Aprendizagem baseada em projeto e a formação médica: relato de experiência introduzindo questões para o debate interprofissional / Project-based learning and medical education: experience report introducing issues for interprofessional debate / El aprendizaje basado en proyecto y la formación médica: informe de experiencia que introduce cuestiones para el debate interprofesional

A aprendizagem baseada em projeto orientada pelos fundamentos da educação interprofissional é um modelo que pode contribuir para a formação de relacionamentos interpessoais, criatividade, empatia e colaboração na educação médica, por meio de uma colaboração mútua com profissionais de saúde da rede. Muito se fala da efetividade desse método no campo do ensino e aprendizagem médica, mas há a necessidade de incluir a importância do desenvolvimento de habilidades interprofissionais, com equipes colaborativas, em ações extensionistas, diante das necessidades locais no contexto da atenção primária, pensando na melhoria dos resultados de saúde. O objetivo deste trabalho é apresentar um relato de experiência de aprendizagem baseada em projeto de estudantes de Medicina no contexto da Estratégia Saúde da Família. Participaram deste trabalho estudantes do Módulo Integração Ensino, Serviço e Comunidade da Faculdade de Medicina da Universidade Federal dos Vales do Jequitinhonha e Mucuri que executaram, em colaboração com uma equipe interprofissional o projeto sobre a saúde do homem. Como resultado da análise qualitativa do feedback entre os integrantes, observaram-se mudanças no comportamento dos estudantes, com melhorias na comunicação, empatia e nas relações interpessoais, por meio do trabalho colaborativo com a equipe interprofissional. Esta experiência poderá ser adaptada para implementar o ensino e aprendizagem no projeto pedagógico orientado pela educação interprofissional na atenção primária.

Project-based learning guided by the fundamentals of interprofessional education is a model that can contribute to the formation of interpersonal relationships, creativity, empathy and collaboration within medical education, through mutual collaboration with health professionals in the health network. Much has been said about the effectiveness of this method in medical teaching and learning, but there is a need to include the importance of developing interprofessional skills, with collaborative teams, within extension actions, in view of local needs in the context of primary care, thinking about the improved health outcomes. The objective of this work was to present a report of a project-based learning experience of medical students in Family Health Strategy. Students from the Teaching, Service and Community Integration Module of the Faculty of Medicine of Universidade Federal dos Vales do Jequitinhonha e Mucuri participated in this work, executing in collaboration with an interprofessional team a project about men's health. As a result of the qualitative analysis of the feedback among the members, changes in student behavior were observed with improvements in communication, empathy and interpersonal relationships through collaborative work with the interprofessional team. This experience can be adapted to implement teaching and learning in the pedagogical project guided by interprofessional education in primary care.

El aprendizaje basado en proyectos y guiado por los fundamentos de la educación interprofesional es un modelo que puede contribuir a la formación de relaciones interpersonales, creatividad, empatía y colaboración dentro de la educación médica, a través de la colaboración mutua con los profesionales de la salud en la red de salud. Mucho se habla de la efectividad de este método dentro de la enseñanza y el aprendizaje médico, pero es necesario incluir la importancia del desarrollo de habilidades interprofesionales, con equipos colaborativos, dentro de las acciones de extensión, frente a las necesidades locales en el contexto de la atención primaria, pensando sobre los mejores resultados de salud. El objetivo de este trabajo es presentar un informe de experiencia de aprendizaje basado en proyectos de estudiantes de medicina en la Estrategia de Salud Familiar. Participaron en este trabajo estudiantes del Módulo Integración Enseñanza, Servicio y Comunidad de la Facultad de Medicina de la Universidade Federal dos Vales do Jequitinhonha e Mucuri que ejecutaron en colaboración con un equipo interprofesional el proyecto sobre la salud del hombre. Como resultado del análisis cualitativo de la retroalimentación entre los integrantes, se observaron cambios en el comportamiento de los estudiantes con mejoras en la comunicación, la empatía y las relaciones interpersonales a través del trabajo colaborativo con el equipo interprofesional. Esta experiencia puede adaptarse para implementar la enseñanza y el aprendizaje en el proyecto pedagógico guiado por la educación interprofesional en atención primaria.

