Announcement

We are looking for books and reports on all topics related to interprofessional education and collaboration to review on the Blog. If you know of a recently published (hard copy/online) book/report, or have an interest in producing a book/report review please email: jic.editorialoffice@gmail.com

Thursday, June 28, 2012

The Rise and Rise of Interprofessional Competence


In the past few years, we have seen a continued growth in the use of competency frameworks for the traditional health and social care professions (e.g. nursing, medicine) as well as the emerging professions such as physician assistants. In this editorial, I attempt to explore the continued rise of competence, with a focus on the use of competency frameworks in the interprofessional field. In doing this, I initially outline the growth of interprofessional competency frameworks and discuss some of the benefits they offer before examining their current shortcomings. The overall aim of this editorial is to argue that, while our efforts in identifying and synthesizing interprofessional competence have taken some important steps forward in defining the key attitudes, knowledge, skills and behaviors for effective interprofessional practice, collectively there are still areas in which we need to improve to ensure the interprofessional competency frameworks we produce are done so in as robust a fashion as possible.

In the past 5 years or so, especially in North America, we have witnessed a growth in the number of interprofessional competency frameworks both from national organizations. We have also seen a number of publications that discuss and explore how competences can contribute to the development of more effective interprofessional practitioners. As I previously argued, the use of competences and competency frameworks has a wide appeal as they help provide consistent standards of professional and interprofessional practice, help validate areas of health care work which are regarded as important (e.g. patient-centered care), can provide observable indicators of performance and also offer an indication of the complex interplay between knowledge, skills and behaviors.

When one reviews the interprofessional frameworks, it is encouraging to note that they have a degree of consistency with the core domains of competence they identify.  In addition, from the perspective of interprofessional education in the USA, it appears that the focus on interprofessional competence has engaged a number of policy-makers and funders into re-investing into the field. As noted above, one of the strengths of the competency movement, which arguably appeals to policy-makers and funders, is the use of competency statements that can potentially provide observable indicators of collaborative performance across an array of clinical contexts.

Nevertheless, the interprofessional competency frameworks produced so far contain two main issues which need some further thought. The first is conceptual. When one reads the various competency statements within the domains of these frameworks, an extremely popular focus is on “teams” and “teamwork”. While interprofessional teams are a very common arrangement in the delivery of health care, they are not the only division of labour. This almost exclusive focus on teams overlooks the fact that there are other forms of interprofessional work which learners also need to have competence in working together effectively when delivering care.

Recently, with colleagues I published a typology of interprofessional work which classified activities into four forms: teamwork, collaboration, coordination and networking (Reeves et al 2010 - Interprofessional Teamwork for Health and Social Care).  We differentiated these forms of interprofessional work as follows: teamwork was seen as encompassing a number of elements such as shared team identity, clarity of roles, interdependence between team members, integration of tasks and shared responsibility. In contrast, collaboration was a “looser” form of interprofessional work, as shared identity and integration of individuals were less important, but there were some shared accountability and interdependence between professions. For coordination, while there was some sense of shared identity, integration and interdependence were less important; there was also little shared accountability or clarity of roles, tasks and goals. Lastly, networking was a relationship in which shared team identity, clarity of roles/goals, interdependence and shared responsibility were less essential; networks were therefore seen as virtual, whereby none of the members necessarily needed to meet face to face, as they could communicate online in an asynchronous manner.

The aim of presenting this topology here is to provide a reminder that we have, so far, neglected to incorporate other forms of interprofessional work, which occur across a range of health and social care settings. Teamwork is one form, but we also need to think about developing competency statements that reflect these wider forms of interprofessional work.

The second issue is focused on measurement. At the moment, we are not clear about how to robustly measure (assess) the many different statements which make up the interprofessional competency frameworks. Importantly, each of the competency statements is very complex in its composition. Each statement can combine multi-faceted attributes related to collaborative attitudes, values, knowledge, skills and behaviors – packaged together in a single sentence. However, it is difficult to see how to tease apart each of the embedded attributes and measure them in a rigorous manner.
Efforts to date, which have used self-assessment approaches, only provide a limited form of evidence. We therefore need to embrace other assessment methods, such as observation of performance.

Another measurement difficulty is that the unit of analysis for these interprofessional competency frameworks is focused on the individual learner. Although this focus is appropriate, as assessment of individuals is extremely important, it overlooks any measurement of the shared learning experience. We fail to assess collectively the interprofessional group or team of learners. This oversight is arguably an important limitation, as we are not focusing on a key element of interprofessional education – its shared, collective approach. We therefore need to better understand, through measurement, this dimension.

Finally, we have little evaluation data, to date, which provide an insight into whether any of these interprofessional frameworks are being implemented. We have no empirical evidence into how effective (or not) they are in capturing the essence of effective interprofessional collaboration. This is another area where we need data to help us understand the broader issues linked the use of interprofessional competence and the frameworks which aim to synthesize its core elements.


