009 were defined: (a) each expert is able to answer every research question, one question particularly competent, (b) interdisciplinarity, (c) sustainability and (d) status [ 27]. To be able to cover a wide range of ideas several disciplines were involved (interdisciplinarity). The sustainable implementation of the study results was supported by experts from different stakeholders associations and politics (sustainability) [ 28]. It was expected that expert answers will depend on their hierarchy level. Thereby, it could not readily assume that experts in higher positions have all the necessary expertise [ 29]. Therefore, experts representing various hierarchy levels were included (status of the person).

Participants were purposely sampled. Recruitment was based on existing collaborations and a web based search. A fixed order for enquiry of experts was defined. When a 'first' requested expert declined to participate, the 'second' expert from the respective list was contacted. This process was repeated until for every research question an adequate expert could be recruited. The first contact was made by telephone: the study was described and the interest for participation was solicited. When the feedback was positive, experts received written study information detailing study aims, methods, data management and a written informed consent. When the written informed consent was completed, signed, and returned to the study center, experts were enrolled in the Care-N Study M-V [ 25].

Nine experts rejected their participation. Reasons for non-participation provided included: (a) lack of time, (b) stay abroad during the data collection phase of the study, and too short-term request. Over the course of the study none of the experts dropped out.

Overall, 25 experts were enrolled in the Care-N Study M-V. Each expert was categorized to one of following six professional areas: (1) Science, (2) Practitioner from the Professional Fields of Nursing and Medicine, (3) Education and Training, (4) Health Care Provision, (5) Politicians, Associations, Organizations and (6) Health Insurance (see Fig. 1 ).

Experts were invited to participated in all data collection rounds and to answer all questions. They decide by themselves, in which data collection round they want to participate and which questions they answer. The distribution was: (a) first qualitative mailed questionnaire n = 13, (b) second qualitative mailed questionnaire n = 14 and (c) group discussion n  = 9). At least, each expert was involved in one of the three data collection rounds. Most of them participate in two of the three data collection rounds. Detailed description can be found by Dreier et al. 2016, doi: 10.1016/j.zefq.2016.03.003.

The majority of experts were female ( n = 16). Of them, 13 experts (52%) participated in the first mailed questionnaire, 14 (56%) in the second and nine (36%) in the focus group discussion. All 25 respondents participated at least in one of the three data collections [ 25].

Data collection

The three data collection rounds were conducted in intervals of 3 months between June 2013 and April 2014. The first qualitative mailed questionnaire consisted of 25 semi-structured research questions. Its completion took 30-50 min. Of this, five research questions addressed IPE. Results of the first qualitative semi-structured interviews with 13 experts were sent to all experts as a written summary. This summary is a key feature of a Delphi method [ 27]. And was the basis for the second mailed questionnaire with 14 experts, which consisted of 17 semi-structured research questions (two of those specifically addressing IPE) of the overall 25 research questions. Experts completed and specified their answers based on the results of the first semi-structured mailed questionnaire. The completion took 20-35 min. A written summary with the results were sent to all experts by mail. Results were the basis for the group discussion to clarify specific aspects of both semi-structured questionnaires.

The focus group discussion was conducted with nine experts and comprised five semi-structured research questions. It took approximately 3 h. One team member was the interviewer. The focus group discussion took place in the study center of the Institute for Community Medicine, University Medicine Greifswald, Mecklenburg-Western Pomerania, Germany. All experts received the results as a written summary by mail. Data saturation was evident in the way that no new information was forthcoming during the focus group interviews for the 20 of overall 25 research questions.

The survey instrument for the two semi-structured questionnaires was digitized using TeleForm® (Electric Paper Information Systems GmbH Lüneburg Germany, version 10.2). The completed questionnaires were scanned and verified in TeleForm®. For analysis, the data were documented in a word-data base and transferred to the software MAXQDA, Version 10 (VERBI GmbH, Berlin). The focus group discussion was audio recorded and transcribed with the f4transkript software (dr. dresing & pehl GmbH, Marburg).

Data analysis

To analyze both qualitative semi-structured interviews and the group discussion, a qualitative content analysis as suggested by Kuckartz et al. [ 30, 31] using the software MAXQDA was conducted. Analysis steps were: (1) Initiating textual work (highlight important text passages, writing memos), (2) development of thematic major categories, (3) coding of the questionnaires and group discussion transcripts by the thematic major categories, (4) assort text passage with the same thematic major categories, (5) inductive development of sub-categories based on the questionnaires and group discussion, (6) coding of the complete text material by the differentiated category system (with thematic major categories and sub-categories) and (7) category based analysis and result presentation. This analysis structures qualitative data into an order and by frequencies [ 30].

Two study team members (SH, ADW) coded the interviews and the group discussion according to the consensual coding approach [ 30]. First, both team members coded separately. Subsequently, both resulting category systems were compared for similarities and differences. In case of differences, the codes were discussed and modified if both coders agreed. This process caused an extension of the category system. Finally, a system with categories, sub-categories and codes based on the code systems of both coders was developed [ 25].

Results

Enablers and barriers for IPE

Experts stated more enablers then barriers for IPE for medical and nursing students (see Table 1 ). Overall, four primary arguments for IPE in medical and nursing training programs were mentioned: (1) development and promotion of interprofessional thinking and acting (2) acquirement of shared knowledge, (3) promotion of beneficial information and knowledge exchange, and (4) promotion of mutual understanding.

Table 1

Enablers

Development and promotion of interprofessional thinking and acting
patient centered care
Acquisition of shared knowledge
Promotion of information and knowledge exchange
Promotion of mutual understanding
mutual acceptance
respect for each other
reduction of hierarchies
Prerequisites for successful IPC
specific skills and knowledge
communication
specific roles and tasks of medical and nursing profession
ability to put oneself in the other profession's perspective

Barriers

Standardization of learning content levels
Different levels of knowledge
Chronological harmonization of medical and nursing curricula
Organization of IPE lectures
personal resources
time resources
financial resources
Low mutual respect between medical and nursing students and resulting limited willingness for IPE
Low appreciation of medical students towards nursing students
Capacity-legal issues a

'Interprofessional education for medicine and nursing students promotes the recognition and understanding of interdisciplinary correlations, the competence for interprofessional acting [...] and the clinical expertise.' (FB_1114: 137-137).

One argument for IPE '[...] is the mutual benefit to investigate themes from medical's and nursing's perspectives.' (FB_1119: 88-88).

According to experts' opinions a mutual understanding particularly supports the acceptance and respect for each other in caring for patients in daily work. The reduction of hierarchies is an additional positive side effect.

IPE '[...] improves the acceptance and thus the mutual understanding of both professions.' (FB_1113: 59-59).

'Interprofessional education can dismantle hierarchies between both professions.' (FB_1115: 92-92).

To further develop IPC, experts mentioned three main skills or competences, which need to be taught by IPE for medical and nursing students: (1) interprofessional communication, (2) profession specific roles and tasks as well as (3) put oneself in the other profession's perspective. In consequence, experts concluded that these are the main preconditions for improving IPC in the long run to address the overall aim of optimization of needs-oriented and patient centered care.

'IPE promotes skills and competences to work effectively in an interprofessional team. Improved communication enhances coordinated interprofessional collaborative practice.' (FB_1115: 92-92).

'The recognition and understanding of interdisciplinary relation help to identify threatening or current health problems.' (FB_1114: 137-137).

Hence, for any broader rollout of IPE, various barriers must be overcome (see Table 1 ).

The experts emphasized (1) standardization of learning content levels, (2) different levels of knowledge and (3) the chronological harmonization of medical and nursing curricula as the major challenges of IPE.

'The different levels of knowledge should be noted, training programs have to be synchronized.' (FB_1115: 95).

'Width and depth of the medical knowledge differ from the nursing knowledge.' (FB_1112: 66).

Furthermore, implementing IPE for all students in medical and nursing curricula may cause capacity-legal challenges.

IPE '[...] leads to capacity-legal problems, because of the restricted acceptance of medical students at medical faculties.' (FB_1115: 95-95).

This also includes the organization of IPE lectures, which requires personnel, time and financial resources. To overcome existing challenges of IPE for medical and nursing students, experts stated, that the willingness of both students groups and the mutual respect are the most important prerequisites for successful implementation.

'The feasibility of IPE is associated with a high effort which needs essential personal, time and financial resources.' (FB_2114: 51).

Expectations for future IPC in routine care

Judging the effects of IPE for medical and nursing students for future IPC to experts differentiated the (a) patient level and (b) professional level (see Fig. 2 ).

