Association of Burnout and Other Factors Within Physicians and Advanced Practice Providers in an Academic Surgery Department.

BACKGROUND: Provider burnout is a work-related syndrome that is under-recognized, under-reported, and has negative repercussions on the individual, system, and patients. This study investigated burnout incidence and its association with wellness characteristics such as resilience, psychological safety, and perceptions of the workplace to inform future work in improving well-being. METHODS: Electronic surveys were sent to 153 physicians and advanced practice providers (APPs) in the department of surgery at a single institution. Survey topics included demographics, intention to stay, engagement, and items from validated measures for workplace perceptions including work pace/stress (Mini Z), burnout, psychological safety, and resilience. Descriptive statistics, bivariate associations, and logistic regression were used to evaluate responses. RESULTS: Overall response rate was 47%. The majority of providers reported feeling burned out (56%), and 48% indicated they would probably leave the organization within three years. Additionally, 61% reported being satisfied with their job and 55% felt that they contributed professionally in the ways they value most (meaningful work/engagement). Significant predictors for burnout included negative work environment perceptions (work pace/stress), low resilience, low meaningful work, and professional role (physician vs APP). DISCUSSION: Maintaining a healthy workforce requires investigation into the factors that support workplace well-being. The strongest predictors of burnout were work pace/stress. Protective factors against burnout were psychological safety and resilience. An organizational culture that promotes psychological safety, as well as workplace improvements to enhance providers' sense of meaning in work, and decreasing work pace and stress may contribute to the prevention of burnout and the retention.

Unpacking interactions among student teams in a practice-based IPE setting: a qualitative evaluation study.

In many healthcare settings, teams change composition regularly, so healthcare students must be trained to function effectively in dynamic teams before entering the workforce. Interprofessional clinical rotations provide an ideal venue for learners to practice these skills, but little is known about how student teams interact in such settings. In this qualitative observational evaluation, learners from multiple health professions at a single institution participated in scheduled clinics in low-income housing communities for older adults. Interprofessional student teams met with program participants for care coordination, health and wellness assessments, and assistance in setting and achieving health goals; team composition changed from week-to-week. A purposive sample was selected from video-recorded encounters between student teams and their program participants. The aim of this study was to explore team interactions and document learner behaviors. Two researchers independently reviewed discrete segments of each video, recorded their observations and reflections, and then the team discussed, categorized, and identified relevant examples of both effective and ineffective behaviors. Four major themes were observed: inclusiveness, leadership, joy of practice, and sharing of clinical knowledge. Students demonstrated both positive and negative examples of behaviors that aligned with each theme. Understanding how students behave on teams in dynamic settings where patient care is taking place can help educators establish practice-based interprofessional education models that better prepare learners to function effectively and strategies that may improve team interactions.

Validity evidence and use of the IPEC Competency Self-Assessment, Version 3.

To guide interprofessional education (IPE), a variety of frameworks have been suggested for defining competency in interprofessional practice, but competency-based assessment remains challenging. One self-report measure developed to facilitate competency-based assessment in IPE is the IPEC Competency Self-Assessment. It was originally described as a 42-item measure constructed on the four domains defined by the Interprofessional Education Collaborative (IPEC) Expert Panel. Response data, however, identified only two factors labeled Interprofessional Interaction and Interprofessional Values. In this study, we tested a revised 19-item, two-factor scale based on these prior findings with a new sample (n = 608) and found good model fit with three items not loading on either factor. This led to a 16-item instrument, which was then tested with an additional sample (n = 676). Internal consistency was high, and scores for both subscales showed variance based on prior healthcare experience. The interprofessional interaction subscale was primarily comprised of items from the Teams and Teamwork domain, with one item each based on competencies from the Interprofessional Communication and Values/Ethics domains; and scores varied by year of enrollment. The interprofessional values subscale was comprised solely of items from the Values/Ethics domain. Scores for both subscales were strongly correlated with scores from the Interprofessional Socialization and Valuing Scale. This study further establishes the validity, reliability, and usability of an assessment tool based on interprofessional competency. The findings also suggest the constructs underlying the subscales may be affected differently by experience and training. Additional study using longitudinal data is needed to test this hypothesis.

How Do Pediatric Hospital Medicine Fellowships Prepare Graduates as Educators? A Survey of Program Directors and Graduates in the United States.

