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INTRODUCTION: Permanent health education (PHE) is a strategy for qualifying work to improve patient care. OBJECTIVE: To analyze dentists' perspectives on the PHE actions in the context of Primary Health Care. METHODS: This qualitative case report study conducted through semi-structured interviews with 26 dentists in primary health care and five managers of PHE actions in the city of Sobral, in the Brazilian Northeast. RESULTS: Data analysis was performed using the Collective Subject Discourse anchored in the following social representations: characterization of PHE actions as educational actions through theoretical-conceptual moments, with an emphasis on technical-scientific approaches and transmissive methodologies of an unprofessional nature; critical reflexivity in indicating improvements for these actions through the incorporation of interprofessional education in PHE actions. CONCLUSION: The involvement of continuing education actions in PHE has the potential to problematize work and develop strategies for the qualification of patient care, without losing the technical and scientific characteristics of each profession. INTRODUÇÃO: A educação permanente em saúde (EPS) é uma estratégia de qualificação do trabalho para a melhoria da atenção ao paciente. OBJETIVO: Analisar as perspectivas dos cirurgiões-dentistas sobre as ações de EPS no contexto da atenção primária à saúde. MÉTODOS: Tratou-se de um estudo de abordagem qualitativa do tipo estudo de caso realizado por meio de entrevistas semiestruturadas com 26 cirurgiões-dentistas da atenção primária à saúde e cinco gestores das ações de EPS na cidade de Sobral no interior do Nordeste brasileiro. RESULTADOS: A análise dos dados se deu por meio do Discurso do Sujeito Coletivo ancorado nas seguintes representações sociais: caracterização das ações de EPS como ações educativas através de momentos teórico-conceituais com ênfase em abordagens técnico-científicas e de metodologias transmissivas de caráter unprofessional; reflexibilidade crítica em indicar possibilidades de melhoria dessas ações por meio da incorporação da educação interprofissional nas ações de EPS. CONCLUSÃO: A perspectiva da inclusão de ações de Educação Continuada como parte das ações de EPS identificada nos cirurgiões-dentistas tem potencial para problematizar o trabalho e desenvolver estratégias de qualificação do cuidado ao paciente, sem perda de características técnico-científicas de cada profissão.
Diabetes mellitus and periodontal disease: The call for interprofessional education and interprofessional collaborative care - A systematic review of the literature.
Diabetes mellitus and periodontal disease are among the most frequently occurring conditions that have a substantial effect on the global health economy. The literature regarding medical professionals' knowledge of the bidirectional link between diabetes mellitus and periodontal disease has not been analyzed systematically. The review aimed to investigate the knowledge and understanding of physicians and specialists regarding the two-way relationship between diabetes mellitus and periodontal disease and their approach to referring their patients for a dental consultation. An electronic search of PubMed and Google Scholar databases was conducted to review the studies that assessed knowledge and understanding of medical professionals regarding the relationship between diabetes mellitus and periodontal disease. Data from 13 included studies involved 4,027 participants: 3,256 primary care physicians and 771 medical specialists. Just over 50% of the medical professionals had an understanding of oral health and/or periodontal disease. Over one-third of medical professionals were ignorant of the relationship between oral health and diabetes mellitus. Only 30% reported ever referring their patients for an oral health assessment. Another key finding of the investigation was the absence of interprofessional collaborative care between medical and dental professionals while managing patients with diabetes mellitus. Medical professionals with an integrated knowledge of elementary oral health education and training could play a central role in the timely diagnosis and management of periodontal disease in patients living with diabetes mellitus.
INTRODUCTION: Interprofessional education (IPE) takes place when representatives of at least two professions work and learn together, about and from each other to provide optimal healthcare. For the successful implementation of an IPE programme, conceptualisation, planning, and operationalisation and coordination among the various professions is crucial, to assist students to obtain the desired competencies of such a programme. The purpose is to investigate if a structured IPE programme assisted radiography students to achieve competencies. METHODS: An online questionnaire was compiled from literature and completed by radiography students who participated in a structured, three-week-long IPE programme. The questionnaire was mainly quantitative (using a Likert scale), though it also consisted of qualitative elements (open-ended questions). A Fischer's Exact test was used to compare the responses of three different year groups. RESULTS: Feedback from the radiography students (n=63) indicated that they achieved this IPE programme's specific competencies: role clarification, interprofessional communication, teamwork, person-centered care and values and ethics. There was good correlation between the feedback from all three year groups. The feedback on the open-ended questions correlated with the quantitative feedback, though some students felt excluded, as there was little reference to their particular profession in the simulation session of the IPE programme. CONCLUSION: The results of the study indicate that radiography students achieved the prescribed competencies of a structured IPE programme. The results provide insight into ways to improve the IPE programme. A recommendation emanating from the results of this study is that, to improve the experience of all healthcare professions students, structured IPE programmes have to promote inclusive teaching and learning. IMPLICATIONS FOR PRACTICE: Radiography students that participate in a structured IPE programme develop competencies necessary for effective collaborative clinical practice.