To read more - go to: http://informahealthcare.com/doi/full/10.3109/13561820.2012.695542

Thursday, May 24, 2012

Physician Assistants in Interprofessional Teams - A Study

Ensuring that interprofessional health care teams have a mix of skilled professionals to meet patient need, safely and effectively. Like a number of other countries, the UK have been exploring the contribution physician assistants (PAs), who are well established in the US, can make to interprofessional  teams. In a study recently published in the J Interprof Care investigated the employment of PAs in primary care and their contribution through an electronic, self report, survey. Sixteen PAs responded, who were working in a variety of types of general practice teams. A range of activities were reported but the greatest proportion of their time was described as seeing patients in booked surgery appointments for same day/urgent appointments. The scope of the survey was limited and questions remain as to patient and professional responses to a new professional group within an interprofessional primary care context.

For more information see: http://informahealthcare.com/doi/abs/10.3109/13561820.2012.686538

Wednesday, February 22, 2012

Informal interprofessional learning: Visualizing the clinical workplace





Very interesting article on JIC early online: Informal interprofessional learning.


Written by: Judith Martine Wagter (Foreest Medical School, Medical Centre Alkmaar
Alkmaar
The Netherlands)
, Gerhard van de Bunt (Faculty of Social Sciences, VU Amsterdam University
Amsterdam
The Netherlands)
, Marina Honing (ICU/MCU, Medical Centre Alkmaar
Alkmaar
The Netherlands)
, Marina Eckenhausen (Foreest Medical School, Medical Centre Alkmaar
Alkmaar
The Netherlands)
, Albert Scherpbier (School of Health Professions Education, Maastricht University
Maastricht
The Netherlands).

Daily collaboration of senior doctors, residents and nurses involves a major potential for sharing knowledge between professionals. Therefore, more attention needs to be paid to informal learning to create strategies and appropriate conditions for enhancing and effectuating informal learning in the workplace. The aim of this study is to visualize and describe patterns of informal interprofessional learning relations among staff in complex care. Questionnaires with four network questions – recognized as indicators of informal learning in the clinical workplace – were handed out to intensive and medium care unit (ICU/MCU) staff members (N = 108), of which 77% were completed and returned. Data were analyzed using social network analysis and Mokken scale analysis. Densities, tie strength and reciprocity of the four networks created show MCU and ICU nurses as subgroups within the ward and reveal central but relatively one-sided relations of senior doctors with nurses and residents. Based on the analyses, we formulated a scale of intensity of informal learning relations that can be used to understand and stimulate informal interprofessional learning.

For more information, please read the Journal of Interprofessional Care, early online (February 14 2012).

Thursday, February 9, 2012

From the nurses' station to the health team hub: How can design promote interprofessional collaboration?



Great article on how can design promote interprofessional collaboration.
Written by: Lyn Frances Gum (School of Medicine, Flinders University Rural Clinical School
South Australia
Australia), David Prideaux (School of Medicine, Flinders University
Adelaide
Australia), Linda Sweet (School of Medicine, Flinders University Rural Clinical School
South Australia
Australia), Jennene Greenhill (School of Medicine, Flinders University Rural Clinical School
South Australia
Australia)


Interprofessional practice implies that health professionals are able to contribute patient care in a collaborative environment. In this paper, it is argued that in a hospital the nurses' station is a form of symbolic power. The term could be reframed as a “health team hub,” which fosters a place for communication and interprofessional working. Studies have found that design of the Nurses' Station can impact on the walking distance of hospital staff, privacy for patients and staff, jeopardize patient confidentiality and access to resources. However, no studies have explored the implications of nurses' station design on interprofessional practice. A multi-site collective case study of three rural hospitals in South Australia explored the collaborative working culture of each hospital. Of the cultural concepts being studied, the physical design of nurses' stations and the general physical environment were found to have a major influence on an effective collaborative practice. Communication barriers were related to poor design, lack of space, frequent interruptions and a lack of privacy; the name “nurses' station” denotes the space as the primary domain of nurses rather than a workspace for the healthcare team. Immersive work spaces could encourage all members of the healthcare team to communicate more readily with one another to promote interprofessional collaboration.


For more information, please read the Journal of Interprofessional Care 
January 2012, Vol. 26, No. 1 , Pages 21-27.


Tuesday, January 31, 2012

Professional status and interprofessional collaboration: A view of massage therapy


Fascinating article that examines massage therapy and professional status and interprofessional collaboration. Written by Cathy Fournier (Department of Health Studies, University of Toronto
Toronto, Ontario
Canada; Department of Psychiatry, Wilson Centre for Research in Medical Education, University of Toronto
Toronto, Ontario
Canada), Scott Reeves ( Director, Center for Innovation in Interprofessional Healthcare Education,University of California, San Francisco).


