Interdisciplinary Health Professionals Research Articles

Global Application of the Assessment of Communication Skills of Paediatric Endocrinology Fellows in the Management of Differences in Sex Development Using the ESPE E-Learning.Org Portal

Background: Information sharing in chronic conditions such as disorders of/differences in sex development (DSD) is essential for a comprehensive understanding by parents and patients. We report on a qualitative analysis of communication skills of fellows undergoing training in paediatric endocrinology. Guidelines are created for the assessment of communication between health professionals and individuals with DSD and their parents. Methods: Paediatric endocrinology fellows worldwide were invited to study two interactive online cases (www.espe-elearning.org) and to describe a best practice communication with (i) the parents of a newborn with congenital adrenal hyperplasia and (ii) a young woman with 46,XY gonadal dysgenesis. The replies were analysed regarding completeness, quality, and evidence of empathy. Guidelines for structured assessment of responses were developed by 22 senior paediatric endocrinologists worldwide who assessed 10 selected replies. Consensus of assessors was established and the evaluation guidelines were created. Results: The replies of the fellows showed considerable variation in completeness, quality of wording, and evidence of empathy. Many relevant aspects of competent clinical communication were not mentioned; 15% (case 1) and 17% (case 2) of the replies were considered poor/insufficient. There was also marked variation between 17 senior experts in the application of the guidelines to assess communication skills. The guidelines were then adjusted to a 3-level assessment with empathy as a separate key item to better reflect the qualitative differences in the replies and for simplicity of use by evaluators. Conclusions: E-learning can play an important role in assessing communication skills. A practical tool is provided to assess how information is shared with patients with DSD and their families and should be refined by all stakeholders, notably interdisciplinary health professionals and patient representatives.

A novel interdisciplinary health professions education program at King Saud University: strategy and structure (Phase I)

A novel interdisciplinary health professions education program at King Saud University: strategy and structure (Phase I)

Patient’s Experience of the Outcomes of Engaging in a Broadly Applicable Health Promotion Intervention for Individuals Facing Chronic Illness

The aim of this study was to explore the health-related outcomes of a new health promotion intervention designed to be broadly applicable among people diagnosed with chronic illness. Qualitative process analysis was applied and a purposeful sample of 52 patients, representing a variety of long-term conditions, was invited to participate in the pilot-implementation and evaluation of the program. Participants attended individually or in groups in seven sessions held over a six-month period. A lay-based conceptual framework that revealed the bodily knowledge of patients with chronic illness as a resource for health was used as the frame for the program content and interdisciplinary health professionals who had undergone 80 hours of training led the program. The pedagogical approaches were varied in order to engage patients in health promotion work. In-depth evaluation interviews took place soon after program completion and data were analyzed in-depth by means of content analysis in order to identify patterns of health-related themes and the program’s possible active ingredients. The intervention was implemented successfully across clinical sites and diagnostic categories. Participants reported improved ability to manage illness-related problems and greater awareness and utilization of personal resources for health after they had participated in the program. They were able to think more positively about their own capabilities, gained greater understanding of factors that made their health condition better or worse, and became more active. Participants identified empowerment and social participation as important outcomes of engaging in the new program.

Understanding and Eliminating Disparities in Health Care: Development and Assessment of Cultural Competence for Interdisciplinary Health Professionals at The University of Utah—A 3-Year Investigation

