Joanne Goldman

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.

A scoping review to improve conceptual clarity of interprofessional interventions

Interprofessional education (IPE) and interprofessional collaboration (IPC) have been identified in health education and health care as playing an important role in improving health care services and patient outcomes. Despite a growth in the amount of research in these areas, poor conceptualizations of these interprofessional activities have persisted. Given the conceptual challenges, a scoping review of the interprofessional field was undertaken to map the literature available in order to identify key concepts, theories and sources of evidence. The objective of this review was to develop a theoretically based and empirically tested understanding of IPE and IPC. A total of 104 studies met the criteria and were included for analysis. Studies were examined for their approach to conceptualization, implementation, and assessment of their interprofessional interventions. Half of the studies were used for interprofessional framework development and half for framework testing and refinement. The final framework contains three main types of interprofessional interventions: IPE; interprofessional practice; and interprofessional organization; and describes the nature of each type of intervention by stage, participants, intervention type, interprofessional objectives, and outcomes. The outcomes are delineated as intermediate, patient, and system outcomes. There was very limited use of theory in the studies, and thus theoretical aspects could not be incorporated into the framework. This study offers an initial step in mapping out the interprofessional field and outlines possible ways forward for future research and practice.

Improving the clarity of the interprofessional field: Implications for research and continuing interprofessional education

Significant investments are being made around the world to improve interprofessional collaboration, yet limits in our knowledge of this field restrict the ability of decision makers to base their decisions upon evidence. Clarity of the interprofessional field is blurred by a conceptual and semantic confusion that affects our understanding of key elements of education and practice activities, their interlinked relationship, and their effects on health or system outcomes. Systematic reviews of interprofessional education (IPE) and interprofessional collaboration (IPC) have provided some insight into the nature and effectiveness of this field, but a lack of clarity remains. In this article we report on a scoping review currently being undertaken to analyze the interprofessional field, improve its conceptual clarity, and identify elements needed to enhance its development. Emerging review findings regarding participants and settings, interventions, and outcomes are reported. The article provides implications from this review and discusses them in relation to continuing IPE and future research.

Ethnography in qualitative educational research: AMEE Guide No. 80.

Ethnography is a type of qualitative research that gathers observations, interviews and documentary data to produce detailed and comprehensive accounts of different social phenomena. The use of ethnographic research in medical education has produced a number of insightful accounts into its role, functions and difficulties in the preparation of medical students for clinical practice. This AMEE Guide offers an introduction to ethnography – its history, its differing forms, its role in medical education and its practical application. Specifically, the Guide initially outlines the main characteristics of ethnography: describing its origins, outlining its varying forms and discussing its use of theory. It also explores the role, contribution and limitations of ethnographic work undertaken in a medical education context. In addition, the Guide goes on to offer a range of ideas, methods, tools and techniques needed to undertake an ethnographic study. In doing so it discusses its conceptual, methodological, ethical and practice challenges (e.g. demands of recording the complexity of social action, the unpredictability of data collection activities). Finally, the Guide provides a series of final thoughts and ideas for future engagement with ethnography in medical education. This Guide is aimed for those interested in understanding ethnography to develop their evaluative skills when reading such work. It is also aimed at those interested in considering the use of ethnographic methods in their own research work.

Review article: medical education research: an overview of methods.

