Dale Sheehan

Comparison of language used and patterns of communication in interprofessional and multidisciplinary teams

Can the language used and the patterns of communication differentiate a multidisciplinary team from an interprofessional team? This research question arose from an unexpected outcome of a study that investigated clinical reasoning of health professional team members in the elder care wards of two different hospitals. The issue at stake was the apparent disparity in the way in which the two teams communicated. To further explore this, the original transcribed interview data was analysed from a symbolic interactionist perspective in order that the language and communication patterns between the two teams could be identified and compared. Differences appeared to parallel the distinctions between multidisciplinary and interprofessional teams as reported in the literature. Our observations were that an interprofessional team was characterized by its use of inclusive language, continual sharing of information between team members and a collaborative working approach. In the multidisciplinary team, the members worked in parallel, drawing information from one another but did not have a common understanding of issues that could influence intervention. The implications of these communication differences for team members, team leaders and future research are then discussed.

Interns' participation and learning in clinical environments in a New Zealand hospital

Purpose To explore factors that encourage interns to participate actively within clinical rotations. Encouraging their participation in workplace interactions and activities during their clinical rotations is central to effective development of clinical practice. Method In 2002–03, individual interviews and a focus group were conducted to gather data about interns’ experiences in clinical rotations within a New Zealand hospital setting. A model for planning and organizing clinical learning was drafted and refined by iteration with other learners and more experienced peers. Results The findings resulted in a model for participation in clinical settings where two critical components were identified: the tasks of patient care and engagement with the clinical team. These two components are further divided into two aspects: initiation and maintenance. The outcome of all four factors working well is a reinforcing cycle of activities that promote and encourage effective participation and learning. Conclusion This model could provide a framework and best-practice guide that could be used for faculty development and thereby allow both supervisors and learners to gain confidence and satisfaction.

Becoming a practitioner: Workplace learning during the junior doctor's first year

Background: Newly qualified doctors (interns) report that they learn a great deal in the first year of practice, but exactly what is learnt is not well understood. Aims: To document the reflections and perceptions of first year junior doctors in order to reveal and chronicle their informal and often tacit learning in the workplace within a practice methodology framework. Methods: New Zealand interns, from three sites, participated in group interviews modelled on a conversation and joint enquiry style. Results: We found that learning in the first year after graduation falls into three broad themes: (1) concrete tasks, (2) project management and (3) identity formation. Identity formation appeared the most challenging and included getting used to being seen by others as a doctor. Conclusion: All themes have implications for curriculum development and clinical supervision in both undergraduate programmes and during internship. The third theme (identify formation) is the most complex. We draw on a model from management literature, to describe intern education as a process of becoming: as an unfolding and as a transformation of the self over time. We argue that reconfiguring internship as a period of identity formation, and as a self-determined, active process of ‘becoming a doctor’ provides a wider perspective than enculturation or socialisation theories to understand this significant transition.

Maximising the clinical learning of junior doctors: applying educational theory to practice.

Effective learning in the workplace emphasises the importance of participation in the social context and activities of that workplace. A model has previously been developed that sets out the elements of positive and participatory learning environments. The introduction of an attachment in the Emergency Department for newly graduated doctors provided an opportunity to (1) identify and implement the relevant elements from the theoretical model; (2) develop an evaluation plan in order to guide and monitor the intervention. The lessons learned from converting a theoretical model into practice and the use of quality management processes for implementation, monitoring, and evaluation are discussed.

Collaborative practice and interprofessional education and workplace learning

One of the biggest challenges faced by workplace educators is the design and implementation of training that primarily requires an attitudinal change or a change in perspective. Currently in the health sector internationally there has been highlevel policy impetus given to interprofessional collaboration, yet health professions primarily educate their new practitioners in silos. The most influential consideration of the role and importance of interprofessional education (IPE) appears in reports published by the World Health Organization (WHO). In its latest report, the WHO considered a range of studies published in the literature (including a systematic review) and carried out extensive consultation culminating in the Framework for Action on Interprofessional Education and Collaborative Practice launched in 2010 (WHO, 2010).

The development of a national bicultural and interprofessional programme in clinical teaching and supervision in New Zealand

Throughout the world, particularly in colonized countries, the health status of indigenous people and the unequal representation of indigenous people within the health workforce is of concern. In 2002, as part of a national health workforce development strategy, a qualification was developed to provide Maori (Indigenous New Zealander) health professionals with the skills and confidence to teach and supervise students on clinical placements in Maori health environments. This project required close collaboration between two education providers, one a Maori private education provider and the other a traditional government-funded tertiary institution; and for both organizations to work cooperatively with Maori communities and Maori health providers. The Christchurch College of Education (CCE) and Mauri Ora Associates are jointly involved in the administration, design and delivery of the programme, recruitment of guest lecturers, and ongoing curriculum updates. The content for the programme is mainstream, international and interprofessional but the pedagogy is Maori, with Maori customs, values and traditions upheld and practised. A national Maori health workforce development organization contracts independently with both organizations and provides an oversight and quality monitoring role. Together, the three organizations work with other Maori health professional groups and Maori elders to deliver the qualification. This paper describes how this course was designed, how it is delivered within a Maori paradigm, and how the outcomes are achieved. It also describes the cooperation between Maori and Pakeha (white New Zealanders) across health, community and educational organizations that was required to sustain this programme over five years and identifies some themes that may be applied in a global context. In sharing our experiences, we hope to inspire others to consider ways they can meet the needs of indigenous learners within their mainstream programmes.

Healthcare Systems and Spaces

Healthcare is a broad yet heterogeneous notion that can be viewed in different ways. On one hand, healthcare is a service industry with major employer status, high expenditure and rapid growth. As a service industry healthcare tends to be objectified as a set of efficient, reproducible, measurable systems. On the other hand, healthcare encompasses a range of human relational experiences. These experiences draw on and reflect people’s various situations, perspectives, needs, fears and aspirations, as healthcare providers, patients, clients, consumers and carers.

Reflections on the impact of time and context in clinical learning

Clinical placements are the foundation of health professional education and a requirement of accrediting bodies internationally. The expectation is that experience in practice environments will equip graduates with the competence and capabilities to be ready for work. Some accrediting bodies quantify this experience in terms of time: hours spent on clinical placements. Placements have become valuable resources as student numbers grow and health providers become increasingly resource poor. How much time students spend in a placement and how that time is structured become important considerations for programme growth as these factors effectively cap the number of students in a programme.

Developing Pharmacy Leaders — Interprofessional Education at Work

This chapter outlines a project in a hospital environment where one profession (pharmacy) took a leadership role in interprofessional education experience. This enhanced understanding between the professions of medicine and pharmacy had a positive effect on medication and safety. This chapter describes the theoretical and practical approach taken to implement this initiative, the program as it evolved, and the outcomes for the professions and the service provider. At the end of the project we reflected that what had emerged from the project was an active, engaged interprofessional community of practice that included two strong and diverse professional groups who have a major influence on medication safety.