Summary: A pilot study to test the effectiveness of an innovativeinterprofessional education assessment strategy

In a recent quasi-experimental pilot study, Emmert and Cai tested an assessment tool designed to evaluate students' teamwork skills, and assessed the effectiveness of an interprofessional education (IPE) course. 

Participants were health professional students (physical therapy, pharmacy, dental and osteopathic medicine) 24 of whom were second-year students who had previously taken part in an IPE course (experimental group), and 22 of whom were third years that had not (control group). Students interacted with a standardized patient and her son during an asynchronous Team Objective Structured Clinical Exam (TOSCE), after which they were scored on their teamwork skills using newly designed teamwork rating scales.

Cronbach Alpha calculations suggested that the rating scales were reliable when rater scores were aggregated (0.81). Pearson coefficient calculations determined that teamwork scores of live raters and video raters were significantly correlated (p < 0.0001), suggesting good consistency across these raters. The experimental group performed significantly better (p = 0.0003) than the control group, suggesting that the IPE curriculum is successfully equipping students with teamwork skills.

The results of this study contribute to the much needed IPE assessment literature, and suggest that teamwork skills can be taught and effectively assessed using this new rating scale.

For more: http://informahealthcare.com/doi/abs/10.3109/13561820.2015.1025373

Summary: Attitudes of nursing school deans toward interprofessionaleducation in Western Pacific Region countries

A previous survey distributed to medical school deans in the Western Pacific Region (WPR) showed positive attitudes toward collaborative practice and interprofessional education (IPE).

Makino et al.'s recent survey built on this, aiming to clarify the present state of IPE and the attitudes of nursing school deans in the WPR. The modified Attitudes Toward Health Care Teams Scale (ATHCTS) and the modified Readiness of health care students for Interprofessional Learning Scale (RIPLS) were used.

Unexpectedly, the response rate was less than 20%. Deans of nursing schools with IPE courses showed significantly more positive attitudes than those of schools without IPE courses. The mean score of the modified ATHCTS and RIPLS of deans of nursing schools in rural areas were significantly higher than those in urban areas.

Compared with medical schools, nursing schools in the WPR pay less attention to IPE and this may be one of the present characteristics of the region.

For more: http://informahealthcare.com/doi/abs/10.3109/13561820.2015.1027337

Summary: Adherence to clinical guidelines in heart failure (HF) outpatients: Impact of an interprofessional HF team on evidence-based medication use

Clinical systolic heart failure (HF) guidelines specify recommendations for ACE inhibitors (ACEI), angiotensin receptor blockers (ARB) and beta blockers according to doses used in clinical trials. However, many HF patients remain suboptimally treated.

Crissinger and colleagues recently conducted a retrospective chart review to determine which provider type, between an interprofessional HF team, non-HF cardiologists and primary care physicians (PCP), most optimally manages HF medications and doses. The study was performed on adult patients at an academic county hospital with an ejection fraction ≤40% and a diagnosis of HF, seen by a single provider type (HF team, cardiologist or PCP) at least twice within a 12-month period.

Utilization rates of any ACEI/ARB and any beta blocker were robust across provider types, though evidence-based ACEI/ARB and beta blocker were greatest from the HF team. Doses of evidence-based therapies dropped markedly in the non-HF team groups. The percent of patients prescribed optimal doses of an evidence-based ACEI/ARB AND beta blocker was 69%, 33% and 25% for the HF team, cardiologists and PCPs, respectively (p < 0.0167). Patients followed by the HF team were more frequently prescribed evidence-based medications at optimal doses.

Crissinger et al.'s findings support the use of specialized interprofessional HF teams to attain greater adherence to evidence-based recommendations in treating systolic HF.

Read more: http://informahealthcare.com/doi/abs/10.3109/13561820.2015.1027334

Summary: Perceptions of interprofessional clinical simulation among medical and nursing students: A pilot study

Interprofessional education (IPE) is a well-supported concept in medical education and a priority for leadership. How students experience IPE is unclear.

A recent pilot study by Shanahan and Lewis evaluated how medical and nursing students perceived and experienced IPE. Ten medical and 10 nursing students participated in a clinical simulation-based IPE exercise with 2 medical and 2 nursing students per group. Participants completed the KidSIM ATTITUDES questionnaire before and after the exercise. Students provided verbal feedback during the post-exercise debrief.

Study results showed perceptions of the group became more positive with the exercise. With statistical significance across all the domains (relevance of IPE and simulation, communication, situation awareness, and roles/responsibilities), verbal comments were positive. A single clinical simulation-based IPE exercise improved perceptions of IPE among these students.

These results provide further impetus to continue to study IPE for medical and nursing students. The findings also support the inclusion of IPE in medical education.


Read more: http://informahealthcare.com/doi/abs/10.3109/13561820.2015.1027336

Summary: Impact of crisis resource management simulation-based training for interprofessional and interdisciplinary teams: A systematic review

Crisis resource management (CRM) abilities are important for different health care providers to effectively manage critical clinical events.