In-person to virtual interprofessional education: Teamwork attitudes and skills among dental and dental hygiene students.

OBJECTIVES: The interruption to clinical professions' instruction due to closures from the coronavirus disease 2019 pandemic posed a significant hurdle to clinical education and presented a necessity to shift how instruction was delivered to resume educational activities. This study sought to answer the research question: did the transition from in-person to virtual instruction for interprofessional education (IPE) have an impact on students' perceptions of team attitudes and skills to learn and work in interprofessional groups? METHODS: All participating first-year dental and second-year dental hygiene students enrolled in the campus-wide IPE course were invited to complete the Team Skills Scale (TSS) assessment before and after the course for two academic years 2019-2020 and 2020-2021. Paired t-tests were utilized to assess the change in student attitudes and skills from pre- to post-course assessment, and t-tests were used to assess mean differences between student cohorts 2019-2020 and 2020-2021. RESULTS: Within the student cohort 2019-2020 students reported significant improvement in all TSS items. Within the student cohort, 2020-2021 students reported significant improvement in all but three TSS items. There were only significant differences in mean values for student reported improvement in attitudes and skills for two TSS items between the 2019-2020 and 2020-2021 cohorts. CONCLUSIONS: Dental and dental hygiene students report significant improvement in team attitudes and skills after participation in a campus-wide IPE course. The mode of administration of the course, in-person or virtual, did not have a significant impact on student-reported improvements.

A community-based geriatric interprofessional education experience and its impact on post-graduate collaborative practice.

While a growing body of interprofessional education (IPE) literature demonstrates a positive impact on learner knowledge, there is limited data on its long-term impact on collaborative practice (CP). With the growth of the aging population globally, understanding both the long-term impact on CP and sustainability of community-based geriatric experiential IPE programs are imperative. This study explores the impact of the Interprofessional Geriatric Curriculum (IPGC), a community-based geriatric IPE program, on post-graduate clinical practice among seven health professions. This study utilized a cross-sectional descriptive design, where both qualitative and quantitative data were collected in the same online survey of health professionals' to measure their perceptions of the impact IPGC has had on their respective clinical practice 1-3 years post-graduation. Forty-six per cent of health profession graduates provided clinical care for people 65 years of age or older; 81% worked in interprofessional teams; 80% reported the IPGC experience significantly impacted their practice (N = 137), and all used validated assessment tools taught in the IPGC program in their practice. Eight themes emerged from the list of what health professionals learned from IPGC that they use regularly in their clinical practice: four themes were interprofessional in nature (i.e. teamwork and team-based care, interprofessional communication, roles/responsibilities, and personal/professional) and four themes related to geriatrics (i.e. aging, screening and assessment, medications, and didactic content). This study is one of the first to describe the sustained influence of a community-based IPE program across multiple health professional disciplines on clinical geriatric practice.

The Interprofessional Standardized Patient Experience: An Effective Interprofessional Education Activity for Prelicensure Health Professional Students.

Introduction: For future success in the modern health care environment, health professions students require effective interprofessional education experiences to develop their perceptions of other professionals on the health care team. The Interprofessional Standardized Patient Experience (ISPE) is an interprofessional education activity for prelicensure health professional students in nursing, pharmacy, physical therapy, medicine, social work, and occupational therapy. Methods: The ISPE involved collaboration among students to conduct a subjective interview. Students from six health care professions individually interviewed a simulated patient while being observed by students from other professions. A structured faculty-guided debriefing session followed the comprehensive interview process. Students completed a voluntary pre- and post-ISPE survey with interprofessional questions and feedback on the activity. Descriptive statistics were used to analyze individual responses. Differences in student opinions by student profession and by the number of professions present were examined using chi-square tests. Results: Over 4 consecutive academic years, 1,265 students completed the ISPE, and 1,028 completed the pre- and post-ISPE surveys. Analysis of the survey responses indicated that the ISPE enhanced student awareness of the functions of an interprofessional team and increased student knowledge of the roles of different health care professions. Students rated the ISPE as a valuable experience. Differences were noted in some of the measures by profession and group size. Discussion: A single ISPE had a significant impact on prelicensure students' perceptions. The ISPE is a novel and effective approach to interprofessional education that students appreciate.