PurposeThis article provides clinician-teachers with an overview of the process necessary to move from an initial idea to the conceptualization and implementation of an empirical study in the field of medical education. This article will allow clinician-teachers to become familiar with educational research methodology in order to a) critically appraise education research studies and apply evidence-based education more effectively to their practice and b) initiate or collaborate in medical education research.SourceThis review uses relevant articles published in the fields of medicine, education, psychology, and sociology before October 2011.Principal findingsThe focus of the majority of research in medical education has been on reporting outcomes related to participants. There has been less assessment of patient care outcomes, resulting in informing evidence-based education to only a limited extent. This article explains the process necessary to develop a focused and relevant education research question and emphasizes the importance of theory in medical education research. It describes a range of methodologies, including quantitative, qualitative, and mixed methods, and concludes with a discussion of dissemination of research findings. A majority of studies currently use quantitative methods. This article highlights how further use of qualitative methods can provide insight into the nuances and complexities of learning and teaching processes.ConclusionsResearch in medical education requires several successive steps, from formulating the correct research question to deciding the method for dissemination. Each approach has advantages and disadvantages and should be chosen according to the question being asked and the specific goal of the study. Well-conducted education research should allow progression towards the important goal of using evidence-based education in our teaching and institutions.RésuméObjectifCet article fournit aux cliniciens enseignants un aperçu du processus qu’il faut suivre pour passer de l’idée initiale à la conceptualisation puis à la mise en œuvre d’une étude empirique dans le domaine de l’éducation médicale. Cet article permettra aux cliniciens enseignants de se familiariser avec la méthodologie de la recherche en éducation (a) pour évaluer de façon critique les études sur la recherche en éducation et appliquer de façon plus efficace dans leur pratique un enseignement basé sur des données probantes et (b) pour mettre en œuvre un projet de recherche en éducation médicale ou y collaborer.SourceCette synthèse utilise des articles pertinents parus dans les domaines de la médecine, de l’éducation, de la psychologie et de la sociologie avant octobre 2011.Constatations principalesLa majorité de la recherche en éducation médicale s’est concentrée sur la description des résultats obtenus par les participants. Il y a eu moins d’évaluations concernant l’impact sur les soins aux patients, ce qui n’a pu renseigner que de façon limitée l’éducation fondée sur les données probantes. Cet article explique le processus nécessaire pour développer une question de recherche en éducation, orientée et pertinente, et il insiste sur l’importance de la théorie dans la recherche en éducation médicale. Il décrit une gamme de méthodologies, dont des méthodes quantitatives, qualitatives ou mixtes, et se termine par une discussion sur la communication des résultats de la recherche. La majorité des études utilise actuellement des méthodes quantitatives. Cet article souligne combien l’utilisation de méthodes qualitatives peut apporter d’informations sur les nuances et la complexité des processus d’apprentissage et d’enseignement.ConclusionsLa recherche en éducation médicale nécessite plusieurs étapes successives, de la formulation de la bonne question de recherche à la décision d’une méthode de communication des résultats. Chaque approche a ses avantages et inconvénients et doit être choisie en fonction de la question posée et de l’objectif spécifique de l’étude. Une recherche en éducation bien conduite doit permettre une évolution vers l’important objectif qu’est l’utilisation de l’éducation basée sur les données probantes dans notre enseignement et nos établissements.

The use of systems and organizational theories in the interprofessional field: Findings from a scoping review

Authors have commented on the limited use of theory in the interprofessional field and its critical importance to advancing the work in this field. While social psychological and educational theories in the interprofessional field are increasingly popular, the contribution of organizational and systems theories is less well understood. This paper presents a subset of the findings (those focused on organizational/systems approaches) from a broader scoping review of theories in the organizational and educational literature aimed to guide interprofessional education and practice. A detailed search strategy was used to identify relevant theories. In total, we found 17 organizational and systems theories. Nine of the theories had been previously employed in the interprofessional field and eight had potential to do so. These theories focus on interactions between different components of organizations which can impact collaboration and practice change. Given the primarily educational focus of the current research, this paper offers new insight into theories to support the design and implementation of interprofessional education and practice within health care environments. The use of these theories would strengthen the growing evidence base for both interprofessional education and practice – a common need for its varied stakeholders.

