Current Literature Summary

Abstract

As noted in the 5th edition of the Athletic Training Education Competencies, a team approach to practice is a foundational behavior for athletic training professional practice. Dating as far back as the 1960s, the World Health Organization has promoted interprofessional education (IPE) that focuses on health professionals and students learning with, from, and about one another in an interactive format—which may occur in the classroom, clinical setting, or online. The rationale for IPE is that learning together will enhance future collaborative practice and thus improve health care delivery. We will provide brief synopses of current research on IPE and discuss possible applications to athletic training education, research, and practice.Hertweck ML, Hawkins SR, Bednarek ML, Goreczny AJ, Schreiber JL, Sterrett SE. Attitudes toward interprofessional education: comparing physician assistant and other health care professions students. J Physician Assist Educ. 2012;23(2):8–15.Reviewed by Jennifer L. Doherty-Restrepo, Florida International UniversitySummary of research context and methods: Until recently, physician assistant (PA) education utilized a team-based approach focusing on the physician-PA working relationship. The revised accreditation standards for PA education now require evidence of interprofessional education (IPE). This curricular change reflects the PA's role in patient-centered care, which requires understanding and coordinating with a variety of health care professionals. The purpose of this study was to compare PA students with other health professions students in regards to their readiness for IPE.The researchers administered the Readiness for Interprofessional Learning Scale (RIPLS) to 158 health professions students (71 PA students, 36 occupational therapy students, 34 physical therapy students, and 17 counseling psychology students; 32 males, 125 females, one who did not indicate gender). The RIPLS uses a 5-point Likert scale (anchors: 1 = strongly disagree, 5 = strongly agree) and consists of 19 items divided into 4 subscales including (1) teamwork and collaboration, (2) negative professional identity, (3) positive professional identity, and (4) roles and responsibilities. The teamwork and collaboration subscale evaluates attitude toward cooperative learning and communication with students from other professions as well as trust, respect, and professional limitations. The negative professional identity subscale evaluates one's value of working with other health care students. The positive professional identity subscale evaluates one's shared learning experiences with other health care profession students as improving communication, problem-solving, and team skills. The roles and responsibilities subscale evaluates students' own roles and those of other health care providers.Summary of research findings: Female students of all the health professions studied scored significantly higher on the RIPLS total score, as well as on the team and collaboration subscale, compared to male students. These data suggest that female students may more readily value cooperative learning with students from other professions than male students. Regardless of the area of study, students with prior exposure to the health care environment, either as a patient or as an immediate family member of a patient, scored significantly higher on the negative professional identity subscale compared to students without such exposure. These data suggest that students with prior exposure to the health care environment may not readily value cooperative learning with other health professions students. Overall, PA students scored significantly lower on 3 of the 4 subscales of the RIPLS (teamwork and collaboration, negative professional identity, and roles and responsibilities), as well as lower in total score. These data suggest that PA students may value IPE less than other health professions students.Implication for athletic training education/research: Given the multifaceted nature of many health issues and health care delivery systems, IPE and collaborative clinical practice is essential. No individual health care provider can adequately address an individual's various health-related problems. Health professions students, including athletic training students, need to learn the roles and responsibilities of other professions, interact with other professions, and collaborate with other professions to improve patient care. The use of IPE in athletic training curricula could further augment efforts to educate others about the athletic training profession. Athletic training students learning with and from other health professions students may facilitate collaborative practice and thus advance the athletic training profession. More research is warranted regarding the efficacy of IPE in the classroom, clinical, and online formats. Additionally, and ultimately most important, research is needed to examine the translation of IPE to clinical practice and improved patient outcomes.Eccott L, Greig A, Hall W, Lee M, Newton C, Wood V. Evaluating students' perceptions of an interprofessional problem-based pilot learning project. J Allied Health. 