Culture and context in Interprofessional education: Expectations in Australia and Japan.

The attributes of collaborative practice in health care vary across contexts, necessitating the adaptation of interprofessional education curricula to prepare students for the collaborative practice expected in their respective health care systems. Culture, when conceptualised through an organisational lens, allows an analysis of the shared assumptions, beliefs and values, without seeking to reduce to a uniform construct. This article explores the differences in interprofessional education competencies between Australia and Japan and considers the systems and patient expectations, which underpin each. While collaborative competence exhibits some similarities across contexts, competency frameworks differ in emphasis, language and key terminology, which highlight multiple points of difference in the expectations of interprofessional collaborative practice across contexts. There are education and practice consequences of these different perspectives of collaborative practice, in an increasingly mobile international workforce.

Access to and effectiveness of clinical supervision for allied health workers: A cross-sectional survey.

INTRODUCTION: Clinical supervision supports patient care and health worker wellbeing. However, access to effective clinical supervision is not equitable. We aimed to explore the access and effectiveness of clinical supervision in allied health workers. METHODS: A cross-sectional survey design using the Manchester Clinical Supervision Scale (MCSS-26), including open-ended survey responses, to collect data on effectiveness. Multivariable regression was conducted to determine how MCSS-26 scores differed across discipline, work location and setting. Open-ended responses were analysed using content analysis. RESULTS: 1113 workers completed the survey, with 319 (28%) reporting they did not receive supervision; this group were more likely to hold management positions, work in a medical imaging discipline and practice in a regional or rural location. For those who received supervision, MCSS-26 scores significantly differed between disciplines and work settings; psychologists and those practising in private practice settings (i.e. fee-for-service) reported the highest levels of effectiveness. Suggested strategies to enhance effectiveness included the use of alternate supervision models, dedicated time for supervision, and training. CONCLUSION: Targeted subgroups for improving access include senior staff, medical imaging professionals, and those working across regional and rural settings. Where supervision was least effective, strategies to address behaviours with organisational support may be required.

Teaching digital interprofessional collaboration.

BACKGROUND: Interprofessional communication in Australian clinical practice has recently shifted from paper records to electronic medical records (EMRs), and there is therefore a need for universities to prepare health graduates for digital communication. APPROACH: An interprofessional team co-designed and co-facilitated an online interprofessional activity for third year pharmacy and fifth year medical students utilising a simulated EMR (EHR Go™). Students completed a series of profession-specific tasks relating to a simulated patient, then came together in interprofessional groups of 10-12 to establish a collaborative medication charting plan. EVALUATION: A total of 640 students participated in the activity, of which 60% (386/640) were medical students. Immediately after the interprofessional workshop, students were invited to complete a voluntary anonymous evaluation. Five-point Likert scales were used to rate the relevance to practice, achievement of learning outcomes, organisation and overall quality of the activity. Students were also asked to contribute qualitative feedback. Of the participants, 28% (180/640) completed the survey, and 53% (96/180) of respondents were medical students. A majority of survey respondents agreed or strongly agreed that the activity was relevant to practice (94%; 170/180), achieved the learning outcomes (84%; 151/180), was well organised (74%; 133/180) and was a quality learning experience (79%; 143/180). The positive feedback focused on appreciating the opportunity to discuss with interdisciplinary colleagues the rationale for admission medications. Constructive feedback included the need for clearer directives regarding pre-workshop activities. IMPLICATIONS: This interprofessional education (IPE) activity presents a feasible, innovative approach to teaching pharmacy and medical students digital communication and collaboration using a simulated EMR. Overall, a majority of learners were satisfied with the learning experience and felt that the IPE activity achieved the learning outcomes and was relevant to practice.

Point-of-Care Ultrasound Educational Development in Australasia: A Scoping Review.

Point-of-care ultrasound (PoCUS) technology is evolving rapidly and is being adopted by many health professionals in their clinical practice. Ultrasound is a complex skill requiring dedicated training. Appropriate integration of ultrasound education into medical, surgical, nursing and allied health professions is a current challenge worldwide. There are patient safety implications for use of ultrasound without adequate training and frameworks. The purpose of the review was to overview the status of PoCUS education in Australasia; investigate what is being taught and learned about ultrasound across the health professions; and identify potential gaps. The review was limited to postgraduate and qualified health professionals with established or emerging clinical use for PoCUS. A scoping review methodology was used to include literature in peer-reviewed articles, policies, guidelines, position statements, curricula and online material relating to ultrasound education. One hundred thirty-six documents were included. The literature revealed heterogeneity in ultrasound teaching and learning across the health professions. Several health professions lacked any defined scopes of practice, policies or curricula. Significant investment in resourcing ultrasound education is required to address the current needs in Australia and New Zealand.