Pediatric hospital medicine (PHM) is the newest recognized subspecialty in pediatrics within the United States. While fellowships in PHM have been available for several years, completion of a 2-year fellowship has become a requirement for subspecialty certification. Pediatric hospitalists provide substantial teaching to trainees, and therefore, PHM fellowships must include dedicated training around teaching and medical education. The purpose of this study was to determine how current PHM fellowships prepare graduates for their roles as medical educators. Two surveys were developed from the published PHM core competencies and Entrustable Professional Activities for pediatric subspecialties. One survey was disseminated to all active PHM program directors and the second was disseminated to all PHM fellowship graduates who completed training between 2012 and 2016. Items included those related to program structure and training/assessment in medical education. A total of 21 program directors (response rate = 58%) and 46 fellowship graduates (response rate = 46%) participated in the survey. All graduates (100%) reported teaching learners in their current setting. Many (67%) fellowship programs offered formal training in medical education, and this is greater than the 50% that was previously described. Direct observation (71%) was the most common method of assessment. Most graduates reported their fellowship provided optimal training in feedback and teaching during family centered rounds but suboptimal training in other skills such as curriculum development. The results of this study highlight areas for improvement in fellowship curriculum and assessment to better prepare fellows for their roles as educators.

Notes from the Field: Evaluating a Budget-Based Approach to Peer Assessment for Measuring Collaboration Among Learners on Interprofessional Teams.

Assessing interprofessional skills poses challenges for health professions educators. While competency frameworks define the skills graduating students should possess, they do not provide guidance for assessment. This brief report explores validity evidence for use of peer assessment to assess learners and provide feedback for improvement. The context was an online learning experience for 477 fourth-year students from medicine, nursing, and pharmacy who worked together on small interprofessional teams to care for a virtual geriatric patient. At the end of each case unit, students were given a budget of points to allocate among teammates to assess their communication and interprofessional collaboration. Ratings were averaged to provide learners with feedback about their performance. Scores were normally distributed, did not demonstrate a leniency effect, were moderately correlated with ratings that preceptors assigned to students, and had smaller correlations with knowledge scores and other case activity measures. Findings support budget-based peer assessment as a valid and feasible approach for differentiating between students with high interprofessional competency and those who may be deficient. Further exploration should focus on the longitudinal effect of peer assessment, how it may influence individual learning and team dynamics, and whether it could be used for other assessment purposes.

Perceived influence of power distance, psychological safety, and team cohesion on team effectiveness.

Interprofessional education needs a stronger theoretical basis informed by the challenges facing collaboration across professions. This study explores the impact of power distance (perception of role hierarchy), on team effectiveness as mediated by team cohesion and psychological safety (believe one can speak up without the fear of negative consequences). Furthermore, it tests for differences between medical and nursing students in these concepts. Final-year medical and nursing students completed a paper survey on study constructs at the end of a three-session, 6-h interprofessional critical care simulation activity. Two hundred and forty-three (76% response rate) retrospective surveys found the relationship between power distance and perceived team effectiveness was mediated by perceptions of team cohesion and psychological safety, suggesting these concepts influence desired interprofessional collaboration. There were no differences between medical and nursing students on study variables. While interprofessional training typically focuses on general attitudes toward interprofessional collaboration and on the acquisition and demonstration of knowledge and skills, these findings suggest important team concepts underlying effective collaboration may include perceptions of psychological safety and power distance. These concepts can be key drivers of cohesion and effectiveness during interprofessional simulation exercises and may be targets for future interventions.

Evaluating a Center for Interprofessional Education via Social Network Analysis.

Centers and institutes are created to support interdisciplinary collaboration. However, all centers and institutes face the challenge of how best to evaluate their impact since traditional counts of productivity may not fully capture the interdisciplinary nature of this work. The authors applied techniques from social network analysis (SNA) to evaluate the impact of a center for interprofessional education (IPE), a growing area for centers because of the global emphasis on IPE.The authors created networks based on the connections between faculty involved in programs supported by an IPE center at Virginia Commonwealth University from 2014 to 2017. They used mathematical techniques to describe these networks and the change in the networks over time. The results of these analyses demonstrated that, while the number of programs and involved faculty grew, the faculty maintained a similar amount of connection between members. Additional faculty clusters emerged, and certain key faculty were important connectors between clusters. The analysis also confirmed the interprofessional nature of faculty collaboration within the network.SNA added important evaluation data beyond typical metrics such as counts of learners or faculty. This approach demonstrated how a center was evolving and what strategies might be needed to support further growth. With further development of benchmarks, SNA could be used to evaluate the effectiveness of centers and institutes relative to each other. SNA should guide strategic decisions about the future of centers and institutes as they strive to meet their overarching goal of tackling a social challenge through interdisciplinary collaboration.

Dental and Dental Hygiene Student Perceptions of Interprofessional Education.