2012;41:185–189.Reviewed by Karen Hostetter, Colorado State University–PuebloSummary of research context and methods: Current health care professionals often collaborate with other allied health care professionals to create interprofessional (IP) teams which provide holistic, comprehensive patient care. Curricular programs that prepare future health care professionals often employ problem-based learning (PBL) modules to improve communication skills and teamwork; however, few opportunities exist for students to experience IP collaboration in the educational setting. In order to address this issue, 5 faculty members from medicine, pharmacy, nursing, physical therapy, and occupational therapy developed a patient-centered interprofessional problem-based-learning (IP-PBL) module that focused on a new mother with low-back pain and postpartum depression.The researchers performed a pilot study using a mixed methods approach of prequestionnaires and postquestionnaires and focus groups to complete this quasi-experimental study. Five groups of students (n = 24), with representation from 5 health professions (medicine, pharmacy, nursing, physical therapy, and occupational therapy), participated in a patient-centered IP-PBL module. The quantitative portion of the study used pretest and posttest scores from a 16-item, 7-point Likert scale instrument designed to assess changes in students' attitudes and knowledge toward interprofessional collaboration. Response options ranged from negative views (low scores) to positive views (high scores) for effectiveness of interprofessional learning. The qualitative portion enlisted 5 investigators who asked 8 questions to obtain deeper information about students' perceptions of the IP-PBL experience. Responses to these questions were recorded and coded using common words or phrases, which were grouped into themes.Summary of research findings: Quantitative findings demonstrated significant increases from pretest to posttest attitudes in 11 of the 16 items. Regarding “understanding of interprofessional teamwork,” 100% of students agreed or strongly agreed the IP-PBL module increased their understanding. Additionally, students indicated the IP-PBL process encouraged open, honest communication, mutual trust within the focus groups, and promoted collaborative efforts between health care professions to achieve objectives. Qualitative findings produced 4 key themes (content, process, learning outcomes, and practical issues) that summarized students' perceptions of IP-PBL. Students expressed increased confidence in making referrals to appropriate health care professionals (content); improved communication and respect for other perspectives (process); increased collaboration and preparation for holistic care (learning outcomes); IP-PBL is not prominent in programs secondary to curricular demands (practical issues).Implication for athletic training education/research: These findings suggest there is merit to crossing curricular or program boundaries in order to develop health care professionals who are able to confidently collaborate with others to provide holistic care for the patient. The importance of a team approach to health care is not a new concept in athletic training, yet athletic trainers are often overlooked as valuable members of such a team. Introducing this IP module approach to students in athletic training and other allied health care education programs provides early exposure to other professions and opportunities to develop mutual respect between health care professions before the need arises in the professional setting. Additionally, students learn to promote their discipline as a necessary entity in providing quality care to patients.Wamsley M, Staves J, Kroon L, et al. The impact of an interprofessional standardized patient exercise on attitudes toward working in interprofessional teams. J Interprof Care. 2012;26(1):28–35.Reviewed by Priscilla M. Dwelly, Clarke UniversitySummary of research context and methods: The integration of multiple health care providers in patient care has led to an academic push for interprofessional education (IPE). The current trend is to engage the learners in a scenario-based environment. Role-play or scenario-based learning is effective in actively engaging students and encouraging communication between health care professions. Therefore, the purpose of this study was to design, implement, and analyze an interprofessional standardized patient exercise (ISPE) using students and faculty from dentistry, medicine, nursing, pharmacy, and physical therapy.The investigators conducted a quasi-experimental pre-post design. Their primary objective was to compare attitudes on ISPEs among participants (n = 94) and students in the professional programs who did not participate (n = 152) using a survey. There were 3 constructs included in the survey: team value, team efficiency, and physician's shared role. The development of the ISPE included faculty from the 4 professions creating a standardized patient inflicted with a variety of health conditions. The faculty then divided participants into groups and instructed them to work together to provide the best care for the patient. After working through the ISPE, participants again completed the survey. Participants were also invited to a focus group led by their faculty representative to further discuss their perceptions of ISPE.Summary of research findings: Participating in