Building Interprofessional Competencies Through a Collaborative Prescribing Activity With Osteopathic, Pharmacy, and Physician Assistant Students.

Introduction: Medication errors can lead to significant adverse events. Nearly 50% of medication errors occur during the prescription-writing stage of the medication use process, and effective interprofessional collaboration and communication are key to reducing error in this process. Methods: We developed a three-part, 60-minute, interprofessional education activity providing medical, physician assistant, and pharmacy students the opportunity to practice collegial interprofessional communication surrounding prescribing practices. Learners met virtually initially as a large group and divided into small groups facilitated by a health professional. Part 1 involved reviewing two prescriptions prepared by learners; part 2 was a discussion about the education, roles, and responsibilities of each profession; and part 3 focused on identifying prescription errors in examples provided by faculty. Students completed a post-pre survey measuring their perception of learning the Interprofessional Collaborative Competency Attainment Survey (ICCAS) areas. Results: Of 317 participants (151 doctor of osteopathy, 68 master of physician assistant studies, and 98 doctor of pharmacy students), 286 completed the post-pre survey, for a 90% response rate. Students reported statistically significant (p < .001) increases in all 20 questions spanning the six ICCAS areas. Discussion: The virtual format allowed multiple institutions to participate from various locations. It broadened the learners' experience by fostering interaction among those with varied perspectives and allowed collaboration between locations and programs that otherwise could not have participated. The activity introduced students to virtual collaboration and key telehealth skills, enhancing their confidence and familiarity with virtual interactions in a professional setting.

Shaping tomorrow's dentists: a multi-institutional survey of undergraduate dental students' perceptions towards interprofessional education.

BACKGROUND: Interprofessional education (IPE) is essential to foster collaboration among healthcare professionals for holistic patient care. However, Malaysian dental education remains discipline-centric, hindering multidisciplinary learning approaches. Hence, this study aimed to explore Malaysian undergraduate dental students' perceptions of IPE. METHODS: The present cross-sectional study employed convenience sampling to survey undergraduate dental students from four Malaysian institutions using a modified questionnaire with 20 close-ended and 2 open-ended questions. The questionnaire covered three domains (effectiveness, preference, importance) to assess students' perceptions using a five-point Likert scale. Psychometric validation was performed to assure validity and reliability of the modified questionnaire. Quantitative analysis (descriptive and inferential statistics), and qualitative analysis (content analysis) were subsequently performed. RESULTS: 397 students responded, and positive perceptions were generally noted with mean scores ranging from 4.13 to 4.35 across all domains. Questions 2 and 3, assessing the improvement in understanding the roles and responsibilities, and communication among healthcare professionals, received the highest mean scores. Meanwhile, Question 15 concerning the incorporation of IPE into educational goals received the lowest mean score. Regression analysis identified gender and clinical phase as significant factors, with females and preclinical students exhibiting more favourable perceptions. Motivators for IPE included a keen interest in diverse perspectives and recognising the importance of teamwork, while barriers encompassed tightly packed schedules, lack of understanding about IPE, misconceptions regarding dental education, and students' nervousness and fear of participation. CONCLUSION: This study produced a valid and reliable instrument to measure undergraduate dental students' perceptions towards IPE. Strategic planning, such as overcoming logistical challenges, improving awareness, and creating a supportive learning environment are crucial for successful IPE integration into existing curricula, especially in resource-constrained developing countries like Malaysia.

Assessing REflective simulation-based e-Training on motivational interviewing among multidisciplinary healthcare practitioners [RESeT-MI]: a mixed methods pilot study.