The utility of an interprofessional education framework and its impacts upon perceived readiness of graduates for collaborative practice. A multimethod evaluation using the context, input, process, product (CIPP) model.

BACKGROUND: Frameworks in higher education can support strategic curriculum change in complex systems. The impact of these frameworks in achieving their stated purpose is less known. An interprofessional education (IPE) framework and related multi-activity curriculum designed to develop health profession graduates with the requisite skills for collaborative care, was introduced in a large university, across eleven health professions. OBJECTIVE: To determine the utility of an interprofessional framework and impact upon perceived work readiness for collaborative practice. METHOD: A multimethod design using the context, input, process, product (CIPP) evaluation model was selected taking a social constructivist theoretical stance. Data collection included staffing allocation to IPE, curriculum audit, and reflections from representatives of all health professions courses offered at the institution. Data was analyzed using framework analysis. PARTICIPANTS: Interviews or focus groups were undertaken with academic Faculty (n = 13), recent graduates (n = 24) and clinical supervisors/employers of recent graduates (n = 17). RESULTS: The framework assisted the systematic implementation of interprofessional curriculum across the different health courses at the university. Collaborative work-ready learning outcomes were identified in graduates where targeted curriculum had been implemented across all four domains of the framework. Gaps identified in framework implementation were consistent with gaps identified in graduate knowledge and skills related to collaborative practice. The combination of formal university-based IPE and informal workplace learning as part of clinical placements contributed to achieving the desired learning outcomes. CONCLUSIONS: These findings offer insights into the use of shared frameworks to drive specific learning activities related to collaborative practice.

Realist review of interprofessional education for health care students: What works for whom and why.

Interprofessional education (IPE) programs, are complex, logistically challenging, and can be expensive to deliver, but these matters are offset by the perceived benefits of IPE. There is little clarity regarding how IPE contributes to the desirable development of collaborative practitioners. To guide educators in the design of IPE programs there is a need to understand the elements that promote optimal learning. A realist review was conducted to identify the mechanisms and resources that contribute to IPE outcomes. Four databases were searched until April 2020 for empirical studies describing mandatory IPE for pre-registration medical, nursing and other health professional students. Twelve articles met the inclusion criteria. Two novel learning design elements were identified; interdependence, where there is a need for genuine contribution of skills and knowledge from the professions learning together to successfully complete tasks, and embodiment, where through being immersed in an authentic scenario, learners feel what it is like to work in their professions. Other observations supported previous research findings such as the importance of skilled facilitators to promote interaction and reflection. Interprofessional interventions incorporating these specific learning design features seem likely to enhance the impact of IPE, thus making the best use of limited institutional resources and student time.

Supporting health professional educators in the workplace: A scoping review.

PURPOSE: Clinical educators frequently request additional support for educating pre-qualification health professions students despite having access to professional development programs to build education knowledge and skills. The breadth of 'additional support' options remains unclear. The aim of this review is to explore what is known about support options for health professional educators in the workplace through the lens of learning organisations. MATERIALS AND METHODS: A scoping review was conducted searching Ovid Medline, CINAHL, ProQuest and PsycINFO electronic databases from 1 January 2005 up to 21 October 2020 for studies that identified support strategies for clinical educators of pre-qualification students in the workplace. Relevant data were charted, summarised thematically and synthesised with reference to support type and implementation level. RESULTS: Fifty relevant records related to medicine, nursing and allied health clinical education were included. Twelve support themes and five cross-cutting support categories were identified across four implementation levels of healthcare systems. CONCLUSIONS: A diversity of support for clinical educators beyond professional development was identified. Future research combined with leadership and commitment from the healthcare and education sectors is needed to better understand the applicability, efficacy and resourcing of any newly integrated support to ensure it is sustainable and improves clinical educator capability.

Interprofessional learning about medication safety.