BACKGROUND: Interprofessional education (IPE) for medical and healthcare professions is highly relevant. It increases knowledge and skills, but also helps to foster the development of collaboration, which is essential for optimal patient care. One important aspect of IPE is to better understand profession's individual attitudes and perceptions towards interprofessionalism and the expected roles and skills for future collaboration in the context of patient care. METHODS: We offered IPE workshops using a peer assisted learning approach, with the focus on anatomy in the area of the lower back and hip. The workshops were attended by medical and physiotherapy students and consisted of three consecutive training sessions with the topics anatomical prosections, anatomy in vivo and orthopedics testing. We focused on student's attitudes and perceptions regarding the relevance of IPE and their expected skills in interprofessionalism. An established questionnaire was used as an instrument for self-assessment before and after the interprofessional experience. To evaluate for significance, analysis was carried out for all groups on pre- and post-course item mean differences. RESULTS: Pre-post score comparison for all groups combined demonstrated significant increase in terms of perceptions and attitudes for several items related to interprofessionalism and interprofessional skills. Medical and physiotherapy students rated themselves significantly higher for different questionnaire items. Students, who had obtained a professional qualification prior to their current studies, rated themselves significantly higher on certain items compared to those who had not. CONCLUSIONS: The results from this brief interprofessional anatomy experience are encouraging. The course led to meaningful improvements in competencies that are highly relevant for effective interprofessional collaboration in the future. Furthermore, identification of differences in professional group perceptions can be useful for development of future IPE workshops.
Blending interprofessional education and simulation learning: A mixed-methods study of an interprofessional learning experience with nursing and occupational therapy students.
In aiming to train health professional students to collaborate in patient care settings, the purpose of this study was to evaluate the perception of registered nurse (RN) students and occupational therapy (OT) students jointly participating in an interprofessional education (IPE) patient simulation learning experience. Eighty-five RN and OT students engaged in a 3-hour IPE patient simulation in an acute care hospital setting. Each student participant completed a pre- and post-test data collection, assessing interprofessional socialization using the Interprofessional Socialization and Valuing Scale (ISVS) Version 9A and provided qualitative feedback about their experience. Findings indicated a significant change in interprofessional socialization for RN and OT students after engaging in the IPE patient simulation learning experience. Furthermore, qualitative findings described the perceived benefits of IPE and collaboration, simulation as a learning tool, and areas for enhancing IPE patient simulation education for the future. Study findings have implications for using simulated IPE experiences with health professional students to foster interprofessional collaboration and socialization with the goal of delivering person-centered quality healthcare.
Development of a questionnaire to assess student behavioral confidence to undertake interprofessional education activities.
Measurement of the impact of interprofessional education (IPE) is the golden chalice educationalists chase. We undertook the development of a scale to measure IPE Academic Behavioral Confidence (IPE-ABC) in allied health, nursing, and social work pre-registration students. This work formed part of the evaluation of a large IPE framework embedded across two Scottish universities. General ABC has been shown to influence student perceptions of study experiences and it is thus reasonable to postulate that ABC could influence student perceptions of IPE. This research developed a questionnaire to ascertain health and social care students' confidence to engage in IPE, utilizing a mixed method approach. Fifteen different professional groups of pre-registration students (n = 565) participated in the assessment of the 38 item questionnaire. Exploratory factor analysis identified three factors: 1/interprofessional teamwork, 2/behaviors underpinning collaboration, and 3/interprofessional communication collectively accounting for 38.2% of the variance. Internal consistency of the overall scale (Cronbach's α = .93) was very good with subscales demonstrating very good internal consistency, 1 (α = .89), or respectable consistency 2 (α = .78) and 3 (α = .79). We conclude the IPE-ABC questionnaire could be utilized to enhance and assess the success of IPE related activities.