BACKGROUND: Many health science curricula have integrated behavioral modification techniques in their plans. Motivational Interviewing is one such technique. Educational interventions to promote Motivational Interviewing have had limited success. Integrating simulation-based learning in health science curricula might offer a platform whereby students can train in well controlled environments with increased authenticity, provision of standardized experiences and the capacity for immediate feedback to participants. Using motivational interviewing as an exemplar, the purpose of this study was to assess the impact of a simulation-based reflective e-training program on knowledge, attitudes, and confidence in Motivational Interviewing among healthcare practitioners from diverse healthcare disciplines. A secondary aim was to explore whether self-reflection can promote reflective learning. METHODS: This was a mixed-method study design. Fifteen participants from different health disciplines were included in the quantitative phase of the study, the simulated interview, and the reflective assignments while five participated in the focus group. Pre and post tests were used to examine the effect of training on knowledge, attitudes, and confidence in Motivational Interviewing. Assessment of Motivational Interviewing Treatment Integrity [MITI] scores in a simulation-based scenario was used. A qualitative content analysis of a focus group provided a more in-depth understanding of the participants experiences. Excerpts from reflective assignments were analyzed using Transformative Learning Theory concepts. RESULTS: A Wilcoxon test showed that the training elicited a change in confidence in performing Motivational Interviewing [Z= -2.766, p = 0.006], median scores increased from 29 to 34. A quarter of technical scores and half of the relational scores indicated good competence. Participants reflected content transformation through feelings of empowerment and satisfaction when they were successful in engaging and motivating clients. Process transformation was evident in reflections on how to improve core skills specifically reflective listening. Reflections on Motivational Interviewing spirit related values showed premise transformation, which may indicate attitude changes. CONCLUSION: A simulation-based e-training program on Motivational Interviewing represents an important educational modality for training in the health disciplines. Results of this study provide evidence supporting the integration of reflective simulation-based e-training into the education curricula of health disciplines in MI and beyond.

Readiness for interprofessional education among health profession lecturers at a University in Vietnam: A cross-sectional study.

Interprofessional education is acknowledged as an efficacious strategy for fostering collaboration among healthcare professionals, especially in developing countries where interdisciplinarity and cooperation among healthcare practitioners are notably deficient. The present study aimed to investigate the readiness among medical, pharmacy, public health, and nursing faculties for development of an IPE curriculum at a university in Vietnam. Employing a quantitative approach, the revised version of the Readiness for Interprofessional Learning Scale (RIPLS) questionnaire, comprising 19 items, was utilized to gather data from sixty-nine lecturers, including 26 medicine, 23 pharmacy, 11 public health, and 9 nursing faculties. Total scores and subscores (pertaining to teamwork and collaboration, professional identity, and roles and responsibilities) were subjected to comparison using the Kruskal-Wallis and Mann-Whitney U tests. Findings revealed a high level of readiness among all faculty members toward IPE with little difference between each faculty. However, nursing lecturers exhibited a more favorable attitude toward the roles and responsibilities associated with IPE in contrast to their counterparts in the medicine faculty (1.89 ± 1.02 vs 3.15 ± 0.63, p = 0.0048). Further study with deep interview methods should be done to explore the barriers of faculty members as well as of the leadership in developing IPE.

Developing pre-licensure interprofessional and stroke care competencies through skills-based simulations.

Interprofessional collaboration (IPC) in stroke care is accepted as best practice and necessary given the multi-system challenges and array of professionals involved. Our two-part stroke team simulations offer an intentional interprofessional educational experience (IPE) embedded in pre-licensure occupational therapy, physical therapy, pharmacy, medicine, nursing and speech-language pathology curricula. This six-year mixed method program evaluation aimed to determine if simulation delivery differences necessitated by COVID-19 impacted students' IPC perception, ratings, and reported learning. Following both simulations, the Interprofessional Collaborative Competency Assessment Scale (ICCAS) and free-text self-reported learning was voluntarily and anonymously collected. A factorial ANOVA using the ICCAS interprofessional competency factors compared scores across delivery methods. Content and category analysis was done for free-text responses. Overall, delivery formats did not affect positive changes in pre-post ICCAS scores. However, pre and post ICCAS scores were significantly different for interprofessional competencies of roles/responsibilities and collaborative patient/family centered approach. Analysis of over 10,000 written response to four open-ended questions revealed the simulation designs evoked better understanding of others' and own scope of practice, how roles and shared leadership change based on context and client need, and the value of each team member's expertise. Virtual-experience-only students noted preference for an in-person stroke clinic simulation opportunity.