Background and Purpose. In 2003, The University of Utah initiated the Cultural Competency and Mutual Respect (CCMR) educational program for the Interdisciplinary Health Sciences Students (IHSS), professionals in medicine (MED), pharmacy (PHARM), nursing (NSG), physical therapy (PT), and others. This 3-year study assessed the pre/post learning outcomes of the CCMR program through Campinha-Bacote's Inventory for Assessing the Process of Cultural Competence-Revised (IAPCC-R©).1-4 Subjects. A total of 2,124 IHSS students, participating in CCMR learning modules, completed the Inventory for Assessing the Process of Cultural Competence-Revised (IAPCC-R©), with 114 PT and MED subjects as controls. Methods. This study was approved by The University of Utah Health Sciences Center Institutional Review Board. Verbal and written permission was received for use of the IAPCC-R©. Following informed consent procedures, IAPCC-R© pre/post data was collected each semester from fall 2003 through spring 2006. Paired and nonpaired analyses were performed, comparing Cultural Competence (CC) scores and constructs, P < .05, for each discipline, along with demographics. Results. Study outcomes resulted in 1,974 usable, completed inventories, with overall IAPCC-R© pre/post scores demonstrating gains in progression towards cultural competence. In year 2, the curriculum was adjusted based upon student feedback and facilitator input; however, overall CC was not necessarily further enhanced. In terms of CC—Asian, Hispanic, and Other demographic IHSS subject categories outpaced Caucasians. Discussion. Overall CC was improved for all disciplines. In terms of the 5 constructs of CC, results indicated that PT, MED, PHARM, and NSG disciplines attained significant scores for the cultural constructs of “attitudes,” “knowledge,” and “skills” but not “encounters” and “desires.” Although posttest scores indicated marked progressions, approaching CC, IHSS did not yet demonstrate Cultural Proficiency. The constructs of cultural “desires” and “encounters” warrant further curricular enhancement and examination for progression towards attainment of Cultural Proficiency. Conclusion. Results of this 3-year investigation indicate that the IHSS are becoming more Culturally Aware as a result of CCMR program participation and are significantly progressing towards Cultural Competence. However, overall, these interdisciplinary health science student subjects have not achieved the level of Cultural Proficiency. Ongoing support is needed to assist facilitators in teaching matters of Cultural Competence, in a way that is sensitive to the core values, beliefs, and attitudes of health care professionals. Further investigation, in both academic and clinical education, is warranted to examine culturally competent practice opportunities within interprofessional health care interactions and to reduce health care disparities and medical errors for the patients/clients served.

2009 Rho Chi Lecture: Interdisciplinary Health Professions Education: A Systems Approach to Bridging The Gaps

None of us is as smart as all of us. -Japanese proverb It is an absolute privilege and honor to stand before you as the 2009 Rho Chi Award recipient. Paying homage to those intellectual leaders and the community of scholars who have come before me, I am truly humbled to have been asked to give this lecture. In keeping with the spirit and fundamental objective of the Rho Chi Society, which is to “promote the advancement of the pharmaceutical sciences through the encouragement and recognition of sound scholarship,” I would like to share my thoughts with you on the criticality of interdisciplinary health professions education and would like to suggest a systems approach to bridging the gaps that exist today. In setting the stage for this lecture, allow me to start by sharing with you the story of the crash of United Airlines flight 232 in 1989. The crash of a DC-10 in Sioux City, Iowa, in 1989 was a major, uncommon tragedy in American aviation. Many lives were lost. But this great tragedy also served as an important lesson and opened new thinking in the training of cockpit crews. On July 19, 1989, when United Airlines flight 232 took off from Stapleton International Airport in Denver, Colorado, and headed to Philadelphia, Pennsylvania, via Chicago's O'Hare International Airport, no one could have imagined what lay ahead. About an hour and 7 minutes into the flight, at an altitude of 37,000 feet, the fan disk on the Douglas DC-10 aircraft tail engine broke in two and suffered an uncontained failure.1 All controls on the aircraft failed except for the power levers in the remaining 2 engines. Using all possible means and resources, Captain Alfred Haynes, First Officer William Records, Second Officer Dudley Dvorak, and DC-10 flight instructor and pilot Dennis Fitch, made an emergency landing on the runway at the Sioux City, Iowa, airport. Unfortunately, during the landing, the aircraft split in two. That day, 111 people lost their lives, including 110 passengers and 1 crew member.2

Medical School Expansion: Déjà Vu All Over Again?