This study by Fung and colleagues aimed to review the effectiveness of simulation-based CRM training for interprofessional and interdisciplinary teams compared to other instructional methods (e.g., didactics). Interprofessional teams are composed by several professions (e.g., nurse, physician, midwife) while interdisciplinary teams are composed by several disciplines from the same profession (e.g., cardiologist, anaesthesiologist, orthopaedist). 

Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC were searched using terms related to CRM, crisis management, crew resource management, teamwork, and simulation. Trials comparing simulation-based CRM team training versus any other methods of education were included. The educational interventions involved interprofessional or interdisciplinary healthcare teams. The initial search identified 7456 publications; 12 studies were included. 

Simulation-based CRM team training was associated with significant improvements in CRM skill acquisition in all but two studies when compared to didactic case-based CRM training or simulation without CRM training. Of the 12 included studies, one showed significant improvements in team behaviours in the workplace, while two studies demonstrated sustained reductions in adverse patient outcomes after a single simulation-based CRM team intervention.

Fung and colleagues' findings suggest that CRM simulation-based training for interprofessional and interdisciplinary teams show promise in teaching CRM in the simulator when compared to didactic case-based CRM education or simulation without CRM teaching. Despite this, one must consider that more research is required to demonstrate transfer of learning to workplaces and potential impact on patient outcomes.

Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2015.1017555

Summary: Interprofessional team meetings: Opportunities for informal interprofessional learning

In their recent study, Gillian Nisbet, Stewart Dunn and Michelle Lincoln explore the potential for workplace interprofessional learning, specifically the learning that occurs between health professionals, as part of their attendance at their regular interprofessional team meetings. While most interprofessional learning research to date has focused on formal structured education programs, this study adds to our understanding of the complexities of the learning processes occurring between health professionals as part of everyday practice. 

Through observations of team meetings and semi-structured interviews, the study found that the interprofessional team meeting provided a practical, time-efficient, and relevant means for interprofessional learning, resulting in perceived benefits to individuals, teams, and patients. The learning process, however, was influenced by members’ conceptions of learning, participation within the meeting, and medical presence. 

Nisbet and colleagues' findings provide a basis for further research to assist health professionals capitalize on informal learning opportunities within the interprofessional meeting.


Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2015.1016602

Book Review: Where No Doctor Has Gone Before: Cuba’s Place in the Global Health Landscape

Where No Doctor Has Gone Before: Cuba’s Place in the Global Health Landscape

Robert Huish 

Waterloo, ON, Canada: Wilfrid Laurier University Press, 2013

156 pages. $31.65 USD

ISBN: 978-1-55458-833-6

Robert Huish, Assistant Professor at Dalhousie University, Department of International Development Studies, presents an overview of the Cuban health system, the Cuban medical education system, and the government’s effort to provide care beyond its borders.  This is a practical book that gives the historical background of how Cuba has survived decades of economic sanctions to become one of the world leaders in universal health care.  The author examines the different aspects of Cuban health care using credible evidence and a variety of sources including the author’s own experiences in Cuba learning how health care and medical education is delivered. 

The author seeks to show how the Cuban government views health care as a basic human right and refuses to compromise on their investment in human capital to provide primary care to all of its citizens.  The author delivers on this purpose by describing the historical background that led Cuba to use the model of training physicians to bring medical care to many outside of its borders.    

The first few chapters focus on the foundational aspect that health care should start at the community level with a focus on disease prevention and health promotion.  These chapters go into a rich and carefully documented amount of detail describing how health care is actually delivered, how Cuba has been able to use this model of care as a form of foreign policy, and how the country has benefitted from this focus on public health. There are also chapters dedicated to the concepts of Medical Tourism and Health Care Worker Migration.  Cuba’s approach to these topics has left positive imprints on many countries in the Caribbean and Latin America.   

The remaining chapters describe the Cuban medical education system, including the largest medical school in the world, the Latin American School of Medicine, or ELAM.  Medical education is discussed on a student level with multiple examples from student interviews that relate their experience of coming to Cuba to learn medicine for free. The only debt the students have is a moral one: a commitment to return to their countries and serve in the areas of most need.  Nevertheless, the author does not shy away from the challenges ELAM graduates face when returning to their native countries to practice. 

The author has written a very commendable book about how medicine, public health and international health blend together to meet the needs of thousands in Cuba. What is missing for me is how they use interprofessional health care teams as a model of care, a recent model of education for medical personnel.  This book was a pleasure to read. It would be perfect for those in medical education, public health, global health and primary care.  

The author ends the book with the five things he has learned from the Cuban health system.  This “top five” list, if you will, is a skillful reminder of the needs of global health and how a small island country has been able to use health care and education policy to make an impact in some of the worlds most underserved regions.   

Review by: Curt Stilp, Assistant Professor, Oregon Health & Science University