Mapping Health Professions Education: Using Complexity Science to Make Sense of Learning Through Electronic Consultations.

Phenomena studied within health professions education are often complex and multifaceted. This article describes a complexity science-informed theoretical framework that was developed for exploring how electronic consultations support learning among primary care providers, as well as within the larger organizations or systems in which they practice. This framework enables researchers to investigate learning occurring simultaneously at multiple levels (including individuals and social groups), without simplistically conflating levels or theories. The various levels of learning and associated theories are illustrated using examples from electronic consultations. This complexity science-inspired framework can be used for studying learning in complex, multilayered systems.

The perceived contributions of non-physician team members to residents' interprofessional education during a critical care rotation.

During rotations, post-graduate medical residents must learn about interprofessional teamwork and collaboration. Our study examined the role of non-physician healthcare team members in such education, from the perspectives of both residents and team members themselves. METHODS: This qualitative study took place in the intensive care unit (ICU) of a teaching hospital in a Canadian city. We conducted semi-structured individual and focus group interviews with both residents (n = 6) and the team members with whom they collaborated: pharmacists, nurses, respiratory therapists, and a social worker (n = 19). RESULTS: We developed a number of themes about interprofessional education (IPE) in this context from the data, including the presence of planned, unplanned, and tacit teaching; the influence of contextual factors like ICU culture, work demands, resident motivation, power hierarchies, and perceptions of 'good' and 'bad' residents; the gap between team member perceptions of their contribution to residents' IP education and residents' own perceptions; and concerns about the transferability of IPE to other contexts. CONCLUSIONS: The influence of non-physician team members on residents' IPE in the clinical environment is an understudied topic. While our study was limited to one ICU, the themes that emerged may be of interest to others in similar contexts.

CONTEXTE: Au cours des stages, les résidents en médecine doivent apprendre le travail d'équipe et la collaboration interprofessionnelle (IP). Notre étude examine le rôle des membres non-médecins de l'équipe soignante dans cette formation, de leur point de vue et du point de vue des résidents. MÉTHODES: Cette étude qualitative a été réalisée dans l'unité de soins intensifs (USI) d'un hôpital universitaire dans une ville canadienne. Nous avons mené des entretiens individuels et des groupes de discussion semi-structurés avec les résidents (n = 6) et les membres de l'équipe avec lesquels ils collaboraient : des pharmaciens, des infirmières, des inhalothérapeutes et un travailleur social (n = 19). RÉSULTATS: À partir des données, nous avons dégagé un certain nombre de thèmes sur la formation interprofessionnelle (FIP) dans ce contexte, notamment la présence d'un enseignement planifié, non planifié et tacite; l'influence de facteurs contextuels tels que la culture des soins intensifs, les exigences du travail, la motivation des résidents, les hiérarchies et la perception des résidents comme étant « bons ¼ ou « mauvais ¼; le décalage entre les perceptions des membres de l'équipe quant à leur contribution à la formation interprofessionnelle des résidents et celles des résidents eux-mêmes; et les préoccupations concernant la transférabilité de la FIP dans d'autres contextes. CONCLUSIONS: L'influence des membres non-médecins de l'équipe soignante sur la FIP des résidents en milieu clinique est un sujet peu étudié. Bien que notre étude se limite à une seule unité de soins intensifs, les thèmes qui en sont ressortis pourraient être généralisés à des contextes similaires.

Socio-material perspectives on interprofessional team and collaborative learning.

CONTEXT: Interprofessional teamwork and collaboration have become important parts of health care practice and education. Most of the literature on interprofessional learning, however, assumes that learning is something acquired by individuals and readily transferred to other contexts. This assumption severely limits the ways in which interprofessional educators and researchers can conceptualise and support learning related to collaborative interprofessional health care. Socio-material theories provide an alternative to individualistic, acquisition-oriented notions by reconceiving learning in terms of collective dynamics, participation in social communities and active engagement with material contexts. METHODS: Socio-material literature and theories were reviewed to identify concepts relevant to interprofessional learning. After briefly summarising the origins and key principles of socio-material approaches, the authors draw upon specific socio-material theories--including complexity theory, cultural-historical activity theory and actor-network theory--in order to reconceive how learning happens in interprofessional contexts. This reframing of interprofessional learning focuses less on individuals and more on collective dynamics and the actual social and material relations involved in practice. DISCUSSION: The paper proposes five ways in which learning may be enacted in interprofessional teamwork and collaboration from a socio-material perspective: (i) diverse contributions; (ii) social interactions and relationships; (iii) synthesis of professional ideas; (iv) integration of material elements, and (v) connections to large-scale organisations. For each of these categories, the paper provides practical illustrations to assist educators and researchers who wish to identify and assess this learning. CONCLUSIONS: Although more exploratory than comprehensive, this paper articulates many key aspects of socio-material learning theories and offers practical guidance for those who wish to employ and assess them in interprofessional contexts.

The development of vaccination perspectives among chiropractic, naturopathic and medical students: a case study of professional enculturation.

An important influence on parents' decisions about pediatric vaccination (children under 6 years of age) is the attitude of their health care providers, including complementary and alternative medicine (CAM) providers. Very limited qualitative research exists, however, on how attitudes towards vaccination develop among healthcare professionals in-training. We explored perspective development among three groups of students: medical, chiropractic, and naturopathic. We conducted focus group sessions with participants from each year of study at three different healthcare training programs in Ontario, Canada. Semi-structured and open-ended questions were used to elicit dynamic interaction among participants and explore how they constructed their attitudes toward vaccination at the beginning and part way through their professional training. Analyses of verbatim transcripts of audiotaped interviews were conducted both inductively and deductively using questions structured by existing literature on learning, professional socialization and interprofessional relations. We found five major themes and each theme was illustrated with representative quotes. Numerous unexpected insights emerged within these themes, including students' general open-mindedness towards pediatric vaccination at the beginning of their training; the powerful influence of both formal education and informal socialization; uncritical acceptance of the vaccination views of senior or respected professionals; students' preference for multiple perspectives rather than one-sided, didactic instruction; the absence of explicit socio-cultural tensions among professions; and how divergences among professional students' perspectives result from differing emphases with respect to lifestyle, individual choice, public health and epidemiological factors-rather than disagreement concerning the biomedical evidence. This last finding implies that their different perspectives on pediatric vaccination may be complementary rather than irreconcilable. Our findings should be considered by developers of professional and interprofessional educational curricula and public health officials formulating policy on pediatric vaccination.

Complexity, collective learning and the education of interprofessional health teams: insights from a university-level course.

This paper describes a collaborative action research project carried out by the author and the instructors of a large university-level interprofessional health team course. The research focused on introducing new complexity science-based ideas about collective learning to the course's pedagogy and curriculum, and tracking resultant changes in both thinking and practice. A number of insights emerged from the research, including a deeper understanding of collective learning in interprofessional contexts, a questioning of the meaning of consensus within teams, and the identification of a special role for trust in interprofessional relationships. One significant practical change in the course curriculum, which related to these insights, is also described.