Evaluating Interprofessional Education Readiness and Perceptions Among Health Professions Students.

Background: Inter-professional learning (IPL) or more broadly Inter-professional Education (IPE) refer to a pedagogical approach that involves creating a learning experience where students from different professions learn about, from, and with each other. IPE is crucial for preparing health professionals to offer patient-centered care as part of an interdisciplinary team. This study aims to assess the readiness for IPL among students from different health professions colleges at King Saud bin Abdulaziz University for Health Sciences. Methods: A cross-sectional design was conducted for this study, with a total of 476 undergraduate students from College of Medicine, College of Nursing, and College of Applied Medical Sciences. By using quota sampling, the readiness for interprofessional learning scale (RIPLS) was used to assess the student's readiness for interprofessional learning. Results: The overall mean score of RIPLS for the students participating was 76.20, with the highest mean score in teamwork and collaboration at 39.73. The lowest mean score was in roles and responsibility at 8.45. The professional identity subscale had a mean score of 26.85. A significant difference in professional identity was found between students in applied medical sciences, nursing, and medicine colleges. Conclusion: The study reveals that undergraduate students have positive attitudes towards interprofessional education, which can enhance their engagement in developing competencies necessary for effective contribution to interprofessional healthcare teams. High readiness among medical, nursing, and applied medical sciences students allows for the Introduction of IPL.

Evidence of reliability and validity of the Brazilian Portuguese version of the Jefferson Scale of Attitudes Toward Interprofessional Collaboration.

Interprofessional collaboration leads to better health outcomes. Measuring attitudes related to interprofessional collaboration is not a simple task, and in Brazil, there are few instruments for this evaluation. This study aimed to evaluate the evidence of validity and reliability of the Brazilian Portuguese version of the Jefferson Scale of Attitudes Toward Interprofessional Collaboration in a population of undergraduate healthcare students. It included 108 undergraduates from medicine, nursing, physiotherapy, dentistry, pharmacy, psychology, and physical education academic programmes. The median age was 22 (18 and 58) and 75% were females. The scale comprises 20 items divided into two domains: working relationships, consisting of 12 items, and accountability, consisting of 8 items. The instrument showed good reliability (Cronbach's alpha = 0.77, 95% CI 0.71-0.83) and no item was considered inconsistent in improving the scale significantly. The scale demonstrated good evidence of validity and reliability for application among a population of Brazilian healthcare students.

Problem-Based Learning for Interprofessional Education: A Review of the Concept and Its Application in a Geriatric Team.

The global population is aging, with those aged 65 years or over increasing in number and accounting for a growing share of the population. There are increasing demands for geriatric care which makes the development and delivery of effective geriatric team training a priority. Training in geriatrics is complex because of the multiplicity of medical, psychosocial, and functional issues in elderly individuals which need to be addressed by a multidisciplinary approach using interprofessional education (IPE). Problem-based learning, a student-centered educational model that brings several natural strengths to IPE, is a unique curriculum replacing the traditional lecture-based learning model. This model enhances physician competency after graduation, mainly in psychosocial and teamwork issues that are fundamentally essential for geriatrics. IPE has been shown to have a substantial positive impact on team collaboration, individual development, and healthcare improvement. In this paper, we summarize the current findings from recent studies on training professionals from different healthcare disciplines to deliver care for the elderly in collaborative practice. We also discuss if an interprofessional problem-based geriatric team program in geriatrics is a promising solution to enhance professional collaboration and quality of patient care.

Empowering Voices: Cultivating a Supportive Network From the Women in Medicine and Health Care Symposium.

Description There are many studies, some discussed in this article, that recognize the numerous issues faced by women in medicine and the health care field. In response to the prevalence of these challenges, Riverside Community Hospital's General Medical Education department organized the second Women in Medicine & Healthcare Symposium on November 17, 2023. The symposium featured a panel of women leaders addressing challenges, such as work-life balance, maternity leave, fertility concerns, and family planning. Personal stories and studies on gender bias and infertility shed light on the shared experiences of women physicians. The positive response prompted Riverside Community Hospital to view the event as the first step in creating a supportive community.