Purpose: Commission on Dental Accreditation standards for dental and dental hygiene programs include interprofessional education (IPE) experiences within the curriculum; an initial step in the acquisition and application of IPE is for students to perceive it as relevant. The purpose of this study is to identify dental and dental hygiene students' attitudes regarding IPE following the completion of a novel interprofessional course involving health professional students from six different degree programs.Methods: Faculty members from the Schools of Allied Health Professions, Dentistry, Nursing, and Pharmacy designed a one-hour, required course focusing on collaborative practice, roles and responsibilities, teamwork, and communication. Students from six different professional programs were divided into interprofessional teams for the thirteen session IPE course. Upon completion of the course, all participants (n=487), were invited to complete an online course evaluation survey utilizing the Student Perceptions of Interprofessional Clinical Education (SPICE-R2) instrument. A retrospective pre-test-post-test approach was used to assess attitudinal change.Results: A total of 300 students from the six health care professions (n=300) completed the SPICE-R2 pre- and post-test surveys for a response rate of 62%. In general, students reported significantly more positive perceptions about IPE after completion (M = 39.7, SD = 7.57) than they did prior to the course (M = 36.6, SD = 7.13), t(299) = -9.24, p < .001; and the effect size was moderate (Cohen's d = .535). One-way analysis of variance revealed a significant main effect for student program on change in scores on the total SPICE-R2 scale. Although post- tests did not reveal differences between specific programs, dental hygiene students exhibited the greatest attitudinal change, while dental students demonstrated the lowest.Conclusions: Sample sizes from the six healthcare programs varied and serve as a limitation for this study. Findings suggest that dental hygiene students may perceive greater benefit from IPE because they see themselves as collaborative practitioners. while dental students may self-identify as leaders of the oral healthcare team. Further research is warranted to examine students' perceptions of IPE to determine the potential impact and success of these curricular activities.

The effect of an interprofessional simulation-based education program on perceptions and stereotypes of nursing and medical students: A quasi-experimental study.

BACKGROUND: Interprofessional education is intended to train practitioners to collaboratively address challenges in healthcare delivery, and interprofessional simulation-based education (IPSE) provides realistic, contextual learning experiences in which roles, responsibilities, and professional identity can be learned, developed, and assessed. Reducing negative stereotypes within interprofessional relationships is a prime target for IPSE. OBJECTIVES: We sought to understand whether perceptions of interprofessional education and provider stereotypes change among nursing and medical students after participating in IPSE. We also sought to determine whether changes differed based on the student's discipline. DESIGN: This was a quasi-experimental pretest-posttest study. SETTING: The study took place at a large mid-Atlantic public university with a comprehensive health science campus. PARTICIPANTS: 147 senior Bachelors of Science in Nursing students and 163 fourth-year medical students participated. METHODS: Students were grouped into interprofessional teams for a two-week period and participated in three two-hour simulations focused on collaboration around acutely ill patients. At the beginning of the first session, they completed a pretest survey with demographic items and measures of their perceptions of interprofessional clinical education, stereotypes about doctors, and stereotypes about nurses. They completed a posttest with the same measures after the third session. RESULTS: 251 students completed both the pretest and posttest surveys. On all three measures, students showed an overall increase in scores after the IPSE experience. In comparing the change by student discipline, medical students showed little change from pretest to posttest on stereotypes of doctors, while nursing students had a significant increase in positive perceptions about doctors. No differences were noted between disciplines on changes in stereotypes of nurses. CONCLUSIONS: This study demonstrated that a short series of IPSE experiences resulted in improved perceptions of interprofessional practice and changes in stereotypical views of each profession even when the experience was not directly designed to address these issues. Differences observed between nursing and medical students should be explored further.

Outcomes of Introducing Early Learners to Interprofessional Competencies in a Classroom Setting.

