Margaret Horsburgh

Multiprofessional learning: the attitudes of medical, nursing and pharmacy students to shared learning

The belief that the effectiveness of patient care will improve through collaboration and teamwork within and between health care teams is providing a focus internationally for ‘shared learning’ in health professional education. While it may be hard to overcome structural and organizational obstacles to implementing interprofessional learning, negative student attitudes may be most difficult to change. This study has sought to quantify the attitudes of first‐year medical, nursing and pharmacy students’ towards interprofessional learning, at course commencement.

The professional subcultures of students entering medicine, nursing and pharmacy programmes

This study sought to determine the attitudes, beliefs and values towards clinical work organization of students entering undergraduate medicine, nursing and pharmacy programmes in order to frame questions for a wider study. In the Faculty of Medical and Health Sciences, The University of Auckland students entering medicine, nursing and pharmacy programmes completed a questionnaire based on that used by Degeling et al. in studies of the professional subcultures working in the health system in Australia, New Zealand, England and elsewhere. Findings indicate that before students commence their education and training medical, nursing and pharmacy students as groups or sub-cultures differ in how they believe clinical work should be organized. Medical students believe that clinical work should be the responsibility of individuals in contrast to nursing students who have a collective view and believe that work should be systemized. Pharmacy students are at a mid-point in this continuum. There are many challenges for undergraduate programmes preparing graduates for modern healthcare practice where the emphasis is on systemized work and team based approaches. These include issues of professional socialization which begins before students enter programmes, selection of students, attitudinal shifts and interprofessional education.

Patient safety in an interprofessional learning environment

ally care. With more medical applicants meeting academic entry criteria than places available, schools increasingly have to discriminate on non-academic grounds. Applicants from disadvantaged backgrounds often lack the school and family support that can help provide relevant work experience, advice on the application process, and the self-belief that an application is worth pursuing, which leads to a successful outcome. Leeds Medical School has established a pre-entry foundation course to assist applications from disadvantaged backgrounds and the student body is committed to supporting WP activity in a variety of ways. Why the idea was necessary Four Year 3 medical students chose a 5-week optional module designed to foster team working and educational skills by creating and implementing a teaching resource that could be used to stimulate interest in medicine in 16-year-old state high school students who would be attending an aspiration-raising medicine summer school. The challenge was to combine our current experiences and enthusiasm for medicine and present them in a way that was accessible and realistic. The resource had to be clearly presented and easy to use by other medical students in the future. What was done We chose a real-life scenario to integrate theoretical and practical aspects and bring medicine to life. We consulted the appropriate GCSE (General Certificate of Secondary Education) syllabus to enable us to deliver the resource at the correct level and decided on a car crash scenario that, by including a driver and 3 passengers, provided 4 different exercises (phlebotomy for blood alcohol levels in the driver, basic life support for an unconscious passenger, electrocardiogram and auscultation of the heart for a passenger with chest pain, and application of arm slings) illustrating a range of different medical activities. With 45 minutes for each scenario, we aimed to keep the students interested whilst not complicating things too much with medical jargon or oversimplification of content. Each scenario was accompanied by an introduction to the themes, instructions on the practical aspects of the exercise, worksheets, prompt questions for demonstrators, colour posters and teachers’ notes. The use of manikins and other aids from the clinical skills department encouraged active learning. A detailed teachers’ pack was produced so that other medical students could replicate the workshop in the future. Evaluation of results and impact In order to aid evaluation and design, 2 ‘taster’ days were organised with local schools. Feedback indicated that the high school students had enjoyed the practical nature of the day and more than 85% stated they were more likely to study medicine as a result. All the students who attended the summer school where the resource was used stated afterwards that they were more likely to study medicine. The tutors at the summer school evaluated the pack as being well designed and appropriate for its current use.

Patients’ Preferences for Ways to Communicate Benefits of Cardiovascular Medication

PURPOSE We wanted to determine patients’ willingness to take preventive cardiovascular disease (CVD) medication in relation to their 5-year CVD risk score and modes of communicating benefits of therapy. METHODS Study participants were 934 consecutive patients drawn from family practitioners’ waiting rooms in Auckland, New Zealand, who knew their 5-year CVD risk (ranging from 5% to 30%) and who completed a questionnaire asking them to rate how much various modes of communicating the benefits of therapy would encourage them to take medication daily, where the benefits from medication were proportional to their estimated CVD risk score. RESULTS Patients’ rankings for modes of communicating the benefits of therapy were little influenced by sex, age, ethnicity, numeracy score, 5-year CVD risk, or concern about a heart attack. Patients clearly found relative risk reduction most encouraging, with absolute risk reduction rated second overall and numbers needed to treat the least likely to be persuasive, although preferences covered the full range and were not predictable from demographic or 5-year CVD risk data. Pictures were preferred to numbers by 55.1%, with a people-chart or a bar chart being equally favored. Even so, 61.8% preferred a doctor’s opinion to any presentation by numbers or pictures. CONCLUSIONS Patients’ willingness to take preventive cardiovascular medication depends more on mode of communicating treatment benefit than on their short-term CVD risk score or their level of concern about a future cardiovascular event. Because individual preferences were not predictable, more than 1 modality is likely to be clinically useful for each patient.