On the patients' level, experts mentioned possible improvements in following areas: (a) collaborative treatment planning (b) coordinated treatment and implementing individualized health care interventions, (c) collaborative development of innovative treatment measures, (d) improved communication and enhanced cooperation during the care process, and (d) continuous interprofessional information and knowledge exchange to be able to adapt a care plan quickly when necessary.

'I expect an improved collaborative treatment planning as well as an enhanced integrated care of patients.' (FB_1111: 73-73)

'[...] the shared development and implementation of new concepts of patient care.' (FB_1101: 122)

'[...] an improved competence to work as a team in the daily health care practice in consideration of patients' interest.' (FB_1119: 107-107)

Based on this further development of IPC, experts expect changes on the professional level including (a) reduction of stereotypes, (b) improvement of mutual attitude toward the medical and the nursing profession and, (c) mutual appreciation by understanding of roles (see Fig. 2 ).

'I expect a reduction of stereotyped behaviors' as well as improved confidence and understanding in working with the other professional group.' (FB_1103: 89-89)

'Everybody has an improved understanding of professional responsibilities of all team members.' (FB_1101: 121)

This might also enhance motivation for practical work in both professions as well as increase job attractiveness especially for the nursing profession (see Fig. 2 ).

'[...] increase of motivation for the practical work.' (FB_1103: 89)

'[...] improvement of job attractiveness for the nursing profession.' (FB_1115: 115)

In consequence, experts assume an optimization of patient centered care by coordinated collaboration, which results in an enhancement to patient safety (see Fig. 2 ).

'I expect a coordinated procedure of both professions in patient care as well as the development of new cooperation models.' (FB_1114: 165-165)

'[...] patient safety will be improved' (FB_1101: 120-122)

Implications for sustainable implementation of IPE in medical and nursing curricula

To achieve possible positive effects on IPC, a sustainable implementation of IPE in the education of medical and nursing students is required. Experts stated four primary influencing factors, which need to be considered: (a) the commitment of medical and nursing faculties for IPE, (b) the necessity to synchronize currently existing medical and nursing curricula with respect to comparable learning content deepness and learning aims, (c) the qualification of lecturers to adequately prepare them for teaching in an IPE approach and, (d) prioritize IPE learning contents with regard to the added value for patients and their caregivers of interprofessional collaborative practice (see Fig. 3 ).

' The implementation of IPE depends on overcome of different structural factors of the both educational institutions (vocational schools vs. medical faculties of universities).' (Fragebögen\FB_2103: 45 - 46)

'Different designs of both training programs - with different depths and scopes of individual fields - are taken into account.' (FB_2115: 40-40)

'It could be critical if lectures are not adequately prepared for interprofessional teaching.' (FB_2103: 49-49)

The experts point out, that it is necessary to comprehensively define IPE themes for both professions followed by the identification of learning aims, the determination of the optimum number of participants depending on IPE theme and teaching format as well as to define the optimal time schedule to implement IPE lectures into both training programs (Fig. 3 ).

'A possible disadvantage arises when curricular decisions and reforms include needs and targets for only one (and not for both) professional group(s).' (FB_1104: 100-100)

It should be asked at which interfaces the mutual understanding and the collaborative practice will provide the best possible health benefit to patients. Here interprofessional education should take place. It is important to learn in competence-focused (not fact-focused) useful learning settings. (FB_2119: 29-29)

Discussion

The Care-N study M-V aimed to identify enablers, barriers for and impact of IPE on future IPC for the medical and the nursing profession. Overall, the experts surveyed mentioned more enablers then barriers for IPE. Expected impacts for future IPC were stated on patient and professional level to make a contribution toward optimizing coordinated patient centered care and to enhance patient safety in the future.

The results showed that IPE for medical and nursing students can encourage positive mutual attitudes, better understanding of professional roles in caring for patients and their caregivers as well as improved information and knowledge exchange to cooperate during their daily practical work. Previous studies reported similar results and emphasized that students ' improved attitude towards teamwork increased mutual respect and understanding between different groups of health care professionals [ 10, 32]. Furthermore, IPE provides opportunities to develop interprofessional communication skills [ 33, 34], and to exercise how to cooperate in an interprofessional team [ 7]. The acquirement of profession-specific roles during patient treatment is one of the primary enablers of IPE in the Care-N Study. This result agrees with findings of previous studies showing that IPE prepares students to better understand their own professional identity as well as their roles and perspectives on patients and their caregivers [ 19, 35, 36].

Furthermore, IPE enables students to learn and exercise interprofessional communication. By improving knowledge about their own roles and responsibilities as well as the roles of the other profession an improvement for interprofessional team working can be expected [ 36, 37]. Finch stated that students can also be better prepared for performing roles traditionally taken over by the other profession [ 38]. Due to the fact, that tasks and roles of medical and nursing professionals increasingly overlap [ 39], and both healthcare professions have expanded their roles and responsibilities [ 40]. IPE might provide the opportunity to better prepare students to taking over the future extended roles and responsibilities already during their training programs.

The Care-N Study M-V experts identify several barriers against a sustainable implementation of IPE in the medical and nursing curricula. These include difficulties in coordinating the two programs. This finding is consistent with previous studies, which showed that program structures and timetables of both curricula are quite different. This has been reinforced by different regulations for professional training programs and the fact that the programs are offered by different providers (university, university of applied science, vocational school, public and private sector etc.) [ 8, 12, 18, 23].

Nevertheless, from the experts' points of view there are various positive impacts for IPC on patient level in the future including an improved patient-centered care and improved coordinated cooperation in interprofessional health care teams. Previous studies showing that an effective cooperation between nursing and medical professionals improves efficiency and quality of patient care as well as patient safety and patient satisfaction. The University of Colorado integrated patient safety into medical and nursing school curricula and tested models for interprofessional student involvement in clinical improvement [ 41]. As a result medical and nursing students improved the efficiency of discharge processes, safety of patient transfers from intensive care, and care for bedsores [ 41]. In their evaluation of an interprofessional student clinical program, Lawrence et al. could show that patients reported high levels of satisfaction with the patient care team and the facility quality [ 42]. In particular results of the items students 'listen to you', 'take enough time with you', 'explain what you want to know', 'answer your questions' described high levels of patient satisfaction [ 42].

To achieve these positive impacts for IPC, IPE must be widely implemented in both professions' curricula. One important precondition is, that existing curricula need to be opened and revised for this learning approach. Experts of the Care-N Study stated that IPE should focus on collaborative care to maximize the value for both patients and caregivers. Liang et al. examined outcomes of Neighborhood Health Screening (NHS), an in-home service provided by medical and nursing undergraduate students for 355 patients in a low-income neighborhood [ 43]. Overall, 240 medical and 34 nursing students were involved in management of chronic diseases, particularly hypertension. NHS had a positive impact on hypertension management. Demonstrably the rates of treatment for blood pressure (63 to 93%) and control of blood pressure (27 to 73%) could be improved already over 1 year [ 43].

The Care-N Study M-V has several limitations. First, the use of purposive sampling can be highly prone to selection bias. The definition of clear inclusion criteria should antagonize this potential bias. Second, the purposive sampling focuses on particular characteristics of an expert population enabling them to best answer the research questions. Thus, generalization to the whole population is limited.

Conclusion

The Care-N Study M-V describes enablers, barriers and impact of IPE for medical and nursing students. IPE promotes interprofessional cooperation between both professions and enhance mutual respect and understanding. For future IPC in routine care it can be expected that skills in interprofessional communication and roles understanding will be primary preconditions to improve collaborative patient-centered care. A sustainable implementation of IPE programs faces various barriers, including the coordination of IPE with the medical and nursing core curricula. In consequence, it is necessary to specify overlapping tasks fields to comprehensively identify IPE themes for both professions. Furthermore, the actual impact on patients health and on caregiver burden as well as on the development of both professions need to be studied in controlled prospective designs in the future.

Acknowledgements

The authors acknowledge the support of the nursing board of the University Medicine Greifswald, who enabled the Care-N Study M-V. Furthermore special thanks to the participating experts who have provided the grounds to the success of the study.

Funding

This study was funded by the nursing board of the University Medicine Greifswald (Director: P. Hingst). PH was involved in data interpretation and critical review of the manuscript. SH received full financial support for her time as a Research Assistant from nursing board.

Availability of data and materials

The dataset supporting the conclusions of this article is available by the corresponding author [Adina Dreier-Wolfgramm], adina.dreier@uni-greifswald.de.