Family health teams: A new Canadian interprofessional initiative

Effective interprofessional teamwork is regarded as essential to improving communication, reducing error, and enhancing the delivery of patient/client care (Department of Health, 2000; Health Canada, 2004). Indeed, numerous studies have indicated that where health care providers collaborate well, improvements in care can be realized (e.g., Thylefors et al., 2005; Zwarenstein et al., 2005). Within Canada, the Ontario Ministry of Health and Long Term Care (MOHLTC) has recently established a Family Health Team (FHT) initiative, which consists of the establishment of interdisciplinary care teams to improve the delivery of primary care services (MOHLTC, 2006). This transition marks a departure from the traditional model of uniprofessional physician care. Given the diverse populations that live across Ontario, each FHT has the mandate to develop a team of health care professionals that addresses the particular local needs; nevertheless, it is anticipated that all FHTs will have a core of health care professionals, typically physicians, nurse practitioners and nurses. By forming themselves into FHTs, it is anticipated that family physicians, nurses, pharmacists, social workers, and other healthcare providers can work collaboratively to ensure that care can be co-ordinated and delivered in an effective and seamless manner. More specifically, goals of FHTs include the provision of patient-centred care, improved access to care from a variety of health care professionals, helping patients navigate their way through the health care system, and an increased emphasis on chronic disease management, health promotion, and disease prevention.

Interprofessional primary care protocols: a strategy to promote an evidence-based approach to teamwork and the delivery of care.

Primary care reform involving interprofessional team-based care is a global phenomenon. In Ontario, Canada, 150 Family Health Teams (FHTs) have been approved in the past few years. The transition to a FHT is complex involving many changes and the processes for collaborative teamwork are not clearly delineated. To support the transition to team-based care in FHTs, a project was undertaken to develop and implement a series of interprofessional protocols in four clinical areas. These interprofessional protocols would contain relevant and evidence-based resources to support both a team and evidence-based approach to care. This paper reports on a qualitative study to examine the process of interprofessional protocol development and pilot implementation. Adopting an exploratory case study approach (Robson, ), 36 interviews were conducted with health professionals and community group members who participated in the creation and piloting of the protocols, and with project managers. In addition, observational and documentary data were gathered on the protocol development and implementation processes. The findings from the protocol development stage demonstrate the value of the focus on evidence and team, the process of assessing and targeting FHT needs, inter-organizational and interprofessional sharing, the importance of facilitation and support, and expectations for implementation. The findings from the pilot implementation stage report on the importance of champions and leaders, the implementation strategies used, FHT and organizational factors affecting implementation, and outcomes achieved. Findings are discussed in relation to the knowledge translation and interprofessional literature. Research is ongoing to examine the effectiveness of dissemination of the protocols to FHTs across the province of Ontario and its impact on health care outcomes.

An emerging framework for understanding the nature of interprofessional interventions

Keenan Research Centre, Li Ka Shing Knowledge Institute & Centre for Faculty Development, St Michael’s Hospital, Wilson Centre for Research in Education, Department of Psychiatry, University of Toronto, Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Office of Continuing Education and Professional Development, University of Toronto, and Sunnybrook Health Sciences Centre, Institute of Clinical Evaluative Sciences, Department of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada

A sociological exploration of the tensions related to interprofessional collaboration in acute-care discharge planning

ABSTRACT Patient discharge is a key concern in hospitals, particularly in acute care, given the multifaceted and challenging nature of patients’ healthcare needs. Policies on discharge have identified the importance of interprofessional collaboration, yet research has described its limitations in this clinical context. This study aimed to extend our understanding of interprofessional interactions related to discharge in a general internal medicine setting by using sociological theories to illuminate the existence of, and interplay between, structural factors and microlevel practices. An ethnographic approach was employed to obtain an in-depth insight into healthcare providers’ perspectives, behaviours, and interactions regarding discharge. Data collection involved observations, interviews, and document analysis. Approximately 65 hours of observations were undertaken, 23 interviews were conducted with healthcare providers, and government and hospital discharge documents were collected. Data were analysed using a directed content approach. The findings indicate the existence of a medically dominated division of healthcare labour in patient discharge with opportunities for some interprofessional negotiations; the role of organizational routines in facilitating and challenging interprofessional negotiations in patient discharge; and tensions in organizational priorities that impact an interprofessional approach to discharge. The findings provide insight into the various levels at which interventions can be targeted to improve interprofessional collaboration in discharge while recognizing the organizational tensions that challenge an interprofessional approach.