Medical education has an important role in developing attitudes, behaviors and cultures that support safe care. Increasingly, however, research has argued for a more interprofessional approach to be taken. This scoping review examines the design and impact of interprofessional education interventions involving medical students that focus on patient safety. We systematically searched PubMed, EMBASE, PsycINFO and CINAHL between January 2000 and November 2019. Studies were eligible if they included medical students and at least one other profession, interactive learning, a strong emphasis on patient safety in the learning objectives, and an empirical method of evaluation. Forty-three studies met these criteria and the diverse range of approaches to intervention design and method of evaluation are detailed in this review. We found that interprofessional patient safety education interventions are generally well received by students with knowledge and skill gain documented; several also reported changes in student behaviour. However, the lack of empirically driven study designs, combined with the lack of rigour when reporting, makes it difficult to draw clear comparisons. Future research should address this, and in particular, report how and why the intervention has been designed to be delivered interprofessionally.
An exploratory, cross-sectional and multi-institutional study using three instruments to examine student perceptions of interprofessional education.
Interprofessional education (IPE) research needs to expand beyond single site, single event inquiry. Multi-institutional studies increase methodologic rigor and generalizability, advancing the pedagogical science of IPE. Four U.S. institutions used three different validated measures to examine early learner interprofessional outcomes. The three assessment tools included the Communication and Teamwork subscale of the University of West England Entry Level Interprofessional Questionnaire (UWE-ELIQ), the Self-Assessed Collaboration Skills (SACS), and the Interprofessional Teamwork and Team-based Practice factor of the Student Perceptions of Interprofessional Clinical Education-Revised, version 2 (SPICE-R2). Across the four institutions, 659 eligible participants, representing 19 programs completed the pre-survey, and 385 completed the post-survey. The UWE-ELIQ showed a statistically significant difference between the pre- and post-survey overall, but the effect size was small. One institution demonstrated a positive change in scores on the UWE-ELIQ with a small effect size, while the other institutions saw no significant change. Two institutions observed lower post-survey scores on the SPICE-R2. Cumulative results from the study indicated no statistically significant change from pre- to post- in total SACS or SPICE-R2 scores. Additional multi-site longitudinal research is needed to investigate use of validated instruments, as well as the impact of curricula and learning environment on educational outcomes.
Interprofessional education in the Dentistry curriculum: Analysis of a teaching-service-community integration experience.
INTRODUCTION: Interprofessional education (IPE) offers relevant theoretical, conceptual and methodological approaches to the development of effective teamwork competencies. OBJECTIVE: To analyse an interprofessional experience of teaching-service-community integration carried out at a public university in the South of Brazil. METHODS: A case study with a qualitative approach was carried out. The study's participants were thirty-eight undergraduate dental students who attended the IPE activity between 2012 and 2019. Data collection was developed in two sequential steps that included the application of an online instrument and semi-structured interviews. The textual material was interpreted by content analysis, considering Kirkpatrick's evaluation levels (reaction, learning and behaviour). RESULTS: In the reaction level, students highlighted the contents provided by the National Curricular Guidelines regarding public health system and teamwork, as well as the pedagogical teaching proposal by tutoring groups, which stimulated students' autonomy. It was observed that the learning was geared towards the development of collaborative teamwork competencies and cultural competencies. In the behaviour level, students perceived positive changes in their attitudes and behaviours towards patients, focused on needs related to life conditions, realising that dentists may work within a team. The elective/optional nature of the experience allied with the absence of other IPE activities in the curricular grid showed to be challenging. CONCLUSION: IPE in undergraduate education presented positive results related to the reaction, learning and behaviour of dental students. We recommend the inclusion of interprofessional activities of teaching-service-community integration in Dentistry curricular structure to complement uniprofessional education.