Abbrevations

Care-N Study M-V

Cooperative academical regional evidence-based Nursing Study in Mecklenburg-Western Pomerania

GMA

Society for Medical Education (Gesellschaft für Medizinische Ausbildung)

IPC

Interprofessional collaboration

IPE

Interprofessional education

NHS

Neighborhood health screening

WHO

World Health Organization

Authors' contributions

SH made substantial contributions to the data collection, data management, data analysis, data interpretation and drafting the manuscript. WH developed the study design, made substantial contribution in data interpretation and critically reviewed the manuscript. RFO and PH were involved in data interpretation and critical review of the manuscript. ADW as the PI of the study developed the study design and made substantial contributions to recruitment of experts, data collection, data analysis, data interpretation and critical review of the manuscript. All authors read and approved the final manuscript.

Notes

Ethics approval and consent to participate

Ethical approval was obtained for the study from the Ethic Committee of the University Medicine Greifswald (reference number: BB 004/14). Written informed consent was obtained from enrolled participants.

Consent for publication

Not Applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Sabine Homeyer, Email: moc.liamg@57reyemoh.enibas.

Wolfgang Hoffmann, Email: ed.dlawsfierg-inu@nnamffoh.gnagflow.

Peter Hingst, Email: ed.dlawsfierg-inu@ptsgnih.

Roman F. Oppermann, Email: ed.bn-sh@nnamreppo.

Adina Dreier-Wolfgramm, Phone: +49 (0) 3834 86 7741, Email: ed.dlawsfierg-inu@reierd.anida.

References

3. World Health Organization. Framework for action on interprofessional education & collaborative practice, vol. 64. Switzerland; 2010. p. 64.

5. Speakman E, Sicks S. Nursing in the 21st century: find opportunities to practice in Interprofessional healthcare teams. Imprint. 2015;63:35-37. [[ PubMed] Google Scholar]

6. Wagner J, Liston B, Miller J. Developing interprofessional communication skills. Teach Learn Nurs. 2011;6:97-101. doi: 10.1016/j.teln.2010.12.003. [[ CrossRef] Google Scholar]

7. Institute of Medicine Committee on the Health Professions Education Summit: Health professions education: a bridge to quality. In Health professions education: a bridge to quality. Edited by Greiner AC, Knebel E. Washington (DC): National Academies Press (US); 2003: 192. [ PubMed]

8. Buring SM, Bhushan A, Broeseker A, Conway S, Duncan-Hewitt W, Hansen L, Westberg S. Interprofessional education: definitions, student competencies, and guidelines for implementation. Am J Pharm Educ. 2009;73:59. doi: 10.5688/aj730459. [[ PMC free article] [ PubMed] [ CrossRef] Google Scholar]

12. Sottas B. Learning outcomes for health professions: the concept of the swiss competencies framework. GMS Z Med Ausbild. 2011;28:Doc11. [[ PMC free article] [ PubMed] Google Scholar]

14. Lindeke LL, Sieckert AM. Nurse-physician workplace collaboration. Online J Issues Nurs. 2005;10:5. [[ PubMed] Google Scholar]

18. Nisbet G, Lee A, Kumar K, Thistlethwaite J, Dunston R: Interprofessional health education - a literature review: overview of international and Australian developments in interprofessional health education (IPE). pp. 43. San Francisco: Centre for Research in Learning and Change, University of Technology, Sydney; 2011:43.

21. Neitzke G. Interprofessional education in clinical ethics. GMS Z Med Ausbild. 2005;22(2):Doc24. [ Google Scholar]

22. Quandt M, Schmidt A, Segarra L, Beetz-Leipold C, Degirmenci Ü, Kornhuber J, Weih M. Teamwork elective: results of a German pilot project on interprofessional and interdisciplinary education with formative team OSCE. GMS Z Med Ausbild. 2010;27(4):Doc60. [ Google Scholar]

23. Walkenhorst U, Mahler C, Aistleithner R, Hahn EG, Kaap-Frohlich S, Karstens S, Reiber K, Stock-Schroer B, Sottas B. Position statement GMA committee-"Interprofessional education for the health care professions" GMS Z Med Ausbild. 2015;32:Doc22. [[ PMC free article] [ PubMed] Google Scholar]

24. Advisoray Council on the Assessment of Developments in the Health Care System Cooperation. Cooperation and responsibility. Prerequisites for target-oriented health care. Report for 2007 (abridged version). Bonn: Advisoray Council on the Assessment of Development in the Health Care System Cooperation; 2007. p. 102.

32. Reeves S, Zwarenstein M, Goldman J, Barr H, Freeth D, Hammick M, Koppel I. Interprofessional education: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2008;23(1):Cd002213. [ PubMed]

37. Inuwa IM. Interprofessional education (IPE) activity amongst health sciences students at Sultan Qaboos University: the time is now! Sultan Qaboos Univ Med J. 2012;12:435-441. doi: 10.12816/0003168. [[ PMC free article] [ PubMed] [ CrossRef] Google Scholar]

Articles from BMC Nursing are provided here courtesy of BMC

# data[].attributes.attachment_link.title
Effects of interprofessional education for medical and nursing students: enablers, barriers and expectations for optimizing future interprofessional collaboration - a qualitative study

# data[].attributes.attachment_link.description
To ensure high quality patient care an effective interprofessional collaboration between healthcare professionals is required. Interprofessional education (IPE) has a positive impact on team work in daily health care practice. Nevertheless, there are ...

# data[].attributes.body
Core competencies include values/ethics for interprofessional practice, roles and responsibilities, interprofessional communication, and teams/teamwork.

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The IPEC core competencies were first adopted in 2011 and updated in 2016. In the years since the original document's release and update, the IPEC core competencies have been widely disseminated throughout the health professions and embedded into both curriculum and accreditation standards.
IPEC Core Competencies for Interprofessional Collaborative Practice Revision, 2021-2023
In May 2021, IPEC announced plans to begin a formal process to review and revise the 2016 IPEC Core Competencies. Key drivers for the 2021-2023 revision include the need to empower the IPE community with the best available evidence and research related to IPE and CP; conduct a cyclical review on common definitions for competence, competency and competency framework; and ensure that this framework accurately reflects any changes in research, policy, and practice.

A preliminary draft of proposed 2023 revisions to the IPEC Core Competencies for Interprofessional Collaborative Practice: 2016 Update is now available for open comment.

Download the materials below.

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IPEC Core Competencies for Interprofessional Collaborative Practice: 2016 Update
This 2016 update reflects the changes that have occurred in the health system since the release of the original report, two of the most significant of which are the increased focus on the Triple Aim (improving the experience of care, improving the health of populations, and reducing the per capita cost of health care) and implementation of the Patient Protection and Affordable Care Act in 2010.
IPEC Core Competencies for Interprofessional Collaborative Practice: 2011 Original
This report is inspired by a vision of interprofessional collaborative practice as key to the safe, high quality, accessible, patient-centered care desired by all. The intent was to build on each profession's expected disciplinary competencies in defining competencies for interprofessional collaborative practice. The IPEC panel identified four core competency domains: 1) values and ethics; 2) roles and responsibilities for collaborative practice; 3) interprofessional communication; and 4) teamwork and team-based care.
Team-Based Competencies, Building a Shared Foundation for Education and Clinical Practice
This summary document is based on the February 2011 meeting that was held to advance interprofessional education, which provides both academic and clinical experiences for students from two or more health professions to work in a collaborative partnership to provide patient-centered care.

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Several models like the Competency-Based Framework, the Interprofessional Collaborative Practice Model, and the Interprofessional Education Collaborative (IPEC) framework guide IPE initiatives.

# data[].attributes.attachment_link.title
Interprofessional Education (IPE): A framework for introducing teamwork and collaboration in health professions curriculum

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Common IPE activities include simulation exercises, case discussions, joint clinical rounds, and workshops. These help in developing practical interprofessional skills.

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Mayo Clinic College of Medicine and Science

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Mayo Clinic College of Medicine and Science

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Activities - Interprofessional Education - Resources for Schools - Academy of Educational Excellence - Mayo Clinic College of Medicine & Science

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Interprofessional Education (IPE) activities and assessments offered by Mayo Clinic professional educators.

# data[].attributes.body
Assessing IPE involves evaluating knowledge, skills, attitudes, and behaviors. Common tools include self-assessment questionnaires, peer reviews, and objective structured clinical examinations (OSCEs).