The first two decades of the 21st century may well be viewed by future generations as the second great expansion of post-Flexnerian medical education in the United States. Given that medical schools are now significantly increasing class size for only the second time in 100 years, it is instructive to remember the last era -- the 1960s and 1970s -- when these challenges were also forefront in the minds of the medical education community.A review of the literature from that period indicates that medical educators had similar concerns as today: the cost of expansion, national health policy, graduate medical education, community-based clinical education, interdisciplinary health professions education and care delivery, and the management of expansion efforts. Two other issues not fully represented in the literature from the 1960s and 1970s are apparent in 2007: graduating a diverse cadre of physicians and creating regional four-year branch campuses. While many concerns about medical school expansion from 50 years ago are with us today, one of the most significant responses from the 1960s and 1970s -- a large influx of federal funding -- does not appear on today's horizon. The novel strategies that today's generation of medical educators will adopt to address projected physician shortages are still emerging.

Breezing up--an interdisciplinary health professions course for high school juniors and seniors and college freshmen.

Recruiting students into the health professions is an ever growing problem as young people are faced with many attractive options for career choices. At the same time, a rapidly growing elderly population will require more health professionals to maintain the health system. To address this recruitment issue an interdisciplinary health professions course delivered to high schools and college campuses in North Dakota via the Internet was developed at the University of North Dakota (UND) School of Medicine and Health Sciences (SMHS). The participating high schools embedded the course in the health professions curriculum and students were given the option of receiving college credit. The course features presentations by professionals representing 16 different health professions and were developed using a new software called Macromedia Breeze that allows for easy recording of PowerPoint audio presentations and imputing video content into the presentation. Blackboard was utilized for course management.

Institutionalizing interdisciplinary health professions programs in higher education: the implications of one story and two laws

The interdisciplinary education of health professionals in the USA has increasingly been tied to renewed efforts directed toward quality improvement in the healthcare system, where problems with communication, collaboration, and cooperation are seen as endemic. Many of the published reports and recommendations on interdisciplinary programming, however, have omitted or downplayed the difficulties and challenges of developing and sustaining efforts in this area. Through the presentation of a detailed case study and the exploration of two laws of interdisciplinary programming proposed from it, this paper explores the fundamental difficulties of developing and, more importantly, sustaining interdisciplinary health professions programs in higher educational settings. The utilization of strategies based on emerging forces in the healthcare system and in higher education itself is suggested for initiating interdisciplinary projects, and structural and procedural factors are explored as critical in guaranteeing the long-term sustainability of such programs. Recommendations for the successful development and implementation of interdisciplinary programs in higher educational contexts are suggested, focusing particularly on the role of an advocate in the top down and bottom up development and maintenance of the resources needed for the success of such programs.

Rural interprofessional service-learning: the Minnesota experience.

The Minnesota Rural Health School (MRHS), which operated from 1996 to 2003, was the University of Minnesota's first initiative that provided rural, community-based, interdisciplinary health professions education. The newly funded Minnesota Area Health Education Center (AHEC) is now coordinating interprofessional rural clinical education at the Academic Health Center level for the university. The service-learning curricular component is one of the most lasting legacies of the MRHS. This article provides a descriptive summary of the initial 61 service-learning projects completed by students from various health professions who participated in the MRHS and indicates the type of projects that have continuing effects. The seven community site coordinators affiliated with the MRHS completed a survey analyzing service-learning projects performed in their communities. Student interest was predominant in selecting 28% of the 61 projects, community interest was paramount in selecting 10%, and a mixture of both student and community interest contributed to 62% of project selection. Thirty of the projects were designed as single interventions, and the remaining 31 projects have ongoing impact. Students demonstrated interprofessional group synergy and significant creativity in addressing multiple community health care issues and needs, within time constraints of only ten to 12 days in which to develop and implement a service-learning project. Two project examples are described in detail to illustrate the challenges and successes of this type of civic engagement.

Nursing and academic mergers of the health sciences: a critique

This article explores the current trend in which the discipline of nursing and other health sciences are merged within a single academic unit in higher education. To date little has been written in the professional literature about the institutions that have engaged in these types of “mergers,” even though they appear to be increasing in occurrence. Since these realignments have the potential to affect the continuing development of academic nursing, attention from the nursing community is warranted. A description of unique dimensions of academic mergers is presented with attention to faculty governance, academic freedom, and tenure. The frame of reference for the exploration uses the goals and expectations from realignments that have been extrapolated from the business literature and reports from health care organizations that have merged. Specifically, academic mergers are presumed to accomplish the following goals: 1. Foster shared resources in terms of faculty talents and content expertise. 2. Consolidate a campus approach to clinical education programming. 3. Increase opportunities for interdisciplinary health professions education. 4. Create a unified and integrated approach to development activities. 5. Coordinate efforts to provide sufficient space for the health sciences. Directions for future exploration and some recommendations for schools of nursing in the throes of merger efforts are offered.