Development of a Train-the-Trainer Quality Improvement Curriculum.

Introduction: Quality improvement (QI) curricula are required for clinical disciplines at all training levels. Despite this, faculty educators often feel inadequately prepared to perform QI functions and thus lack the skills necessary to teach QI to learners. We aimed to improve faculty QI skills so they could oversee didactic curricula and experiential QI projects. Methods: We developed a train-the-trainer curriculum for faculty within medicine, nursing, and allied health that was delivered as a 2-hour interactive workshop. Core concepts included QI methodologies, measurement, implementation, and scholarship. Prior to the workshop, attendees completed a baseline knowledge test and a self-assessment of their confidence in teaching QI. Both assessments were repeated 1 month and 6 months postworkshop. Participants also completed a course evaluation. Results: We report on our experience after two workshops with 23 participants total. Baseline median knowledge test percentage correct was 36%. This increased to 77% at 1 month and remained at 57% at 6 months. Self-assessment ratings of QI teaching skills increased consistently from baseline to 1 month to 6 months, with all respondents reporting feeling some confidence or very confident by the end of the study period. The course overall was rated very good or excellent by 91% of attendees. Discussion: A focused QI train-the-trainer curriculum can sustainably improve faculty knowledge and self-ratings of QI teaching skills. Participants rated the interactive 2-hour workshop highly. Its materials can be easily adapted across disciplines and clinical departments to increase the number of faculty competent to facilitate didactic and experiential QI training.

Interprofessional education in cancer care - a scoping review.

BACKGROUND: Comprehensive cancer care requires effective collaboration by interprofessional healthcare teams. The need to develop educational initiatives to improve interprofessional collaboration is increasingly recognised. However, there is no agreement regarding the interprofessional competencies required for effective cancer care leading to much variation on the focus of research, planning and managing change. A scoping review was conducted to identify the current status of IPE in cancer care and to summarise the results of previous research in order to guide the development of interprofessional education in cancer care. METHODS: The JBI Scoping Review guidelines were used to guide the process of the review. A search of the available literature was conducted in CINAHL, MEDLINE (Ovid), PubMed, PsycInfo, Scopus databases from January 2012 to March 2023 to investigate IPE for health professional clinicians working in cancer care. RESULTS: Of the 825 initial references and 153 studies imported for screening, a total of 28 studies were included in the final review. From those studies, seven focused on the need for IPE and interprofessional competence for oncology healthcare professionals, four reviewed existing IPE programs and 17 described the development and evaluation of interprofessional education. Findings show variation and lack of concept definitions underpinning research in IPE in cancer care settings. Variation also exists in the range of research activities in IPE, most notably related to communication, teamwork and the development of interprofessional practice. The evaluation of impact of IPE is mainly focused on health care professionals' self-evaluation and general feedback. Impact on patient care was only evaluated in one study. CONCLUSIONS: Based on the results, interprofessional education research in the field of cancer care is limited in Europe. Thus, there is a significant increase in publications in the last five years. A more systematic focus on the theoretical framework and definition of concepts would be of value. Research and programme development should be based on a shared understanding on what constitutes the interprofessional competences and IPE. Programmes to develop interprofessional practice should be developed and implemented systematically with inclusion of validated assessment methods, and evaluated and improved regularly.

Integrating Community Care for the Prevention and Treatment of Diabetes.

Introduction: This paper describes 'Project 8', a campaign that aims to reduce glycated haemoglobin (HbA1c) to 8% or more among patients with diabetes mellitus, utilising healthcare professionals and local community residents and focusing on education and support. The study is based in Uonuma-a small rural city in Japan with a declining population and an increased number of older people. Description: 'Project 8' began in Uonuma's Koide Hospital in 2008. The Uonuma School for Community Health and Social Care was established in 2011 with the cooperation of a clinic's general practitioner. Medical students, trainees, doctors, and health care professionals have been holding 'open schools' (daytime lectures) and 'night schools' (evening lectures) to educate the community residents about various health issues. Through repeated lectures, the residents have been made aware of lifestyle-related diseases, including diabetes, and the meaning of 'Project 8'. Discussion: Over the last decade, the hospital's campaign has expanded within the community, showing a statistically significant reduction of diabetic patients with HbA1c ≥ 8%, which successfully deferred the start of dialysis for many of them. Conclusion: Well-integrated community care requires interprofessional education, collaborative practice, and the participation of community residents in health education.

