Della Freeth

The effectiveness of interprofessional education: key findings from a new systematic review.

Over the past decade systematic reviews of interprofessional education (IPE) have provided a more informed understanding of the effects of this type of education. This paper contributes to this literature by reporting an update of a Cochrane systematic review published in this journal ten years ago (Zwarenstein et al., ). In updating this initial review, our current work involved searches of a number of electronic databases from 1999–2006, as well as reference lists, books, conference proceedings and websites. Like the previous review, only studies which employed randomized controlled trials, controlled-before and-after-studies and interrupted time series studies of IPE, and that reported validated professional practice and health care outcomes, were included. While the first review found no studies which met its inclusion criteria, the updated review located six IPE studies. This paper aims to add to the ongoing development of evidence for IPE. Despite some useful progress being made in relation to strengthening the evidence base for IPE, the paper concludes by stressing that further rigorous mixed method studies of IPE are needed to provide a greater clarity of IPE and its effects on professional practice and patient/client care.

'It teaches you what to expect in future...': interprofessional learning on a training ward for medical, nursing, occupational therapy and physiotherapy students

This paper presents findings from a multimethod evaluation of an interprofessional training ward placement for medical, nursing, occupational therapy and physiotherapy students.

The London training ward: an innovative interprofessional learning initiative

This paper reports the findings from an evaluation of a pilot interprofessional training ward project for pre-qualification medical, nursing, occupational therapy and physiotherapy students. This initiative required sustained collaboration from staff based in two National Health Service (NHS) trusts and four schools in three universities. The ward was based on a model of interprofessional education developed in Sweden, but adapted in the light of this experience and also to meet the needs and aspirations of the training ward stakeholders in London. The training ward was evaluated using a multi-method design. Data were collected from all participants involved in this pilot: students, facilitators and patients. The findings from the evaluation are presented and discussed. This paper pays particular attention to the collaborative experiences of the students, staff and institutions involved in this initiative. In addition, 1-year follow-up data collected from the students who had, by then, qualified as clinical practitioners are reported. The paper presents conclusions from the evaluation, and comments on the training wards strengths, limitations and future development.

Sustaining interprofessional collaboration

There has been much written about new interprofessional collaborations, rather less about established or terminated collaborations. This paper briefly rehearses well known factors that encourage and discourage interprofessional collaboration, before considering factors that may help sustain collaborations or signal that termination of the collaboration is appropriate. The Clinical Skills Initiative at St Bartholomews in London, UK is offered as a case study of a sustained interprofessional collaboration. It will be argued that a combination of continued need to collaborate and empowerment to do so, creates favourable conditions for sustained collaboration. The composition of the interprofessional team that comprises the collaboration is also seen as key.

Learning to work together: using the presage, process, product (3P) model to highlight decisions and possibilities.

Collaborative practice is seen as a core aspect of professional practice and, therefore, a focus of professional education. Current interprofessional and quality assurance literature provides enumeration and discussion of a range of competencies required for effective collaborative practice. Case studies of education and training related to collaborative competences rarely discuss the nature of influences on development, delivery and learning. Barriers to development and delivery have been identified for interprofessional education, but we want to move beyond the mental picture of climbing over or moving around fixed hurdles. Learning opportunities are complex dynamic systems, seeking equilibrium. The creative tension of influences provides opportunities for insightful management. This paper uses the systems-form 3P (presage – process – product) model of learning and teaching (Biggs, 1993) to help examine the nature of educational opportunities designed to promote collaborative working. Presage, process and product factors are identified and discussed. We argue that untangling (or at least seeing) the web of influences on learning to work together promotes critical awareness and encourages more informed and timely decisions.

The evidence base and recommendations for interprofessional education in health and social care

Emeritus Professor of Interprofessional Education, School of Integrated Health, University of Westminster, UK, Reader in Education for Health Care, Institute of Health Sciences, City University, London, UK, Education and Research Consultant and Visiting Professor, Anglia Ruskin University, UK, General Practitioner and Principal Lecturer, School of Integrated Health, University of Westminster, UK and Associate Professor, Wilson Centre, University of Toronto, Canada