Massage therapy is one of the fastest growing complementary and alternative medicine (CAM) modalities in North America. Massage therapy has been regulated under the Regulated Health Professions Act (RHPA) in Ontario, Canada since 1994. The RHPA governs physicians, nurses and midwives, among other health care professionals. There
is a growing body of evidence for the efficacy of massage therapy for a number of conditions considered a burden for patients and the health care system, such as musculoskeletal
pain, discomforts of cancer treatment, depression and anxiety (Moyer, Rounds, & Hannum, 2004; Sturgeon, Wetta-Hall, Hart, Good, & Dakhil, 2009). Patient/public demand has contributed to CAM modalities, including massage therapy, being made available to patients on a fee for service basis within hospital and other medical settings (e.g. Soklaridis, Kelner, Love, & Cassidy, 2009). Despite the developing evidence for the role of massage therapy in health care and patient/public demand for this service, it remains on the periphery of mainstream health care. The peripheral role of massage therapy is apparent by questions about its legitimacy, and its absence in discussions of interprofessional collaboration, in health care. While regulation is commonly associated with a move towards professionalization and improvements in the status of health care professionals (Finch, 2009), these issues in relation to massage therapy continue to be a challenge. A small number of studies have recently examined CAM in relation to interprofessional collaboration, yet massage therapy was not the main focus (Gaboury, Bujold, Boon, & Moher, 2009; Soklaridis et al., 2009). The purpose of this study was to explore perceptions of the professionalization
and status of massage therapists, and the implications for interprofessional collaboration.

For more information, please see the Journal of Interprofessional Care January 2012, Vol. 26, No. 1 , Pages 71-72.


Tuesday, January 24, 2012

Collaboration: What is it like? – Phenomenological interpretation of the experience of collaborating within rehabilitation teams



Great article by: Croker, Trede, & Higgs (The Education For Practice Institute, Charles Sturt University
Sydney
Australia)

Although a core component of many current health-care directions, interprofessional collaboration continues to challenge educators and health professionals. This paper aims to inform the development of collaborative practice by illuminating the experiences of collaborating within rehabilitation teams. The researchers focused on experiences that transcended team members' professional role categorizations in order to bring individuals and their lived experiences to the forefront. An inclusive view of “teams” and “collaboration” was adopted and the complexity and multifaceted nature of collaborating were explored through a hermeneutic phenomenological approach. Semi-structured interviews were used to gather data about experiences of collaborating in nine rehabilitation teams. Sixty-six team members across nine teams were interviewed. Eight interdependent dimensions, core to the experience of collaborating, emerged from the analysis of the data. Five dimensions expressed interpersonal dimensions of endeavorengaging positively with other peoples' diversity; entering into the form and feel of the team; establishing ways of communicating and working together; envisioning together frameworks for patients' rehabilitation and effecting changes in people and situations. Three reviewing dimensions, reflexivity, reciprocity and responsiveness, operated across the endeavor dimensions. By identifying meaning structures of the experience of collaborating, this study highlights the importance of seeing beyond team members' professional affiliations and being aware of their contextualized interpersonal and activity-related collaborating capabilities.

For more information, please read the Journal of Interprofessional Care 
January 2012, Vol. 26, No. 1 , Pages 13-20.




Tuesday, January 17, 2012

Changes in attitudes toward interprofessional health care teams and education in the first- and third-year undergraduate students



Great article written by: Tomoko Hayashi, Hiromitsu Shinozaki, Takatoshi Makino, Hatsue Ogawara, Yasuyoshi Asakawa, Kiyotaka Iwasaki, Tamiko Matsuda, Yumiko Abe, Fusae Tozato, Misako Koizumi, Takako Yasukawa, Bumsuk Lee, Kunihiko Hayashi, and Hideomi Watanabe. (Gunma University, Japan)


The interprofessional education (IPE) program at Gunma University, Maebashi, Japan, implements a lecture style for the first-year students and a training style for the third-year students. Changes in the scores of modified Attitudes Toward Health Care Teams Scale (ATHCTS) and those of modified Readiness of health care students for Interprofessional Learning Scale (RIPLS) at the beginning and the end of the term were evaluated in the 2008 academic year. Two hundred and eighty-five respondents of a possible 364 completed the survey. In both the scales, the overall mean scores declined significantly after the lecture-style learning in the first-year students, while the scores improved significantly after the training-style learning in the third-year students. Exploratory factor analysis revealed that the modified ATHCTS was composed of three subscales, and the modified RIPLS two subscales. Analyses using regression factor scores revealed that the scores of “quality of care delivery” subscale in the modified ATHCTS and those of “expertise” subscale in the modified RIPLS declined significantly in the first-year students. Consequently, IPE programs may be introduced early in the undergraduate curriculum to prevent stereotyped perceptions for IPE, and comprehensive IPE curricula may result in profound changes in attitudes among participating students.
For more information, please read the Journal of Interprofessional Care (Early Online)


Thursday, January 12, 2012

Welcome 2012!