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National Center for Interprofessional Practice and Education

# data[].attributes.attachment_link.readable_text
The ISVS-21 represents a refinement of a previous tool (ISVS-24, King et al., 2010); both are self-report instruments designed to measure interprofessional socialization among students and health practitioners and their readiness to function in interprofessional teams. Items were developed to capture respondent beliefs, attitudes, and behaviors at baseline and at post-intervention time periods. The original ISVS has been used in multiple studies. The purpose of the study reported here was to...

The SPICE-R is a short (10-item) self-report survey designed to measure health professions students' perceptions of interprofessional education and interprofessional collaborative practice. It represents a variation of an earlier instrument (SPICE-1), which was developed specifically for medical and pharmacy students. Items reflect a 3-factor model capturing interprofessional teamwork and team-based practice; roles and responsibilities for collaborative practice; and patient outcomes from...

The PACT Tool set was designed by faculty and staff at the University of Washington (Center for Health Sciences, Interprofessional Education, Research, and Practice), as part of a Macy and Hearst Foundations grant to develop a simulation-based team training program for pre-licensure health professions students. To develop the program, the authors chose the "Team Strategies and Tools to Enhance Performance and Patient Safety" (TeamSTEPPS®) model as a guiding framework. The PACT...

The SF-36 is a multi-purpose survey designed to capture adult patients' perceptions of their own health and well-being. Based on a much longer survey developed in the 1980's by Ware, J.E., the SF-36 has 36 items grouped in 8 dimensions: physical functoning, physicial and emotional limitations, social functioning, bodily pain, general and mental health. It is a generic measure, as opposed to one that targets a specific age, disease, or treatment group. It can be administered in a...

The ITPPS was designed to assess interdisciplinary team process and performance in long-term care settings, particularly those of the Program of All-Inclusive Care for the Elderly (PACE). Specifically, the tool measures team processes (i.e., leadership, communication, coordination, and conflict management) and team outcomes (i.e., team cohesion and perceived unit effectiveness) in a 59-item self-report instrument. The results are meant to identify weaknesses in team processes that can be...

PROMIS® is a set of patient-centered tools that can be used to evaluate the physical, mental, and social health of adults and children. The tools can be used with the general population and individuals with chronic conditions. PROMIS instruments measure concepts such as pain, fatigue, physical function, depression, anxiety and social function. PROMIS has constructed item banks (a collection of questions measuring the same thing that can be administered in short forms or adaptively through...

National Institutes of Health (NIH)

PROMIS Health Organization

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This is your gateway to finding measurement tools that can be used to assess individual learners, groups, teams, practice environments, and organizations; and to evaluate the impact of interprofessional education programs and collaborative practice on Triple Aim Outcomes.

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Common barriers include logistical issues, differing schedules, and resistance to change. Understanding these challenges is the first step towards addressing them effectively.

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Abstract

Background

Changes in the structure and nature of health care highlight the need for better collaboration between professions focusing on patient or health-care users. Interprofessional education (IPE) has attracted a lot of attention at the international level, and its positive consequences in different areas of health care have been investigated and approved. This study explored the opinions and viewpoints of professors and experts regarding the challenges to the implementation of interprofessional education in health profession education in Iran in 2018.

Methods

This qualitative study was conducted with 15 IPE professors and experts using semi-structured interviews. We used an inductive approach to content analysis as developed by Elo et al. The interviews were analyzed using Graneheim and Lundman method by MAXQDA software version 12.

Results

The main challenges to the implementation of IPE were categorized into educational system, structural and cultural challenges. The educational challenges were the professors' lack of ability, a non-flexible and single-disciplined curriculum, and weaknesses in the current education. The professors and experts felt that the most important structural challenges included centralism, hierarchy of power, poor educational groundwork, and lack of support of organizations. Cultural challenges mainly related to the attitudes of managers, professors, and even students regarding IPE and the need for change.

Conclusion

Designing and implementing IPE in Iran face major challenges. Cultural and attitude issues were the greatest challenges to be addressed in the context of implementing IPE in health-care education.

Keywords: interprofessional education, multiprofessional education, shared learning, medical education

Background

As a modern, efficient and effective approach in improvement of the community health services quality and proportionate to the widespread global changes in the third millennium, Interprofessional education has attracted a lot of attention to the international level and its positive consequences in different areas of health care have been investigated and approved.1 Based on the definition of the World Health Organization, IPE "occurs when two or more professions learn from each other regarding the effective collaboration and improvement of health outcomes".2 Through IPE, students and physicians can develop their competencies in the areas of knowledge, attitude, skills, and behaviors that enable them to participate in patient care, collaboratively.3 Changes in the structure and nature of care highlight the need for better collaboration between professions focusing on patient or health-care users which needs providing a more comprehensive, integrated, and patient-centered approach through the future health profession education.4,5 In their report about the achievements, challenges, and implications of the health system, the Iranian Ministry of Health identified a range of issues. These included asymmetric development in medical education, emphasis on specialization, a change in the pattern of diseases and lifestyle, lack of integration and the existence of island thinking and the lack of horizontal and vertical integration of curriculums. There was also inadequacy in intra-communication, inadequate inter-institutional interaction, lack of commitment within the education system to social responsibility and weakness of justice in meeting health-care needs. This report reflects the lack of attention to the team-based educational approaches to health education and the need to revise it.6,7 Along with changes in the health needs of communities over the past decades, the World Health Organization in 2010 warned against undesirable outcomes by emphasizing the lowered quality and safety provided by disqualified graduates in providing team care.8 There is no formal training courses for interprofessional education in Iran. Some universities understand the necessity of interprofessional education to improve patient care and hold their clinical education in the field of interprofessional with informal and unplanned manner. Few studies were conducted on IPE in Iran, and the major studies emphasize on the background, structure, facilitators, and barriers of this educational approach;9 however, a few qualitative studies investigated the perceptions of professors and students from the IPE. Mafinejad et al investigated the perception and perspective of faculty members and students about IPE in an integrated system for IPE planning and implementation. Their results were classified into four categories, namely, educational structure, professional identity, moderating factors, and perceiving concepts.10 The Irajpour et al, study results indicated that although IPE in Iran had a significant expansion, it was unofficially.11 The aim of this study was collecting and analyzing the views, experiences, and perspectives of the people involved in IPE in Iran's educational system to identify the important challenges of IPE.

Methods

Ethics

To comply with ethical considerations and protect the participants rights. Ethics approval was obtained from the Shahid Beheshti University of medical sciences and then researcher introduced himself to the participants, explained the goals of the research, and obtained informed consent. Participants took part in the study, voluntarily. After the completion of the analysis and publication of the article, interviews were deleted.

Research Design

This study was conducted using qualitative content analysis, aiming at providing new cognitions, promoting the researcher's perception of the phenomena and identification of operational strategies.12 This study aims at explaining and describing the experiences and views of IPE experts in the Iranian educational system to identify the important challenges of IPE.

Participants

The participants were comprised of professors and experts in the field of IPE. To conduct the research, 15 faculty members in this area were selected based on the purposive sampling and in-person semi-structured interviews13 were conducted during May-August 2018. Using snowball method, more participants took part in the present study until the data saturation was achieved. The interviewer was a Ph.D. student of medical education whom the participants were not familiar with. The maximum variation was observed in participant's selection. Since basically the number of participants in qualitative studies is not determined, sampling was continued until data saturation was achieved, so that by conducting the interview, no more themes, dimensions, components, or identity were extracted from the participants, ie, the final interviews only confirmed or proved the previous findings. Considering that there are no official IPE courses in the Iranian medical education system and students or patients are not familiar with this approach, only the professors involved in this field were sampled.

Data Collection

In order to collect the data, semi-structured interviews were used. In order to conduct the interview, informed consent was obtained after contact with participants. The time and place of the interview were selected according to the participants. To prepare the participants for interview, the general framework of the topics was expressed. After time coordinating, the semi-structured interviews began with informed consent and a brief explanation of the research and objectives. Interviews were begun with open and public questions and then led to enlightening and in-depth questions. During the interview and based on the respondents' answers, open and probing questions were posed to clarify the details. The interview time varied from 39 to 72 mins, with an average of approximately 56 mins, based on the willingness and readiness of the participants, recorded by a digital recording device. Although the main data were taken from semi-structured interviews, observations, and observation notes, field notes and memory notes were also used alongside the data. Observation notes illustrate what happened during the interview. The field notes are a report of interactions observed in the field and show analytical insights during the data collection. The memory notes also express deep thoughts about the event, written often after leaving the field and analyzing the data.14 Although these data were not all added to the data collected from the interviews, it helped to manage, pose further questions and better understanding the relationship between the topics, thus directed the collection and analyzed the data.