the ISPE resulted in a significant positive response for participants from all professions on team value; however, dentistry and medical students had limited increases compared to other professions. All professions, except medical, also reported a more positive attitude after the ISPE on team efficiency. However, participating in the ISPE had no effect on participants' attitudes toward physicians' shared role. Students and faculty involved were highly satisfied with the ISPE and believed the ISPE met their goals of increasing understanding of various health care professions and increasing collaboration among professions.Follow-up focus groups identified successful and challenging components of the ISPE. Successful strategies for increasing collaboration and communication included: assigning specific tasks based on profession, adjusting throughout the scenario based on patient responses, and providing an authentic patient. The challenging components included: authenticity for dentistry students (the physical exam was limited as the standardized patient could not mimic physical dental disease), negotiation of roles between nursing and medical students, and time constraints. Upon completion of the ISPE, the investigators identified 3 education outcome themes: professional roles, clinical skills, and confidence.Implication for athletic training education/research: The use of athletic trainers in various health care facilities warrants an investigation into current practices of interprofessional educational strategies. This investigation did not identify a particular curriculum; it did provide a basic framework for creating an ISPE with multiple health care professions. Understanding each profession's role and skill set is required for optimal patient care, and exposure to other professions early in a student's education will provide a better awareness to these roles and skill sets. The positive results of this investigation demonstrate the advantages of exposing students to interprofessional teamwork, which helped students to understand their profession's uniqueness. Future investigations should include athletic training students with other professions that are involved in patient care, such as nursing, physical therapy, and orthopedic students.Robben S, Perry M, van Nieuwenhuijzen L, et al. Impact of interprofessional education on collaboration attitudes, skills, and behavior among primary care professionals. J Contin Educ Health Prof. 2012;32(3):196–204.Reviewed by Tonya Parker, Grand Valley State UniversitySummary of research context and methods: Health care is increasingly provided by a large number of professionals from different disciplines. This is especially true of those patients with complex needs. Previous research has found that poor collaboration between professionals can negatively impact patient outcomes, decrease work satisfaction of professionals, and waste valuable resources. One approach to improving collaboration between professions is interprofessional education (IPE), when members of 2 or more professions learn with, from, and about each other. However, this method of professional education has not been well studied, and effectiveness remains unclear.In this study, the researchers developed, delivered, and evaluated an IPE program for general practitioners, pharmacists, nurses, social workers, and paramedical disciplines (ie, physical therapists, occupational therapists, dietitians). This was a mixed-methods study with before-after evaluations and semistructured interviews. The researchers utilized the Attitudes Toward Health Care Teams Scale, Interprofessional Attitudes Questionnaire, Team Skills Scale, and qualitative components from the interviews to examine outcomes of learners' reactions, changes in perceptions and attitudes toward collaboration, acquisition of collaboration skills and knowledge, and change in collaborative behaviors.Summary of research findings: The researchers found that the brief IPE program resulted in a small but significant improvement in participants' attitudes toward other professions and in self-reported team skills; however, their attitudes toward health care teams did not change. Interviewees indicated that the most important part of the IPE education program was the group discussion of case studies which allowed them to learn and better understand the way other professionals approach a case, thus making it more likely for them to collaborate.Implication for athletic training education/research: This study suggests that interactive IPE in small groups, comprising local professionals that are likely to interact, using role-play and group discussions of case studies has the potential to improve interprofessional attitudes as well as collaboration skills and behaviors. However, creating IPE that meets the need of all participants is difficult. This type of program is likely best for clinical and collegiate settings where the interaction and collaboration between doctors, athletic trainers, physical therapists, and nurses is foremost in providing health care. Interprofessional education provides the opportunity for improved communication and understanding that may lead to improved health care outcomes for the patient, as well as a means to improve the profile of the profession among other health care professionals.