Student-led clinics provide a unique opportunity for interprofessional education as part of the education of future allied health professionals. A rapid review was conducted to determine the benefits to allied health students participating in interprofessional education in student-led clinics. Studies were included if they took place within a student-led clinic, reported on outcomes for students and where the clinic involved interprofessional education for students from either two or more allied health professions, or one allied health and one nursing student. Results were analyzed using a descriptive qualitative approach. Five themes were identified: (a) understanding of own role and scope of practice; (b) understanding of the role and scope of practice of other professions; (c) individual benefits to the students; (d) impact on patient-centered care; and (c) understanding of how to work in an interprofessional team. These benefits indicate that student-led clinics are a suitable setting for the delivery of interprofessional education to allied health students. More research is needed that considers the long-term impact on these student outcomes following students' entry into the healthcare profession, as well as on the impact of specific components of the interprofessional education models on student outcomes.
Interprofessional health-care ethics education for medical and nursing students in Germany: an interprofessional education and practice guide.
Early interprofessional learning among nursing and medical students provides various benefits for future collaboration among professionals, and high-quality care for patients. Expert committees, thus, urge the integration of interprofessional education (IPE) in undergraduate studies to achieve significant sustainable improvements in health-care practice. In Germany, IPE interventions are already implemented in some health-care disciplines, but Health-care Ethics are scarcely regarded in undergraduate education. There are, however, several reasons why Health-care Ethics is particularly appropriate for teaching in an interprofessional format. Thus, after reviewing the legal framework and the current curricula of both professions, an IPE course on Health-care Ethics for medical and nursing students was developed and implemented, consisting of seven classes of 180 minutes each. Drawing on the evaluation results after two rounds of the course, this interprofessional education and practice guide reports on challenges, obstacles and perspectives for improvement of an IPE course on Health-care Ethics. It aims to provide guidance for teaching pioneers and innovators who implement similar projects and to foster practice-oriented and open discussion about the possibilities and limits of IPE in Health-care Ethics.
Does collective efficacy drive readiness for interprofessional learning? Evidence from a large-scale interprofessional education program in Hong Kong.
Interprofessional education has been widely integrated into health education curricula to enable students to work comfortably as members of a healthcare team. However, not much is known about the psychosocial mechanism that defines students' readiness for interprofessional learning. Drawing from social cognitive theory, we examined the pathway where collective efficacy was construed to influence subsequent students' satisfaction with team experiences, readiness for interprofessional learning, and attainment of interprofessional learning outcomes. Through path analysis, we examined data from 1,005 health and social care students who participated in a large-scale interprofessional education in Hong Kong. Results indicated that collective efficacy directly and indirectly predicted students' readiness for interprofessional learning and perception of attainment of IPE learning outcomes. Theoretical and practical implications of findings in the management of interprofessional education are discussed.
The short version of students' perceptions of interprofessional clinical education-revised (SPICE-R3): a confirmatory factor analysis.
The Students' Perceptions of Physician-Pharmacist Interprofessional Clinical Education and its revision (SPICE, SPICE-R) were designed to understand medicine and pharmacy students' perceptions of interprofessional education and collaborative practice in managing complex health problems. The SPICE-R authors, however, suggested for additional items for subscales "roles and responsibilities for collaborative care" and "patient outcomes from collaborative practice". We added two items and introduced SPICE-R3 to differentiate it from the 10-item SPICE-R2 and to adapt the scale to a wider range of healthcare members. We administered the SPICE-R3 to healthcare students at the height of the COVID-19 outbreak in Hong Kong in February 2020. Using data from 225 students from Chinese medicine, medicine, nursing, and pharmacy, confirmatory factor analysis indicated nine items having acceptable item coefficients. Our data obtained a good fit to the three-factor, nine-item model suggesting construct validity. Results of the between-network analysis suggest that the three subscales of SPICE-R3 correlated systematically with other theoretically relevant variables in the nomological network suggesting convergent validity. The SPICE-R3 is a valid measure to examine Hong Kong healthcare students' interprofessional attitudes in online interprofessional education even during the pandemic. Implications and directions for future research are provided.
Interprofessional education and collaborative practice in Kuwait: attitudes and perceptions of health sciences students.