Data Analysis

The data analysis process was conducted according to the proposed steps of Graneheim and Lundman where the researcher transcribed the interviews and studied those several times in order to obtain a complete knowledge of them.15 After each interview, the audio file was carefully transcribed and the text of the interviews was read several times for data analysis. Transcripts returned to participants for comment and correction. Meaning units were determined and condensed with a description close to the text. Then, a list of codes was prepared and with revising, semantic review, determining the similarities and differences in meaning, the similar codes were placed through reduction and induction method at a more abstract level. By continuous comparison, the acceptable sub-categories and categories were obtained. All interviews and observations were considered as the analysis unit. Paragraphs, sentences, or words were considered as meaning units. Subsequently, the meaning units were named through codes and reached the level of abstraction and conceptualization according to their latent meaning. The codes were compared with each other in terms of similarities and differences, and were categorized under abstract categories with a specific label. Eventually, by comparing the categories with each other and thorough and deep reflection on them, the latent content of the data was introduced as the theme of the study. All interviews were independently analyzed by the two researchers. MAXQDA v.12 software was used to facilitate the forward and backward, listing, categorization, frequent comparison of various data and retrieval of quotes in the data analysis process.

The proposed criteria for Guba and Lincoln were used for the trustworthiness of the study.16 To ensure the findings, the author gave further validity to the data by spending adequate time collecting and reviewing data, using variety in sampling (selecting participants with different characteristics), giving interview feedback to participants, and confirming the categories derived from the interview texts. In order to achieve trustworthiness, we used the findings dependency; so that in order to analyze and revise the transcribed interviews, they were presented to the faculty members familiar with the qualitative research to ensure the dependency of the content and the results. Transferability was assigned to readers under similar conditions. The resulting categories of the quotes of the participants were presented as said before. Since the interviewers were the data collection instrument, this research is not as error-free as other qualitative research, because the mentalities, thoughts, and opinions of the interviewer sometimes affect the subject of research and the process of data collection. Attempts were made to bracket the researcher's thoughts through the process of collecting and analyzing data to conduct a proper research. In addition, all participants were assured that their responses remained confidential to the researcher to reduce the probable bias of the respondents.

Results

Fifteen professors participated in the study which eventually 15 interviews were conducted. The participants fields included medicine (N=4), nursing (N=6) and medical education (N=5) . Ten participants were Faculty member and 5 participants were Manager.

Participants argued that the development and implementation of IPE in the field of medical education in the country faces many challenges that have to be overcome. According to the participants' perspective, these challenges fell into three categories: educational, structural, and cultural challenges ( Table 1 ).

Table 1

Codes

Sub Categories

Categories

Pseudo-IPE knowledge of professors

Wrong Belief of professors in knowing IPE

Lack of skill of professors in IPE

Lack of knowledge of professors

Great distance from IPE

Weakness in current education

Informal interpersonal Education

Unplanned IPE

Traditional education system

Single professional education

Disproportionate education with teamwork

Person-centered education

Teacher based education

Inefficient education

Old teaching methods

Lethargy-inducing educational environments

Stressful education

Traditional thinking

Lack of innovation and creativity

Lack of creativity in the education

Restrictive environments

Passive students

Not worthy of new ideas

Single professional curriculum

Non-flexible curriculums

Subject-centered curriculum

The need to modify the curriculum

Rigid curriculum

Traditional curriculum

Inability to change curriculum

Educational Challenges of IPE

Participants argued that one of the main challenges facing IPE in the country is challenges pertaining to education. Approximately all participants stated that the lack of ability of professors was one of the major educational challenges. One of the problems with IPE based on the experiences of professors was the false belief of familiarity with IPE. Even the specialized boards are not familiar with IPE:

Everyone thinks they know, though when you ask them in practice, they know nothing. We changed environments for implementing IPE at the University of Tehran, where nobody heard or knew nothing about IPE.

The professors were unfamiliar with the IPE. Not only faculty members knew little about new educational approaches, but also specialist boards did not know about these approaches.

Since most of the professors in the field of health professional education were not fully familiar with this approach or sporadically gained information in this regard; thus, the current unofficial courses for IPE were inefficient:

We have not planned Interprofessional education, but some universities might have been compensated this defect in some ways or some sections. In general, although, we have not designed Interprofessional education, this might happen in practice.

Professors in the field of health professional education, especially the highly experienced, preferred to use traditional and familiar approaches to education due to lack of familiarity with new educational approaches. IPE in Iran is considered as a new approach to the preparation of health professional students. Therefore, faculty members of the medical sciences have difficulty using this approach and do not use it as far as possible. Therefore, the lack of innovation and excessive adherence to the traditional education system is one of the challenges facing IPE:

We do not seek innovation in our education and prefer the traditional and existing education. Each of the disciplines doesn't get involved with other disciplines. Students are basically educated with an individual approach since the beginning.

According to professors, rigid, non-flexible, and single-disciplined curriculums are one of the most important educational challenges facing IPE. The health profession curriculum in Iran is based on the subject of the course and no position is considered for IPE:

The present curriculum is unsuitable for the integration of IPE. If the curriculum is taken into consideration, then the commonalities should be taken into consideration and should be supplemented or appended to the current curriculum. Different courses should be injected into the curriculum for various educational environments.

The professors agree that the curriculum should be interprofessionally written and investigated in order to identify and consider the opportunities available for IPE:

The interprofessional curriculum should be written and investigated interprofessionally. In the existing curriculum, the points that can be interprofessionally implemented should be determined, and interprofessionally conducted in those particular points. In the existing curriculum, the interprofessional opportunities can be identified and reviewed, but they cannot be interprofessional in essence, because they are written as a single discipline.

Structural Challenges of Interprofessional Education

In the perspective of participants, appropriate structures were one of the most important factors affecting the IPE design and implementation. Participants in the study stated some obstacles such as centralism, power hierarchy, and inadequate educational environments to implementing these programs.

Our universities are struggling with problems such as centralism, levels of power, and unique structure where IPE can be raised as a solution, the hierarchy of power must be eliminated, and students should see each other in the same level. It is very difficult to implement such educations in the hierarchical fields of Iran.

According to participants, creating or improving the existing platforms is the first step in implementing IPE:

Laying the groundwork is the first pillar of everything. Now, in education, which is one of the most important pillars of the country's progress, we cannot do a useful work without the proper groundwork, and in my opinion, in the first step, we should provide the appropriate groundwork for this particular type of education.

In hospitals, clinical education is similar to island, and a variety of disciplines, including medicine, nursing, pharmacy, midwifery, physiotherapy, radiology, social working, laboratory, and occupational therapy are educated in separate environments, with a variety of methods there is little interaction between students and faculty members. One of the faculty members stated:

One of the problems that prevent the design and implementation of IPE is the structural problems that exist in our education system. The existing structures should be changed for IPE. In our environment, these things are impossible, because they are not attractive.

Policymakers and educational managers have not yet understood the need to use IPE as a useful approach in solving health profession problems after completing their education, despite their concerns about health profession education and work and searching for new educational methods. IPE would be difficult and almost not implementable without the support of various organizations involved in education:

The support of various organizations is vital for the IPE implementation. While ago there were talks about community-oriented education of students from different disciplines in rural areas, where a nursing student, a medical student, and even in some provinces, a pharmacy student stayed, I mean in the social medicine rotation, The kids worked practically for a month as a resident, but they were canceled because of issues like cost and security, and a couple of other things. It was precisely a targeted IPE.

Currently, almost all of the colleges of medical sciences in the country are educating students separate from each other and have little interaction in the shared fields of education because of their distance as well as inappropriate physical space. Participants acknowledged that appropriate educational environments should be developed for designing and developing IPE initiatives and projects in the country's education system:

IPE cannot be translated within the existing contexts and environments, and a new field should be created that is patient-centered. In many cases, educational environments can be improved without having to pay any certain costs. For example, in the delivery room with both the midwifery students and residents, we need to change the environment so that they both learn from each other.

Obviously, as long as people are physically distant, they lack sufficient opportunities to interact and get familiar, and thus will have trouble cooperating. Regarding the need for interaction and cooperation in the IPE, participants in the study also acknowledged the following:

As long as our faculties are separated from each other, even the professors do not meet each other except for few sessions, so expecting cooperation on behalf of students would be in vain. The wall between the faculties should be removed. First, we need to physically connect students and professors, certainly, over time, students will somehow work together.

