Reshmi L. Singh

Examining Change in Confidence: A Unique Approach to Interprofessional Education Evaluation

INTRODUCTION Measuring student confidence is integral to evaluating student perceived ability regarding interprofessional collaborative practice. The purpose of this study was to examine change in confidence after an introductory interprofessional education assignment using Bandura’s self-efficacy framework. METHODS A retrospective pre-post design assessed change in student confidence, targeting the strength dimension of self-efficacy beliefs. Students enrolled in health discipline-specific courses in two sequential years participated in an introductory embedded case-based IPE assignment. Sixteen statements were developed to assess students’ confidence for specific Interprofessional Education Collaborative (IPEC) sub-competencies consistent with student learning outcomes. Descriptive statistics, paired sample t-tests (comparing pre-post), analysis of variance and independent samples t-tests (comparing across disciplines and the two years) were used in the analysis. RESULTS Data from 203 participants provided a useable response rate of 80.6%. The percent of students indicating an increase in their confidence for the different IPEC sub-competencies ranged from 38.9% for “Encourage ideas and opinions of other team members” to 82.3% for “Explain the roles and responsibilities of other professionals.” Differences in mean change in confidence was found among nine sub-competencies when comparing across the disciplines. In addition, students in Year 1 reported larger increases in confidence for nine sub-competencies compared to Year 2 students. DISCUSSION Results give insight to student perceptions for strategic formative assessment and IPE assignment design. A retrospective pre-post design provided a novel means of examining change in confidence that avoids response-shift bias, while providing students the opportunity to explicitly self-report change or lack of change in confidence. Smaller increases in confidence in Year 2 compared to Year 1 were unexpected and may be due to the Year 2 requirement that teams discuss and agree upon team rules. Although counter-intuitive, the potential for reducing the amount of conflict may have contributed to less of an increase in confidence, as confidence can be gained from not only being well prepared, but also overcoming adversity (mastery experience). Each Year 2 student also was required to write a reflection regarding team ground rules and their implementation. This may have helped students realize greater complexities of successful interprofessional collaboration and their own limitations to achieve it. Received: 07/18/2016 Accepted: 04/06/2018

Identifying and describing patient perspectives on long-term antidepressant use

Abstract Background: Major depression is a chronic disease which often requires long-term antidepressant use. Prescriptions of antidepressants have increased in the past two decades in the US Although current clinical data support the treatment efficacy of antidepressants, early discontinuation of their use by the patient is common. Aim: To identify the treatment experiences of patients, including their perceptions on antidepressant effects, changes in personality, and addiction. Overall goal was to identify factors for larger studies on patterns of antidepressant medication use. Method: This cross-sectional, descriptive study interviewed 45 adults in a large metropolitan city in the US using a structured interview guide that consisted of: demographic characteristics, depression and medication history, antidepressant drug taking behaviors, and antidepressant drug effects. Results: All 45 patients had health insurance. 71.1% of the subjects reported mild to moderate feelings of depression at the time of interview. Almost all (93.3%) patients felt that their antidepressants had made their depression better. 53.3% of patients perceived a change in their personality due to antidepressant use. A third (31%) perceived their antidepressant use to be their choice, while 69% stated it was a necessity. A majority (63.6%) felt they were dependent on their antidepressant, but 88.6% felt they were not addicted to their medication. Conclusions: Overall, important factors on long-term antidepressant use from the patient’s perspective were obtained in this study. Thus these study data can be considered pilot information since it will help to develop tailored intervention studies to improve long-term antidepressant adherence.