MOSES: Multidisciplinary obstetric simulated emergency scenarios

In the UK, as elsewhere in the world, the turn of the century witnessed a step change in the attention paid to improving patient safety. Two government reports, An Organisation with a Memory (Department of Health (DoH), 2000) and Building a Safer NHS for Patients (DoH, 2001) synthesized concerns that had grown over several years and advocated a systems-led approach to improving patient safety. A National Patient Safety Agency (NPSA; www.npsa.nhs.uk) was created in 2001 to encourage learning from adverse events occurring in the National Health Service (NHS) and to promote safety improvements. Maternity care provides a wide spectrum of patient safety challenges. Most pregnancies are uncomplicated. In the UK midwives deliver most babies and it is common for interventions to be limited to screening, monitoring and health promotion. However obstetric emergencies may necessitate rapid and complex responses from a multidisciplinary team. Routine patient safety foci are therefore vigilance, excellent record keeping, prevention of cross-infection, accurate diagnosis of underlying or emergent problems, and well-targeted and competently performed responses to problems. Frontline staff require an extensive range of technical and non-technical skills and knowledge, applying these correctly and flexibly in a manner that supports choice. They also need to be prepared for high dependency care of sick women and babies. Effective interprofessional teamwork is essential, especially between midwives and doctors. Conclusions drawn from Confidential Enquiries into Maternal Deaths (e.g., Lewis, 2004) continue to show that 50% of direct maternal deaths involved some form of sub-standard care (vigilance and/or responding to problems), with the main factors being poor communication and teamwork. These and similar findings from other confidential enquiries (e.g., CESDI 2001) have directed attention towards the continuing professional development (CPD) of maternity services staff. Advances in simulation have afforded greater opportunities for CPD that models the complexity of professional practice without placing patients at risk. Human patient simulation (HPS) can help healthcare professionals develop their technical and Journal of Interprofessional Care, October 2006; 20(5): 552 – 554

An innovative interprofessional experience for pre-qualifying medical, nursing, occupational therapy and physiotherapy students

These factors are assessed by means of a questionnaire completed before the start of the programme, and at the end of the ® rst and subsequent years.Outcomes for service users who are seen by trainees on the course are measured in terms of mental health, social functioning and quality of life. Trainees are asked to recruit three users, randomly selected from their caseloads and to complete a set of standardised assessment measures on two occasions, 6 months apart. Users are invited to complete a questionnaire or to be interviewed in order to assess their perspectives on the trainees’ working practices and to complete a user-de® ned measure of empowerment. Users can choose to be interviewed by a trained service user or by a researcher.

Mechanisms that support the assessment of interpersonal skills: A Realistic Evaluation of the interpersonal skills profile in pre-registration nursing students

In many health professions, experienced practitioners assess students’ or inexperienced practitioners’ clinical skills but do not formally or explicitly rate their interpersonal skills, even though it is often suggested that failing or struggling students have poor interpersonal skills. The Interpersonal Skills Profile (ISP) has been widely used in UK health care programmes. The tool allows assessors to select five statements from a list, which they feel reflect the student’s achievement. These are usually graded from fail to excellent. Using a Realistic Evaluation approach this study examined how the ISP was used to assess interpersonal skills in a university pre-registration nursing programme. The use of the ISP was investigated through interviews with clinical nursing mentors, practice education facilitators and education champions as well as a documentary analysis of student assessment booklets. The findings led to the development of three middle range theories which may be useful in other contexts. These focus on: 1) overt assessment of interpersonal skills, 2) providing support to mentors and 3) feedback and ‘feeding-forward’ to students.

Mechanisms that support the assessment of interpersonal skills

In many health professions, experienced practitioners assess students’ or inexperienced practitioners’ clinical skills but do not formally or explicitly rate their interpersonal skills, even though it is often suggested that failing or struggling students have poor interpersonal skills. The Interpersonal Skills Profile (ISP) has been widely used in UK health care programmes. The tool allows assessors to select five statements from a list, which they feel reflect the student’s achievement. These are usually graded from fail to excellent. Using a Realistic Evaluation approach this study examined how the ISP was used to assess interpersonal skills in a university pre-registration nursing programme. The use of the ISP was investigated through interviews with clinical nursing mentors, practice education facilitators and education champions as well as a documentary analysis of student assessment booklets. The findings led to the development of three middle range theories which may be useful in other contexts. These focus on: 1) overt assessment of interpersonal skills, 2) providing support to mentors and 3) feedback and ‘feeding-forward’ to students.