Cultural Challenges of Interprofessional Education

The inappropriate cultural environment creates an inappropriate learning environment for IPE. This inappropriate cultural environment exists for IPE at all levels, including curriculum directors and planners, faculty members and even students. In order to overcome this inappropriate cultural environment of universities, the educational officials of different professions should have more interaction with each other. This problem is seen not only at universities but also in clinical settings. The professors stated that considering IPE in the country, there are attitudinal problems:

Basically, our problems are mostly related to attitude. Because our look is either all or nothing, we usually find these attitudinal problems. In my opinion, the attitude dimension of education has not gone well in other dimensions. In many universities, there is now a tendency towards putting together the students with the same field.

IPE requires more attitude intervention than technical intervention. It is necessary to work on the attitude of people before the implementation of curriculum, because all competencies must take place within the cultural context of the country.

Because of resistance against shift to IPE in managers, changing the attitudes is one of the requirements of moving toward IPE and break this resistance.

Many university and institute managers are reluctant to conduct such educations due to problems such as financing, executive issues, and the resistance of the professors.

The importance of the problem of the structures and the educational environment for IPE is far less than the problem with the managers' mentality and the minds of the people prevent the implementation of such education.

One of the pillars of interprofessional education is that, in addition to the lack of readiness for knowledge, they lack readiness considering attitudes to implement IPE. Successful IPE requires enthusiasm, commitment, and positive attitudes towards the other disciplines, individuals, and teamwork.

An interprofessional professor with a positive look at the rest of the professions can contribute with these opportunities. In clinical care services, care is provided as a team, but, the problem is that the members of the group often do not know about being a group or do not recognize themselves and do not consider that this group should cooperate intentionally, consciously and in a programmed manner.

We have to work on people's attitudes in order to learn to respect each other. Respecting others and accepting the opinions of others is a kind of valuation. Everything that is respected is increasingly becoming valuable.

The misleading and destructive attitudes in the society and the university create negative stereotypes among students and prevent students from knowing about other disciplines and individuals. In many cases, students of other disciplines consider themselves higher than other disciplines and are reluctant to cooperate and interact where their destructive effects on the health system are revealed after graduation.

Students of different disciplines lack a good attitude towards each other, which provokes hatred. When people are employed, they show a series of strange behaviors. Bad attitudes and suspicions are found among different people. If they were normally educated since the beginning, while knowing all the limitations of each other, they will respect and realistically accept each other.

The culture we have in our universities has made our medical students to have a higher and different opinion of themselves. These attitudes prevents interaction among students, so students have no common mental model for the patient. IPE itself is a solution to this problem.

Discussion

According to the participants, designing and planning of IPE in the educational system of the country are associated with educational, structural, and cultural challenges.

Lack of Ability of Professors

One of the main challenges of IPE was the lack of ability of the professors. Developing the faculty members is recognized as a key factor in the success of IPE projects.17 Lawlis et al stated that a lack of individual skill and commitment at the college level is a barrier to IPE.18 University professors and clinics need to prepare for IPE, especially for the facilitating role.19 Increasing collaborative activities at different faculties increases the awareness and interest of faculty members from IPE, although many institutional and individual barriers may prevent their full involvement as IPE leaders.20 Introducing and clarifying the benefits of IPE is a strategy in raising awareness.21

Non-Flexible Curriculum

The non-flexible and traditional curriculum was identified as another challenge for IPE. Nowadays, in almost all Iranian universities, students of different health professions are educated in separate classes or in clinical settings without the opportunity to interact and share information, recognize the role and perceive the differences, commonalities and abilities, responsibilities, and a shared goal, which is the ground for providing teamwork.22⁻25 In Canada, the main obstacles to the IPE timetable were the dry curriculum and a defect in the perceived value of IPE.26

Weakness in Current Education

Dependence on traditional, theme-based, single-disciplined, and isolated educational approaches is another important challenge for IPE. Education in isolated conditions creates worldview, language, culture and attitude specific to each profession, the appearance of prejudices, patterns and specific mental forms, territoriality and extremist tribalism, negative competitions, imbalance of power and superiority seeking.19,27⁻29 Bridges states that the most important adverse effect of isolated and separate education of health professions includes the disruption and failure in the process of professionalization and socialization of students and consequently unfavorable professional behaviors, ie, non-professional behaviors in graduates after entering the work environment.30

Based on the study, centralism, hierarchy of power, poor educational groundwork, and lack of support were the structural challenges of IPE.

Inadequate Infrastructures

The operational management of the educational system in many professions requires a change in the curriculum arrangement, including the physical space as well as designing the course and timetable. Designing and implementing IPE is a structural task that faces challenges such as course scheduling, course content alignment, resistance of faculty members and managers, and a culture of valuing the collaborative learning among faculty members and students, and institution policies to share courses among faculties.34

Conclusion

Considering the ever-increasing complexity of needs and health-care services, the importance of teamwork and participation in the provision of more health-care services becomes evident. Medical science education is inevitably required to use IPE to gain teamwork skills and effective care. Interprofessional education as a new educational approach focuses on Interprofessional interaction in the education and learning process, and the promotion of the socialization process of medical science students leads to the acquisition of identity and professional role, competency, and capability to develop effective interactions and extensive collaboration between professionals and the provision of comprehensive, integrated team-based patient care. Educational policymakers in Iran should understand the importance of IPE and address the barriers and challenges they face. IPE challenges take place at policy-making, management, faculty members, and student levels. Evidence-based policies, the establishment of IPE centers at the Ministry of Health and Universities of Iran, budget allocations, the design of IPE courses for managers, professors, and students, and the development of IPE curriculums are necessary for IPE development. One of the important ways to start IPE in Iran is to design and implement small curses of IPE in the universities that can be researched in the future.

Acknowledgment

We sincerely thank all faculty members from medical universities of Iran who participated in this study.

Ethics and Consent Statement

Ethics approval was obtained from the Shahid Beheshti University of medical sciences. Written informed consents were obtained from all participants.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

References

6. Vafadar Z, Vanaki Z, Ebadi A. Barriers to implementation of team care and interprofessional education: the viewpoints of educational managers of iranian health system. [ Iran J Med Educ. 2015;14(11):943-956. Google Scholar]

7. Ministry of Health and Medical Education. Achievements, challenges and horizons of the Islamic Republic of Iran Health System; 2015.

8. World Health Organization. [ Framework for Action on Interprofessional Education and Collaborative Practice; 2010. [ PubMed] Google Scholar]

9. Yamani N, Asgarimoqadam M, Haghani F, Alavijeh AQ. The effect of interprofessional education on interprofessional performance and diabetes care knowledge of health care teams at the level one of health service providing. [[ Adv Biomed Res. 2014;3. doi: 10.4103/2277-9175.140622 PubMed] [ PMC free article] [ CrossRef] Google Scholar]

10. Mafinejad MK, Ahmady S, Arabshahi SKS, Bigdeli S. Interprofessional education in the integrated medical education and health care system: a content analysis. [[ J Adv Med Educ Prof. 2016;4(3):103. PubMed] PMC free article] [ Google Scholar]

20. Hall LW, Zierler BK. Interprofessional education and practice guide no. 1: developing faculty to effectively facilitate interprofessional education. [[ J Interprof Care. 2015;29(1):3-7. doi: 10.3109/13561820.2014.937483 PubMed] [ CrossRef] PMC free article] [ Google Scholar]

26. Buring SM, Bhushan A, Broeseker A, et al. Interprofessional education: definitions, student competencies, and guidelines for implementation. [[ Am J Pharm Educ. 2009;73(4):59. doi: 10.5688/aj730459 PubMed] [ CrossRef] PMC free article] [ Google Scholar]

32. Mafinejad MK, Ahmady S, Arabshahi SKS, Bigdeli S. Effective factors in the design and implementation of the interprofessional education from the faculty members' perspective: A qualitative study. [ Res Dev. 2013;2(1):25-30. Google Scholar]

Articles from Advances in Medical Education and Practice are provided here courtesy of Dove Press

# data[].attributes.attachment_link.title
Challenges to the Implementation of Interprofessional Education in Health Profession Education in Iran

# data[].attributes.attachment_link.description
Changes in the structure and nature of health care highlight the need for better collaboration between professions focusing on patient or health-care users. Interprofessional education (IPE) has attracted a lot of attention at the international ...

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Solutions include ensuring institutional support, facilitating flexible scheduling, and promoting a culture of collaboration. Interprofessional mentorship programs can also be beneficial.

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Case Study: Successful IPE in a Hospital Setting

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Case Study: Successful IPE in a Hospital Setting

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This case study explores how a hospital implemented IPE to improve patient outcomes. Key strategies included interprofessional meetings and integrated care pathways.