Sharpening the lens to evaluate interprofessional education and interprofessional collaboration by improving the conceptual framework: a critical discussion.

It has been difficult to demonstrate that interprofessional education (IPE) and interprofessional collaboration (IPC) have positive effects on patient care quality, cost effectiveness of patient care, and healthcare provider satisfaction. Here we propose a detailed explanation for this difficulty based on an adjusted theory about cause and effect in the field of IPE and IPC by asking: 1) What are the critical weaknesses of the causal models predominantly used which link IPE with IPC, and IPE and IPC with final outcomes? 2) What would a more precise causal model look like? 3) Can the proposed novel model help us better understand the challenges of IPE and IPC outcome evaluations? In the format of a critical theoretical discussion, based on a critical appraisal of the literature, we first reason that a monocausal, IPE-biased view on IPC and IPC outcomes does not form a sufficient foundation for proper IPE and IPC outcome evaluations; rather, interprofessional organization (IPO) has to be considered an additional necessary cause for IPC; and factors outside of IPC additional causes for final outcomes. Second, we present an adjusted model representing the "multi-stage multi-causality" of patient, healthcare provider, and system outcomes. Third, we demonstrate the model's explanatory power by employing it to deduce why misuse of the modified Kirkpatrick classification as a causal model in IPE and IPC outcome evaluations might have led to inconclusive results in the past. We conclude by applying the derived theoretical clarification to formulate recommendations for enhancing future evaluations of IPE, IPO, and IPC. Our main recommendations: 1) Focus should be placed on a comprehensive evaluation of factual IPC as the fundamental metric and 2) A step-by-step approach should be used that separates the outcome evaluation of IPE from that of IPC in the overarching quest for proving the benefits of IPE, IPO and IPC for patients, healthcare providers, and health systems. With this critical discussion we hope to enable more effective evaluations of IPE, IPO and IPC in the future.

The Medical Student Guide to Pharmacy: Piloting an Interactive Textbook on Basic Pharmacology Principles and Clinical Correlations.

OBJECTIVES: Despite the wide use of medications in clinical practice, graduating medical students often feel unprepared for the task of prescribing upon starting residency. With recent educational initiatives aiming to transform learning modalities, we sought to pilot an interactive textbook on basic pharmacology principles at our institution as a supplement to first-year lectures and assess its subjective impact on students' knowledge of content as well as confidence to apply material in the real world through pre- and post-intervention surveys. METHODS: First-year medical students were invited to complete non-validated, voluntary, anonymous, emailed, online surveys consisting of Likert scale and free-text response questions. Our investigation served as a pilot test for future iterations of this research. RESULTS: Response rates for the pre- and post-intervention surveys were 73/145 (50%) and 38/145 (26%), respectively, with the post-intervention survey further reduced to 13 individuals who indicated use of the interactive textbook. Questions regarding interactive textbook chapters that overlapped with course content were excluded from data analysis due to an inability to separate learning gains from lectures versus the interactive textbook. Post-intervention survey responses all showed significant changes in mean Likert scale scores on student-perceived knowledge and confidence to apply material with P < .001. Free-text response questions revealed limited exposure to the field of pharmacy and interactions with pharmacists prior to medical school. CONCLUSION: Our pilot study on the initial use of an interactive textbook titled The Medical Student Guide to Pharmacy presented us with valuable insight into providing first-year medical students with a clinically oriented supplemental resource within coursework on basic pharmacology. Challenges for the future include better integrating the interactive textbook into class lectures to facilitate increased use by students as well as developing more targeted, validated assessments of the impact it has on students' learning.