BACKGROUND: Safe medication management requires collaboration between health professionals. APPROACH: A mixed academic and clinician team co-designed and co-facilitated a 2-h interprofessional medication safety workshop, covering medication history taking, perioperative medication management, discharge planning, incident review and dosing and administration calculations. Three workshop sessions were delivered across three sites during September 2019 at a large metropolitan healthcare network. Senior nursing, medical and pharmacy students were invited to participate in the workshops and evaluation. EVALUATION: We evaluated satisfaction, learning experience and perceived clinical application for medical, pharmacy and nursing students. Surveys were conducted immediately after each workshop and at 4 weeks. Quantitative data was analysed descriptively and qualitative data analysed using thematic analysis. Forty-five students participated in the evaluative component of the workshops. Mean student response scores demonstrated a high level of satisfaction with the workshop's relevance and utility to their learning. Students expressed strong agreement that the workshop promoted communication across professions for medication safety. Analysis of the qualitative data identified seven key themes, with consistently positive responses provided in each: interactions within the interprofessional team; recognising the importance of teams; learning the process of medication use; acknowledging and working with difference; role playing; thinking patient safety; and authenticity. IMPLICATIONS: A 2-h interprofessional workshop about medication safety provided positive learning experiences with high satisfaction to medical, nursing and pharmacy students, and had strong perceived applicability to their future clinical practice.

Development of the Feedback Quality Instrument: a guide for health professional educators in fostering learner-centred discussions.

BACKGROUND: Face-to-face feedback plays an important role in health professionals' workplace learning. The literature describes guiding principles regarding effective feedback but it is not clear how to enact these. We aimed to create a Feedback Quality Instrument (FQI), underpinned by a social constructivist perspective, to assist educators in collaborating with learners to support learner-centred feedback interactions. In earlier research, we developed a set of observable educator behaviours designed to promote beneficial learner outcomes, supported by published research and expert consensus. This research focused on analysing and refining this provisional instrument, to create the FQI ready-to-use. METHODS: We collected videos of authentic face-to-face feedback discussions, involving educators (senior clinicians) and learners (clinicians or students), during routine clinical practice across a major metropolitan hospital network. Quantitative and qualitative analyses of the video data were used to refine the provisional instrument. Raters administered the provisional instrument to systematically analyse educators' feedback practice seen in the videos. This enabled usability testing and resulted in ratings data for psychometric analysis involving multifaceted Rasch model analysis and exploratory factor analysis. Parallel qualitative research of the video transcripts focused on two under-researched areas, psychological safety and evaluative judgement, to provide practical insights for item refinement. The provisional instrument was revised, using an iterative process, incorporating findings from usability testing, psychometric testing and parallel qualitative research and foundational research. RESULTS: Thirty-six videos involved diverse health professionals across medicine, nursing and physiotherapy. Administering the provisional instrument generated 174 data sets. Following refinements, the FQI contained 25 items, clustered into five domains characterising core concepts underpinning quality feedback: set the scene, analyse performance, plan improvements, foster learner agency, and foster psychological safety. CONCLUSIONS: The FQI describes practical, empirically-informed ways for educators to foster quality, learner-centred feedback discussions. The explicit descriptions offer guidance for educators and provide a foundation for the systematic analysis of the influence of specific educator behaviours on learner outcomes.

Work Readiness of New Graduate Physical Therapists for Private Practice in Australia: Academic Faculty, Employer, and Graduate Perspectives.

OBJECTIVE: The purpose of this study is to explore academic faculty, employer, and recent graduate perspectives of the work readiness of Australian new graduate physical therapists for private practice and factors that influence new graduate preparation and transition to private practice. METHODS: This study used a mixed-methods design with 3 surveys and 12 focus groups. A total of 112 participants completed a survey, and 52 participated in focus groups. Descriptive statistics were used to summarize the quantitative data, and thematic analysis was used to analyze the qualitative data. Triangulation across participant groups and data sources was undertaken. RESULTS: Australian new graduate physical therapists were perceived to be "somewhat ready" for private practice and "ready" by their third year of employment. Participants proposed that new graduates bring enthusiasm, readiness to learn, and contemporary, research-informed knowledge. New graduates were also perceived to find autonomous clinical reasoning and timely caseload management difficult; to have limited business, marketing, and administration knowledge and skills; and to present with underdeveloped confidence, communication, and interpersonal skills. Factors perceived to influence graduate transition included private practice experience, such as clinical placements and employment; employer and client expectations of graduate capabilities; workplace support; university academic preparation and continuing education; and individual graduate attributes and skills. CONCLUSION: Australian new graduate physical therapists have strengths and limitations in relation to clinical, business, and employability knowledge and skills. New graduate work readiness and transition may be enhanced by additional private practice experience, employer and client expectation management, provision of workplace support, and tailored university and continuing education. IMPACT: The number of new graduate physical therapists employed in private practice in Australia is increasing; however, until this study, their work readiness for this setting was unknown. This exploration of new graduate performance in private practice and transition can help to increase understanding and enhancement of work-readiness.