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These case studies-involving real-life teams, patients, students, and families-feature examples of successful IPP collaboration across a variety of settings.

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An example of IPE in community health settings where nurses, social workers, and medical practitioners work together to provide holistic care for underserved populations.

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Abstract

BACKGROUND:

An interprofessional community-based education provides proper situations that learners can be prepared to play their professional responsibilities and team duties in the community. This study aims to assess the effect of interprofessional community-based education on attitudes and performances of learners toward interprofessional collaboration and their readiness for interprofessional learning.

MATERIALS AND METHODS:

The study is a quasi-experimental design. The learners in six different disciplines, including medicine, pharmacy, nursing, midwifery, public health, and nutrition (n=122) at Shahid Sadoughi University of Medical Sciences were participated in the present study. in the present study, interprofessional education intervention was conducted in two steps. First, the interprofessional learning situation brought learners the familiarity with the concepts of interprofessional collaboration, teamwork, and educational medical content, such as backache, fatty liver, diabetes, and HIV. Second, learners from different disciplines participated in interprofessional teams in community settings. These learners taught people about health-related topics, such as backache, fatty liver, and HIV. Participants filled out the questionnaires before and after interventions. Data were analyzed by Student's t-test and one-way ANOVA in SPSS 16.0 software (SPSS, Inc., Chicago, IL, USA).

RESULTS:

The present results showed that the scores of learners in readiness for interprofessional learning 3.82 (0.35) versus 4.60 (0.29) ( P = 0.001) ( P = 0.0001), attitudes to interprofessional teamwork 3.83 (0.40) versus 4.18 (0.30) ( P = 0.0001) ( P = 0.0001), interprofessional collaboration 7.46 (0.70) versus 8.35 (0.43) ( P = 0.001) improved significantly before and after the educational interventions.

CONCLUSION:

The present results showed that interprofessional community-based education has improved the readiness of the learners for interprofessional learning. Besides, attitude toward teamwork and interprofessional collaboration performance have also been improved from participants' viewpoints.

Keywords: Interprofessional collaboration, interprofessional education, community based education, education, interprofessional learning, performance, readiness, attitudes

Introduction

The strategies of interprofessional education and community-based education have been considered to prepare the medical science learners for the future career.[ 1] The community-based strategy focused on a better understanding of the community needs and the role of health-care providers in the community. The interprofessional education strategy was defined when a group of students or health workers train together with different professionals in a way that interaction is considered a key goal in developing collaboration to provide health promotion services, prevention, treatment, rehabilitation, and other health services.[ 2] The matter of interprofessional education and collaboration has also been regarded as a concern of the World Health Organization (WHO). In this respect, interprofessional education as a strategy to provide situations for learning from each other, together, and about each other to improve collaboration and the quality of patient care.[ 3] The main purpose of interprofessional education is to prepare students for "Team-based care". The interprofessional education strategy was used in different settings such as the simulated environment, voluntary community routines, rural areas, and in the clinic.[ 4] Community is one of the most interesting contexts in the implementation of interprofessional education. Interprofessional education in the community provides learners with better understanding of the needs of the community members and the role of team members in the community setting.[ 4]

Community-based education familiarizes students with different ways to deal with health-care problems in the community and prepare them to acquire problem-solving skills in the future. The advantages of community-based education include students' familiarity with socioeconomic factors that affect health and disease, health services in the community, and teamwork in the health-care team. Community-based education refers to learning activities related to the health needs of the people in a community context.[ 5] Using an interprofessional approach, together with the participation of students from different professions in the community, enables learners to interact with people in the society and to experience interprofessional interaction, learning, and preparedness for their role in the future. In addition, the participation of learners in the society and rural areas is one of the ideal settings for exercising interprofessional collaboration and understanding the importance of community needs.[ 4] The advantages of interprofessional education in the community context are understanding the health needs of the community, creating an opportunity to collaborate in real situations, increasing self-confidence in the interaction of members in the society, and developing attitudes toward community resources.[ 4] The interprofessional education and community-based strategies have not been used perfectly in medical disciplines at the investigated context. Hence, training of interprofessional collaboration abilities, accountability of community needs, and teamwork require serious attention. Implementing the interprofessional approach in the community is suggested to develop skills such as teamwork, communication, and community-based performance.[ 6] In addition, learners from different professions exercised in the interprofessional learning and collaboration in the real situations. Kent and Keating in a systematic review stated that contributors have learned teamwork competencies and improved knowledge of the role of health-care professions through interprofessional education in the community. However, evidence of changing attitude toward other disciplines has not been found and more studies are required.[ 7] In another study, Segal-Gidan explored participants' experiences of the community-based interprofessional education course in two themes; "understanding the role and responsibilities of other health care professions" and "the application of team-centered care in practice.[ 8]" Further studies are recommended about the effect of interprofessional learning in the community context.[ 8, 9, 10] The investigated context, the education system is a discipline-based and the interprofessional education has not been considered in formal and informal curriculums. The implementation of an interprofessional education in developing countries is facing challenges such as discrimination among members of different disciplines, traditional curriculums, and dominance of individualistic and uniprofessional culture.[ 11, 12, 13, 14] The challenges prevented learners from working properly in interprofessional team. The reform of the community-based education courses is necessary to achieve improvement in role recognition, the correction of uniprofession stereotypes, and the preparation to play their roles in interprofessional teams. It is hypothesized that the integration of interprofessional education and community-based strategies may facilitate achieving these skills through providing the interprofessional situations. The aim of this study was to assess the effect of the interprofessional community-based education on readiness for interprofessional learning, the attitude, and performance of learners toward interprofessional collaboration.

Materials and Methods

The present study is a quasi-experimental study. The learners in six different disciplines including medicine, pharmacy ( n = 122), nursing, midwifery, public health, and nutrition at Shahid Sadoughi University of Medical Sciences were participated in the present study. The inclusion criteria were determined by the students in the mentioned disciplines who have spent at least 2 months of clerkship courses. Since the interprofessional community-based education courses were developed as extracurricular activities, the randomization of learners was not conducted and they participated voluntarily.

Interprofessional interventions have been carried out in two steps. First, interprofessional learning situations were provided to familiarize the learners with the concepts of interprofessional collaboration, patient education principles, as well as a core medical content including diabetes, HIV backache, and fatty liver. In this situation, learners from different professions participated in small groups to share their information and discuss the determined subjects. Instructors from various professions (clinical teachers and experts in medical education) facilitated the interprofessional learning process of students. Then, facilitators explained the process of interprofessional education and collaboration in the community and learners' duties. The learners were asked to form their interprofessional teams, divided duties, and determined their role in teamwork. The main interprofessional activities of learners were determined to assess the health literacy of people and educate them about the determined subjects. The educational content and materials were produced by facilitators and learners. In the phase of community-based education, 5-7 learners, as an interprofessional group, assessed the need of people by structured interviews according to the interview guide in the beginning of the sessions. They taught people about health-related topics, answered the questions, and provided the educational material such as pamphlets. Facilitators supervised the learners' activities in the interprofessional team. Each course took place for 3 months. The learners filled out the questionnaires before and after interventions as self-assessment.

The instrument in the present study consisted of readiness for interprofessional learning (19 items) (Cronbach's α= 0.8),[ 15, 16] and the assessment of attitude toward teamwork (14 items) (intraclass correlation coefficient [ICC] = 0.87, Cronbach's α = 0.74). The scoring of the questionnaires was a 5-point Likert scale (1 = completely disagree, 5 = completely agree). Participants assessed interprofessional collaboration by a 33-item instrument as interprofessional collaborative assessment rubric. The rubric consists of six domains: communications (7 items), role and responsibility (7 items), conflict management (5 items), collaboration (5 items), team function (5 items), and collaborative patient/client-centered approach (4 items)[ 17, 18] which had been validated in the investigated context (Cronbach's α = 0.71, ICC = 0.76).[ 19] Scoring on each item is on a scale of 1-9 for the competency scores where 1 = minimal and 9 = mastery.

Data were analyzed by descriptive (mean, SD, and percentage) and analytical tests; the independent Student's t-test was used to compare the mean of age and gender of participants and their scores in the investigated variables, respectively. Paired Student's t-test compared the mean scores of learners before and after the interventions. In addition, one-way ANOVA was used to compare learners' scores in their professions, and post hoc tests (Tukey honestly significant difference [HSD]) were assessed whether the difference among these values was significant. Data were analyzed by SPSS 16.0 software (SPSS, Inc., Chicago, IL, USA).

Results

The participants in different professions were entered in the present study ( n = 122) [ Table 1 ]. The mean age of participants was 23.8 years 4.4.