PROBLEM: Although interprofessional practice is important for improving healthcare delivery, there is little evidence describing interprofessional education (IPE) outcomes beyond changes in attitudes and knowledge of prelicensure learners. More rigorous evaluation of early IPE is needed to determine its impact on teaching interprofessional collaborative practice and providing a solid foundation for applying collaborative skills in the clinical environment. INTERVENTION: First-year students (N = 679) in 7 health professions programs participated in a 4-session series focusing on professional roles and responsibilities, teams and teamwork, and the healthcare system. Interprofessional teams of 5-6 students, from at least 3 professions, were assembled for the duration of the series and created a team charter during their first session to guide their work. Each subsequent session included a brief lecture and interactive exercises. Faculty facilitators from the participating programs provided support to students during the sessions. As a culminating project, each team created a short video depicting a barrier to interprofessional collaboration. Students evaluated the performance of their team members using a web-based peer assessment survey. A course evaluation with an embedded validated attitudinal scale was used to assess changes in student perceptions about IPE. A sample of videos were also scored by 2 faculty using a rubric linked to course expectations. CONTEXT: This educational offering took place on the health sciences campus of a large, mid-Atlantic research university with more than 3,200 clinical learners in schools of allied health professions, dentistry, medicine, nursing, and pharmacy. It was the first interprofessional activity for most of the learners. OUTCOME: There were 555 students who participated in some or all of the sessions. Comments indicated that students enjoyed interacting with their peers and prefer activities allowing them to apply content to their profession over lectures. The assessment measures revealed a disconnect between student ratings targeting interprofessional socialization and faculty ratings targeting the products of their teamwork. Although students provided positive feedback to their teammates through peer assessment, and the attitudinal scale showed a small but significant increase in positive attitudes toward IPE, the videos they created did not demonstrate a deep understanding of barriers to interprofessional practice. LESSONS LEARNED: This large-scale IPE activity for early learners supported progress toward interprofessional socialization, but student learning was inconsistently demonstrated in teamwork products. Course planners should augment self- and peer-reported interprofessional socialization measures with faculty-generated behavioral outcome assessments. Such triangulation produces a more robust data set to inform decisions about curricular revisions and development.

Refinement of the IPEC Competency Self-Assessment survey: Results from a multi-institutional study.

Effective interprofessional practice requires interprofessional education that facilitates learners' achievement of competency in the interprofessional domains. Unfortunately, educators currently have a limited number of tools to identify the level of competency of their learners. Previous investigations by some of the authors described the initial characteristics of a tool based on the Competencies for Interprofessional Collaborative Practice. Building on this work, this study describes a multi-institutional, three-part study refining this tool. The series of studies further established the validity, reliability, and usability of the assessment tool. Based on the data derived from this study, we created a shorter, more easily utilised version of the tool that retains previous psychometric strengths. This article describes a tool that consists of two domains, one linked to interprofessional interaction and one linked to interprofessional values. It is believed that this assessment tool may help educators define competence in interprofessional practice and guide assessment of both programmes and learners.

Training and Assessing Interprofessional Virtual Teams Using a Web-Based Case System.

PURPOSE: Today, clinical care is often provided by interprofessional virtual teams-groups of practitioners who work asynchronously and use technology to communicate. Members of such teams must be competent in interprofessional practice and the use of information technology, two targets for health professions education reform. The authors created a Web-based case system to teach and assess these competencies in health professions students. METHOD: They created a four-module, six-week geriatric learning experience using a Web-based case system. Health professions students were divided into interprofessional virtual teams. Team members received profession-specific information, entered a summary of this information into the case system's electronic health record, answered knowledge questions about the case individually, then collaborated asynchronously to answer the same questions as a team. Individual and team knowledge scores and case activity measures--number of logins, message board posts/replies, views of message board posts--were tracked. RESULTS: During academic year 2012-2013, 80 teams composed of 522 students from medicine, nursing, pharmacy, and social work participated. Knowledge scores varied by profession and within professions. Team scores were higher than individual scores (P < .001). Students and teams with higher knowledge scores had higher case activity measures. Team score was most highly correlated with number of message board posts/replies and was not correlated with number of views of message board posts. CONCLUSIONS: This Web-based case system provided a novel approach to teach and assess the competencies needed for virtual teams. This approach may be a valuable new tool for measuring competency in interprofessional practice.

Commitment to change and assessment of confidence: tools to inform the design and evaluation of interprofessional education.

INTRODUCTION: This study examines use of the commitment-to-change model (CTC) and explores the role of confidence in evaluating change associated with participation in an interprofessional education (IPE) symposium. Participants included students, faculty, and practitioners in the health professions. METHODS: Satisfaction with the symposium and levels of commitment and confidence in implementing a change were assessed with a post-questionnaire and a follow-up questionnaire distributed 60 days later. Participants who reported changed behavior were compared with those who did not make a change. Independent sample t-tests determined whether there were differences between groups in their average level of commitment and/or confidence immediately following the symposium and at follow-up. RESULTS: At post-symposium, attendees were satisfied with content and format. Sixty-eight percent said they would make a change in profession related activities. At 60 days, 53% indicated they had implemented a change. In comparison to those who reported no change, those who made a change reported higher levels of commitment and higher levels of confidence. Logistic regression suggested that the combination of commitment and confidence did not predict implementation in this sample; however, confidence had a higher odds ratio for predicting success than did commitment. DISCUSSION: Confidence should be studied further in relation to commitment as a predictor of behavioral change associated with participation in an IPE symposium. Evaluators and instructional designers should consider use of follow-up support activities to improve learners' confidence and likelihood of successful behavior change in the workplace.