"Why have you done it that way?" Educator perceptions of student-initiated conversations about perceived deviations from evidence-based clinical practice.

Students on clinical placement may encounter practice that deviates from what they perceive to be evidence-based. However, queries by students about the evidence-base of their clinical educators decision-making and practice can be a challenging conversation to initiate. It is unclear how these conversations occur, and what impact engaging in these challenging conversations may have on practice, the learning experience, and the relationship with the educator. This study sought to explore clinical educators' experiences of student-initiated discussions that question the evidence-base of their clinical practice. And to identify their preferred approaches for students to initiate these conversations. Individual interviews were conducted with 23 clinical educators from five professions at three different hospitals in Victoria, Australia. Semi-structured interviewing techniques were employed to identify participants' context and experiences. Participants described student-initiated conversations about deviations from evidence-based practice as challenging encounters with potential for positive or negative impact on clinical educators, students and patients. They noted that the perceived appropriateness of the discussion could be influenced by the method utilised by students to initiate the conversation. Elements identified by clinical educators as barriers or enablers to support students to appropriately initiate conversations about clinical practice may be utilised by education and health providers to enhance opportunities for learning conversations to occur.

Community health placements for junior medical and nursing students for interprofessional learning.

Health care is increasingly delivered in primary and community settings, yet undergraduate clinical education remains focused in hospitals. Interprofessional student placements in community health offer an alternative to traditional clinical education and extend the capacity for clinical education beyond hospital placements. This study sought to investigate the value of interprofessional clinical placements at a community health center for dyads of second year medical and nursing students. A mixed methods evaluation was used. Quantitative and qualitative feedback was collected using the Interprofessional Clinical Placement Learning Environment Inventory (ICPLEI). Students (n = 58) completed the ICPELI after observation of community health half day sessions, at one of three community health sites. Two focus group interviews were undertaken with the health care practitioners (n = 8) to explore their perception of the new interprofessional placements. The placements were rated highly by all participants with three themes identified: It takes a team, Bouncing ideas and Realities of Community Health. Innovative approaches to clinical education and learning are needed to prepare a healthcare workforce capable of working in a collaborative, interprofessional manner. Community health offers a promising location for interprofessional learning for junior medical and nursing student teams.

Online interprofessional simulation for undergraduate health professional students during the COVID-19 pandemic.

This report describes the Obstetric and Neonatal Simulation (ONE-Sim) workshop run in a remote learning format for medical and midwifery students in an interprofessional setting during the COVID-19 pandemic. It explores the observation of students as participants in the online learning of using Personal Protective Equipment and simulation-based learning of perinatal emergency management. This was followed by their mutual interaction and reflections. This paper aims to understand the role of synchronous remote learning through simulation and its impact on interprofessional interactions. We describe the experience of medical and midwifery students with the ONE-Sim workshop, facilitated by medical (obstetric and neonatal) and midwifery educators. Formal thematic analysis will be performed as part of the ongoing study; however, initial direct observation demonstrated that students reacted positively to the online ONE-Sim workshop and engaged well with facilitators and peers. Students mutually interacted amongst themselves, shared their previous experiences, knowledge of roles as medical and midwifery practitioners and how they see themselves in those roles in a perinatal emergency setting. The initial observations demonstrate that interprofessional education delivered in an e-learning format can be useful and meaningful, and may be utilized across a number of specialties.

Education for sustainable healthcare: A transdisciplinary approach to transversal environmental threats.

Global Environmental Changes are dynamic and complex, crossing disciplines, sectors, regions, and populations and shaping the health of current and future generations. GECs present an unprecedented challenge demanding a response of equal scale and complexity involving unfettered collaboration beyond disciplines with implications for global health. At this critical point, health professions' education should have moved on from building consensus about the relevance of education for sustainable healthcare (ESH) to active implementation. In this commentary, we discuss why transdisciplinary problem-solving and interprofessional education should be considered in education for sustainable healthcare. We review types of collaborative educational practices, outline opportunities, challenges, and resources to enable implementation.