Educating for healthcare quality improvement in an interprofessional learning environment: A New Zealand initiative

The Faculty of Medical and Health Sciences at the University of Auckland provides undergraduate education for medicine, nursing and pharmacy students. Two modules with a focus on quality improvement in healthcare are used to bring together students for a shared learning programme. Quality healthcare, defined as ‘‘providing patients with appropriate services in a competent manner with good communication, shared decision making and cultural sensitivity’’ (Schuster et al., 1998), has helped shape this inter-professional learning programme. The specific dimensions of healthcare quality covered in this programme are: patient safety, equity, access, effectiveness, efficacy and patient-centeredness. The goals of inter-professional learning (Barr, 2002) to develop adaptable, flexible and collaborative healthcare team workers, are also necessary prerequisites for improving quality in healthcare. Teamwork implies recognition by each healthcare worker of the strengths that other professions bring to the clinical team, respect for other members of the team and trust to allow open discussion within the team and translation of this discussion into action. The two interprofessional learning modules are ‘‘Maori Health’’ (Maori – the indigenous people of New Zealand) and ‘‘Patient Safety’’. The ‘‘Patient Safety’’ module is a two-day interprofessional learning experience with all 3rd year students. The focus is on understanding the concepts of quality improvement and patient safety through recognition of underlying factors and latent weaknesses in healthcare systems (Reason, 1997) that can lead to avoidable patient harm. Students work in small interprofessional groups, undertake ‘‘root cause analysis’’ (Bagian et al., 2001) of case vignettes based on real adverse events, and explore the actions a healthcare team might take to prevent their recurrence. Specific skills learned are: the making of flow-charts and cause and effect diagrams, the development of causal statements and the measurement of the impact of change. A teaching team drawn from the three professions facilitates the group work, with input from hospital-based quality managers. This ensures that the learning relates to clinical practice and in addition creates the possibility it might impact on the clinical practice environment. Journal of Interprofessional Care, October 2006; 20(5): 555 – 557

Maori health issues explored in an interprofessional learning context

In New Zealand there is emphasis on improving access to primary healthcare, particularly for high health need populations such as Maori, the indigenous people of New Zealand. Critical to the development of the primary healthcare environment is building healthcare teams and better utilising health practitioners. This article reports on an interprofessional educational initiative where medical, nursing and pharmacy undergraduates learnt together in order to understand Maori health issues, how these are addressed by health services and also appreciate the contribution of different health professionals within the healthcare team. The educational initiative is described and interprofessional learning issues are explored across the different curricula structures of medicine, nursing and pharmacy.

Visiting the museum together: Evaluating a programme at Auckland Museum for people living with dementia and their carers

Museums have an increasingly important role in supporting specialized groups including people with dementia. This practice-based report discusses the development, delivery and evaluation of a six-week programme for people living with dementia and their carers at Auckland Museum in 2014. The programme, delivered by specialist volunteers, was evaluated through observation during museum-based sessions followed by focus groups and interviews. Overall, the programme expanded the community opportunities available for people with dementia and their carers, and was considered a success in terms of socialization and through providing a positive and shared experience. Evaluation highlighted programme improvements for future iterations.

Lessons learnt from attempting to assess the evidence base for a complex intervention introduced into New Zealand general practice

Background and context Currently, in New Zealand general practice, the introduction of new initiatives is such that interventions may be introduced without an evidence base. A critical role is to respond to the challenges of chronic illness with self-management a key component. The ‘Flinders Model’ of self-management collaborative care planning developed in Australia has not been evaluated in New Zealand. A study was designed to assess the usefulness of this ‘Model’ when utilised by nurses in New Zealand general practice. This paper describes the issues and lessons learnt from this study designed to contribute to the evidence base for primary care. Assessment of problems Analysis of interviews with the nurses and the research team allowed documentation of difficulties. These included recruitment of practices and of patients, retention of patients and practice support for the introduction of the ‘new’ intervention. Results of assessment A lack of organisational capacity for introduction of the ‘new’ initiative alongside practice difficulties in understanding their patient population and inadequate disease coding contributed to problems. Undertaking a research study designed to contribute to the evidence base for an initiative not established in general practice resulted in study difficulties. Lessons learnt The need for phased approaches to evaluation of complex interventions in primary care is imperative with exploratory qualitative work first undertaken to understand barriers to implementation. Collaborative partnerships between researchers and general practice staff are essential if the evidence base for primary care is to develop and for ‘new’ interventions to lead to improved health outcomes.

Course approval processes

Focuses on processes of course approval, which lead to enhancement of the curriculum and student learning. Findings from a recent study concerned with the question: To what extent does quality monitoring impact on the student experience of learning? showed the curriculum, and how it was approved, to be significant factors in enhancing student learning. It is argued that the focus for quality in a rapidly changing world should be on the attributes of graduates, with quality monitoring concerned with improvement and enhancement of student learning. Where quality monitoring does have a positive impact on student learning, through the approval and ongoing monitoring of the curriculum and its outcomes, then these processes should be improved. This should be through a process which fosters collegiality and encourages pedagogical discussion amongst academic colleagues. A series of prompts or questions, which seek to challenge teachers and enhance dialogue with colleagues, is proposed.

What does a Population Health Approach Mean for Nurses Working in Primary Health Care? A Cardiovascular Disease Risk Reduction Programme

Cardiovascular (CVD) disease is the leading cause of death and hospitalisation in New Zealand, with major disparities between ethnic groups. Implementing the New Zealand Guidelines on the assessment and management of cardiovascular (CVD) risk is urgent and requires a range of activities from social marketing, community development and health promotion through to clinical care. Clarification of a population health approach and how primary health care nurses can integrate both personal and public health activities is important to the implementation of the CVD risk guidelines. This paper reports on an innovative project where primary health care nurses have a key role in integration of public and personal health and improving management of chronic conditions.