Table 1

Variable

n (%)

Profession

Nursing

38 (31)

Midwifery

32 (26.2)

Public health

13 (10.7)

Medicine

19 (16)

Nutrition

16 (13.1)

Pharmacy

4 (3.3)

Gender

Men

24 (20)

Women

98 (80)

The results of the study illustrated that the mean scores of readiness for interprofessional learning ( P = 0.001), attitude toward interprofessional teamwork ( P = 0.001), and interprofessional collaboration performance of participants ( P = 0.0001) were significantly different before and after the educational interventions [ Table 2 ].

Table 2

Outcome measure

Mean±SD

t

P

Therefore, interprofessional educational interventions have remarkably improved the attitude toward teamwork, readiness for interprofessional learning, and interprofessional collaboration performance. The result of the one-way ANOVA showed that there is no significant difference among learners' discipline with the level of readiness for interprofessional learning ( P = 0.09) and interprofessional collaboration of learners ( P = 0.26). The attitude scores of learners were different in various disciplines ( P = 0.01). Tukey HSD test showed the difference between the scores of midwifery learners (4.32 ± 0.35), which were significantly higher than other professions' attitude ( P = 0.04). There was no significant difference between gender of learners and the scores of attitude toward interprofessional teamwork ( P = 0.95), readiness for interprofessional learning ( P = 0.77), and interprofessional collaboration of learners ( P = 0.35). There was no significant difference between the mean of age of participants and their scores of attitude toward teamwork ( P = 0.65), readiness for interprofessional learning ( P = 0.32), and interprofessional collaboration of learners ( P = 0.46). The scores of learners in interprofessional collaboration domains were significantly different [ Table 3 ]. The results showed that 95% of the participants were satisfied with the educational intervention and tended to participate in the educational interventions in the future.

Table 3

Interprofessional collaborative performance domain

Mean±SD

t

P

Pretest

Posttest

Discussion

Interprofessional community-based education can provide a suitable opportunity to develop learners' abilities in teamwork and better understanding of interprofessional collaboration. In the present interventions, activities of community-based education were designed through integrating the strategies of interprofessional education and community-based education. The results showed that the interprofessional community-based education improved learners' readiness for interprofessional learning and collaboration.

The present results showed that the scores of the learners had been improved significantly in all domains of interprofessional collaboration competencies. In this study, the interprofessional community-based activities provided opportunities for learners of different professions to be able to play their role in interprofessional teams for interactions people and their training. Similarly, the results of Pit's study illustrated that interprofessional learning has led to the improvement of the relationship and teamwork among team members as well as recognition of the role and responsibility of other professions.[ 20] In Ryan et al. study, the learners of different faculties of medicine, nursing, and pharmacy participated in interprofessional community-based education. The community environment provides situations in which the learners can work in interprofessional teams to inquire the community needs and find solutions to answer people's needs. The Ryan's results showed that the learners felt more comfortable by working in the team and interacting with various patients. The understanding of the learners from community needs, social factors of health, obstacles, challenges to access of health services, and patient-centered care were significantly improved among learners. Similarly, it was emphasized that interprofessional community-based education has had a key role in the learning process of the contributors in Ryan study.[ 21] In our study, the participants assessed their interprofessional collaboration in a desirable level after interventions that were similar to the results of the Ryan's study, which showed the improvement of self-confidence of participants in teamwork. Self-efficacy and self-confidence were defined as key components in the behavioral change process[ 22] that it seems the interprofessional situations in the community provided a proper situation to improve their skill, attitude, and self-efficacy. The results of Stubbs' study showed that interprofessional community-based education and participation of the learners from ten different disciplines in interprofessional teams has made positive changes related to teamwork and learners' team-centered competencies,[ 23] which is similar to the results of the present study. The results may be achieved for the reason that the learners were asked to play the defined role as a team member in real situations. Xyrichis in a review study has defined "team structure" and "team process" as facilitators of interprofessional teamwork in the community.[ 9] It seems the interactions with other team members and the implementation of the professional and team responsibilities improved learners' teamwork competencies.

Interprofessional community-based education can lead to changes in the performance of participants through developing attitude, value, and vital abilities to meet community health needs.[ 19] The result of a systematic review study showed that there is no suitable evidence for attitude change resulted from interprofessional education.[ 7] The present study showed that the learners achieved positive attitudes toward interprofessional teamwork after educational intervention. In this regard, the results of Furze's study that the participants in nursing, pharmacology, occupational therapy, and physical therapy participated in interprofessional educational courses, showed learners' attitudes toward the people of the society, especially the elderly and also other health professions had been improved.[ 24] In this study, the interprofessional education has been determined as one of the effective methods to improve learner's understanding and respect to other professions.[ 24] Similarly, the learners' attitudes were improved, especially, the attitude of midwifery learners upgraded more than the learners' attitude of other disciplines in the present results. It can be due to the necessity of the nature of teamwork in their professional performance. The participation of learners in the process of teamwork in the community brought situations for the learners of different disciplines to work together and learn from each other, causing the significant improvement in attitudes toward teamwork[ 24] which is similar to our results. Moreover, the present results showed that the readiness for learning from other professions has significantly developed among the learners. The results of a mixed-method study, which aimed to assess the readiness level of learners toward interprofessional education in the context of Asia, showed that students had suitable readiness for interprofessional education. Although, challenges such as the unwillingness of medical students to participate with other students, feeling the imposition of a leadership role on medical students, weak understanding of other professions, and the boundaries of each profession were explored as challenges to interprofessional learning.[ 25] The results of a study aimed to assess the readiness of postgraduate students of Isfahan University of Medical Sciences for interprofessional learning showed that the readiness of postgraduate students were in desirable level and suggested opportunities for development of interprofessional learning.[ 16] Further studies are required to explore the factors affecting readiness for interprofessional learning and collaboration.

The present study has designed as a quasi-experimental study, and there was no control group and randomization. Students participated in the courses as extracurricular activities and voluntary entrance and the number of participants in each discipline was other limitations of the present study.

Conclusion

The present results showed that the interprofessional community-based education has led to an improvement in the readiness of the learners for learning in the interprofessional team. Moreover, the attitudes toward teamwork and interprofessional collaboration performance have been improved from the participants' viewpoints. Thus, it is suggested that the community-based education programs will design by applying the interprofessional education strategy in formal and informal courses.

Financial support and sponsorship

The study was approved by the Committee of the Ethics at Shahid Sadoughi University of Medical Sciences. (ID: IR. SSU. REC.1399.147). This research has been supported by the grant of Shahid Sadoughi University of Medical Sciences (ID: 8511).

Conflicts of interest

There are no conflicts of interest.

Acknowledgment

This article is extracted from a research project approved by Shahid Sadoughi University of Medical Sciences, Iran (NO: 8511). The researchers would like to express their appreciation for the contribution of participants.

References

3. [Last accessed on 2011 Mar 02];World Health Organization. Learning Together to Work Together for Health: Report of a WHO Study Group On Multiprofessional Education of Health Personnel: The team approach: Technical Report No. 769. 1988 Available From: [ http://whqlibdoc.who.int/trs/WHO_TRS_769.pdf . [ PubMed] Google Scholar]

6. Dent J, Harden RM, Hunt D. A Practical Guide for Medical Teachers. Philadelphia: Elsevier Health Sciences; 2009. [ Google Scholar]

16. Irajpour A, Alavi M. Readiness of postgraduate students of Isfahan University of Medical Sciences for inter professional learning. Iranian J Med Edu. 2012:1050-6. [ Google Scholar]

22. Glanz K, Rimer BK, Viswanath K. Behaviour and Health Education: Theory Research and Practice. San Francisco: Jossey--Bass Press; 2008. [ Google Scholar]

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Interprofessional education in a community-based setting: An opportunity for interprofessional learning and collaboration

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An interprofessional community-based education provides proper situations that learners can be prepared to play their professional responsibilities and team duties in the community. This study aims to assess the effect of interprofessional community-based ...

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Framework for action on interprofessional education & collaborative practice

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The need to strengthen health systems based on the principles of primary health-care has become one of the most urgent challenges for policymakers, health workers, managers and community members around the world. Human resources for health are in crisis. The worldwide shortage of 4.3 million health…

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Centre for the Advancement of Interprofessional Education

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Centre for the Advancement of Interprofessional Education

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CAIPE is a community of practice whose members are dedicated to a collaborative future. CAIPE works nationally and internationally to generate, synthesise and translate evidence for best practice in interprofessional education and collaborative practice.