Looking back, 2011 has been another successful year for Journal of Interprofessional Care (JIC). This success is expressed in a number of different ways. The editorial office has continued to receive an increasing number of submissions over the past 12 months. Last year, the editorial team processed over 250 articles, editorials, commentaries, reports and reviews. The quality of the submissions has continued to increase, indicating that the academic work of our colleagues in the interprofessional field strives forward. For example, we have seen an expansion of methodological papers that outline innovative approaches by which we can build more robust empirical work. Also, our current call for papers on theoretical perspectives (due to be published later this year) has yielded nearly 20 potential contributions, with a range of stimulating ideas for using social science theories to illuminate and better understand the interprofessional domain.
Importantly, in 2011, JIC was awarded its first impact factor (0.793) from Thomson Reuters. Securing an impact factor provides an indication of the value of a journal in its academic domain, and is therefore a cause for celebration among editorial team and board members, authors, peer reviewers and our publisher – Informa. However, as the first JIC editorial of 2012 points out, while it is important to recognize the opportunities an impact factor offers an academic journal (e.g. increased attraction for authors), one also needs to understand the limitations of the methods used to calculate an impact factor (Reeves, Kenaszcuk, Sawatzky-Girling & Goldman 2012).
In 2011, we have also strengthened our editorial team by a number of new appointments whose talents will further enhance the quality of our editorial work. I am delighted to announce that we have four new associate editors – Julia Coyle (University of New South Wales, Australia), Craig Kuziemsky (University of Ottawa, Canada), Angus McFadyen (AKM-STATS, Glasgow, UK), Flemming Jakobsen (Regional Hospital Holstebro, Denmark); a new co-editor for the short reports section – Tina Martimianakis (University of Toronto, Canada) and a new co-editor of our reviews section – Tyler Law (McMaster University, Canada).
Encouragingly, the Journal's social media sites continue to have a widening presence on the Internet. For example, the JIC Twitter account now has over 400 followers, while the JIC Facebook account has nearly 100 members. Earlier this year, the Journal launched its own YouTube Channel and Blog, and posted a number of podcasts on its main website. Collectively, these different forms of social media provide additional insights and information which aim to complement the Journal's conceptual, empirical and theoretical papers and reports, editorials, commentaries and reviews.
Personally, this year has been one of change. After 6 years at the University of Toronto, I moved to the University of California, San Francisco, to begin an exciting new role as the Founding Director for the Center for Innovation in Interprofessional Healthcare Education. This new post allows me to extend my increasing interest in leading interprofessional initiatives while continuing my research and editorial work. As a result of this move, the editorial office is now more virtual in nature, spanning both San Francisco and Toronto, as Joanne Goldman continues her invaluable work as JIC Managing Editor based in Toronto. This means that the editorial office work is now undertaken by use of various information technologies, similar to many journals that have online submission systems like JIC.
Looking into 2012, our aim is to continue to build upon these successes: strengthen the quality of JIC papers through robust editorial work, work to increase our impact factor and extend our Internet presence by continued use of different social media applications. Once again, I would like to thank all the members of our editorial team and editorial board, whose hard work and contributions ensure the continued success of Journal of Interprofessional Care.

Thank you,
Scott Reeves (Editor-in-Chief)


For more information, please see the Journal of Interprofessional Care: http://informahealthcare.com/journal/jic

Tuesday, January 3, 2012

A cross-institutional examination of readiness for interprofessional learning



Happy New Year from everyone at the Journal of Interprofessional Care!

Great article exploring a cross-institutional examination of readiness for interprofessional learning. 
Written by: Sharla King (Health Sciences Education and Research Commons, University of Alberta
Edmonton, AB
Canada, Department of Educational Psychology, University of Alberta
Edmonton, AB
Canada)
Elaine Greidanus (Health Sciences Education and Research Commons, University of Alberta
Edmonton, AB
Canada)Rochelle Major (Department of Educational Psychology, University of Alberta
Edmonton, AB
Canada)Tatiana Loverso (Department of Educational Psychology, University of Alberta
Edmonton, AB
Canada)Alan Knowles (Department of Social Work, MacEwan University, Edmonton
Alberta
Canada)Mike Carbonaro (Department of Educational Psychology, University of Alberta
Edmonton, AB
Canada)Louise Bahry (Department of Educational Psychology, University of Alberta
Edmonton, AB
Canada).

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

For more information, please read the Journal of Interprofessional Care, Early Online: http://informahealthcare.com/toc/jic/0/0