Implementing a collaborative medicine and pharmacy educational activity in two countries.

BACKGROUND: To promote better collaboration for patient care, interprofessional education (IPE) is required in many health professions courses. However, successful IPE implementation at scale can be challenging because of complicated logistics and competing priorities. Implementing across multiple geographies adds further complexity. OBJECTIVE: This paper describes the implementation of a full cohort IPE activity for medical and pharmacy students delivered at both the Australian and Malaysian campuses of Monash University. DESIGN: We designed a 150-minute, blended learning activity centred around asthma care for second-year medical and pharmacy students. Student perceptions were measured with a pre- and post-activity survey using the validated ten-item, three-factor, SPICE-R2 instrument. Analysis focused on differences between professions and countries. RESULTS: All second-year medicine (N = 301 in Australia and N = 107 in Malaysia) and pharmacy students (N = 168 in Australia and N = 117 in Malaysia) participated in the learning activity. A total of 326/693 (47%) students participated in the associated research by completing both the pre- and post-activity surveys. The pre-activity survey showed significant differences in four items between medicine and pharmacy students in Australia and two items in Malaysia. Post-activity, we observed significant changes in 8/10 items when the two professions were combined. Specifically, we noted changes across the countries in perceptions of roles and responsibilities for collaborative practice and patient outcomes from collaborative practice. CONCLUSIONS: IPE across different professions and countries is feasible. Positive outcomes in role understanding and perceived patient outcomes are achievable through a context-sensitive, locally driven approach to implementation. Longitudinal experiences may be required to influence perceptions of teamwork and team-based care.

Factors influencing implementation of organizational health literacy: a realist review.

PURPOSE: Healthcare systems are increasing in complexity, and to ensure people can use the system effectively, health organizations are increasingly interested in how to take an organizational health literacy (OHL) approach. OHL is a relatively new concept, and there is little evidence about how to successfully implement organizational health literacy interventions and frameworks. This study, a literature review, aims to explore the operationalization of OHL. DESIGN/METHODOLOGY/APPROACH: A realist literature review, using a systems lens, was undertaken to examine how and why the operationalization of OHL contributed to changes in OHL and why interventions were more effective in some contexts than others. Initial scoping was followed by a formal literature search of Medline, CINAHL plus, Web of Science, Scopus, Embase and PsychINFO for original peer-reviewed publications evaluating OHL interventions until March, 2018. FINDINGS: The search strategy yielded 174 publications; 17 of these were included in the review. Accreditation, policy drivers, executive leadership and cultures of quality improvement provided the context for effective OHL interventions. The dominant mechanisms influencing implementation of OHL interventions included staff knowledge of OHL, internal health literacy expertise, shared responsibility and a systematic approach to implementation. RESEARCH LIMITATIONS/IMPLICATIONS: This study outlines what contexts and mechanisms are required to achieve particular outcomes in OHL operationalization. The context in which OHL implementation occurs is critical, as is the sequence of implementation. ORIGINALITY/VALUE: Health services seeking to implement OHL need to understand these mechanisms so they can successfully operationalize OHL. This study advances the concept of OHL operationalization by contributing to the theory underpinning successful implementation of OHL.

Sustainable interprofessional learning on clinical placements: the value of observing others at work.

Clinical placements have the potential to offer meaningful interprofessional learning opportunities for pre-registration students. Informal, as opposed to structured interprofessional learning opportunities, may offer a sustainable solution to the challenges of scheduling formal interprofessional programs in the workplace. To investigate this concept, students on clinical placement from a range of professions were invited to observe another profession undertake a patient consultation, after which they completed a standardized reflective tool. A grounded theory research design was used to explore the educational value of the one-off interprofessional observations, through an analysis of student written reflections (n = 79) and staff perceptions collected by interview (n = 11). The qualitative data was iteratively analyzed throughout the study period. A range of learning outcomes were described post student observations, ranging from knowledge or skills that informed profession-specific practice, to how others' roles related to patient needs, and the need for collaboration in order to provide high quality care. Staff orientation and facilitated reflection contributed to student learning. Positive learning value, though varying in depth, was identified through single interprofessional observations. Informal activities offer a sustainable interprofessional learning strategy that can be embedded into clinical placements; additional informal learning activities now warrant investigation.