Interprofessional education (IPE) prepares health students to become collaboration-ready healthcare professionals. Assessing students' baseline attitudes toward IPE and collaborative practice is essential to inform development of IPE curricula. Kuwait University Health Sciences Center (HSC) is early in its IPE journey but is planning to join the broader global movement toward IPE. A cross-sectional survey was conducted to explore the attitudes of HSC students from Faculties of Medicine, Dentistry, Pharmacy, and Allied Health Sciences toward collaborative practice and IPE at early and late stages of study. A total of 770 students completed the survey (81.1% response rate). Students expressed positive attitudes toward interprofessional healthcare teams and IPE (median [IQR] overall attitudes were rated 4.0 [1.0] and 4.0 [2.0], respectively, on a scale of 5). Overall attitudes toward both scales were significantly more positive among pharmacy students than students from other faculties (p < .001). Final-year students reported more positive attitudes toward healthcare teams than early- and middle-year students, while early- and final-year students expressed more positive attitudes toward IPE than middle-year students (p < .001). There were no significant differences in overall attitudes between female and male students toward the two scales (p > .05). These findings have implications for engaging students from different professions in IPE initiatives.
ISSUE: Although interprofessional education (IPE) is acknowledged as a way to prepare health professions students for future interprofessional collaboration (IPC), there is a need to better ground IPE-design in learning theory. Landscapes of practice and its concepts of knowledgeability and identification are suggested as a framework that may help optimize IPE. This Observation paper provides an explanation of how these concepts might be used in IPE-design. EVIDENCE: We propose using three modes of identification, i.e., engagement, imagination, and alignment, described in this framework, for an IPE-design that fosters IPC skills, professional identity formation, and knowledgeability about a field and its actors. Identification and knowledgeability are through to enable successful collaboration across professional and practice boundaries. IMPLICATIONS: Focusing on identification implies that students develop a sense of relevance to one another in solving complex problems (engagement), they become aware of their own roles and responsibilities in relation to others (imagination), and they gain awareness of the context in which the different professions align and collaborate (alignment). Altogether, this enables students to become knowledgeable in the landscape, which prepares them for successful interprofessional collaboration in practice.
The purpose of this mixed-method longitudinal study was to understand how health professional students' perceptions of their professional flexibility, role interdependence, and reflection on their process of working together change over time as a result of participating in an interprofessional education course. Data were collected from students enrolled in an interprofessional service-learning course each year from Fall 2014 to 2018 via online surveys at four assessment points and through qualitative reflection papers that served as course assignments. The 14-week course consisted of both didactic instruction and an experiential component whereby students conducted a service-learning activity in interprofessional teams. Quantitative findings demonstrate that students experienced a significant quadratic growth trajectory in reflection on process and a significant linear growth trajectory in professional flexibility. Students reported experiencing non-significant changes in role interdependence. Qualitative data, however, suggest student learning across all three domains. This study has implications for interprofessional educational initiatives aimed at promoting students' interprofessional competencies.
SUMMARY STATEMENT: On-site interprofessional education (IPE) simulation is primarily used to teach students teamwork, communication, and crisis resource management. Participants view it as an educational environment in which to acquire and consolidate skills. Virtual IPE simulation is traditionally seen as an opportunity to supplement, complement, and reinforce on-site IPE (OI). We used VI as the sole simulation method during the COVID-19 pandemic to provide IPE because of constraints of social distancing. The VI resulted in substantially achieving similar learning outcomes to OI. This suggests that VI, which has the advantage of being cheaper and more easily scalable than OI, may be an effective remote learning modality for IPE.
OBJECTIVE: The objective of this scoping review is to identify, characterize, and summarize evidence from the published literature on clinical interprofessional education. INTRODUCTION: Clinical interprofessional education refers to learning within clinical learning environments, such as hospitals, primary care clinics, and long-term care facilities. The learning involves direct interaction with real patients, where learners collaborate to deliver care and improve health outcomes. INCLUSION CRITERIA: This scoping review will consider clinical interprofessional education activities in the context of patient care. Criteria include two or more health professions, two or more learner groups, and involvement of real patients/patient care. METHODS: This review will be conducted in accordance with the JBI methodology for scoping reviews. Databases searched will include PubMed, CINAHL, and Scopus. Results will be limited to English language publications from 2015 to the present. Extracted data will include the different types of clinical learning environments, the professions involved, the targeted learning/competency outcomes, and the measurement tools used by the authors. Titles/abstracts and full texts of articles will be screened by two reviewers for potential inclusion, with discrepancies resolved by a third reviewer if necessary. Extracted data will be presented in diagrammatic or tabular format. A narrative summary will accompany the tabulated and/or charted results, describing how the results relate to the review objective and research questions, and how the results might inform future clinical interprofessional education in health professions education.