Building Research Competence in Nursing Through Mentoring

To explore how mentoring can be used to build research competence in nursing in various professional and geographic settings. The traditional concept of mentoring in interdisciplinary health professions and its application to nursing research. Literature review of MEDLINE and CINAHL databases 1990-2001 and personal reflections on mentoring and mentored experiences. Mentoring relationship models identified include: traditional mentor and protégé, team, peer, inclusive, and mentoring forward. E-mentoring strategies facilitate interactions for long-distance relationships. Discrete projects, multiple mentor sources, and mutually beneficial peer relationships can enable mentoring across one's career. Psychosocial dimensions of mentoring support creative work. When scholarly productivity with funded research is the desired outcome, intense involvement of a protégé with an expert researcher is essential. Choices among mentoring models can be made in accordance with resources, priorities, and objectives congruent with a given nursing setting and time, but optimum scholarly productivity requires experts and sustained support.

Public policies to promote community-based and interdisciplinary health professions education.

Many rural and inner-city communities in the United States have persistent shortages of health professionals. In addition, health services are increasingly delivered in community-based settings by interdisciplinary teams. Yet, health professions students in the US continue to receive most of their training in urban hospitals. To assess the extent to which national and state government programs in the US that fund health professions education provide financial resources for community-based and interdisciplinary education in the health professions. Literature review. Most national and state government funding provided to health professions schools and clinical training sites in the US is not targeted to community-based and interdisciplinary education. Nationally, the Bureau of Health Professions, however, does administer some targeted grant programs. In addition, a number of states are addressing these needs through targeted appropriations to health professions schools and Medicaid payments to clinical training sites. The US experience with government funding of health professions education suggests several questions that policymakers in other nations should consider and several principles for developing effective policies to promote community-based and interdisciplinary education.

Impact of interdisciplinary education in underserved areas: health professions collaboration in Tennessee.

A community-based interdisciplinary health professions education project, involving the Colleges of Medicine, Nursing and Public and Allied Health, was implemented at the undergraduate level at East Tennessee State University from 1990 to the present. The outcomes of this project and the extension of the project into graduate health profession programs are described. Committed leadership, effective communication, and genuine community involvement are identified as essential to the success of community-based, interdisciplinary health professions training programs.

Can Educational Accreditation Drive Interdisciplinary Learning in the Health Professions?

Accreditation in higher education serves as a means of assuring the public of academic program quality and of promoting continuing review and self-improvement by educational units. Educational program accreditation is a means of seeking continuous improvement in the academic activities of programs and institutions. Discussions of interdisciplinary education raise questions about the responsiveness of accreditation to such approaches. Some health professions accrediting agencies have followed the lead of industry and have adapted their approach and philosophy of evaluation to a continuous improvement philosophy, while others continue to perpetuate an "inspection" mentality. The perpetuation of such an approach limits the value of the accreditation process. Accrediting agencies need to focus attention instead on stimulating professional preparation to develop in students the knowledge, skills, and competencies needed for health professions practice. Since such practice frequently occurs in team or interdisciplinary settings, the accreditation evaluation can support practice by incorporating an interdisciplinary perspective. As models of interdisciplinary education are developed in the health professions, accreditation will be challenged to evolve in its effectiveness to evaluate interdisciplinary learning experiences. The accrediting community will need to recognize the barriers posed by interdisciplinary learning, as well as the special skills and situations needed to offer effective interdisciplinary experiences. Without this perspective the usefulness of accreditation will be diminished. Standards and procedures for accreditation will need to be revised to address the unique characteristics of interdisciplinary education. A set of mock accreditation standards to guide the evaluation of interdisciplinary health professions education learning experiences is proposed. Finally, questions are posed about the role of accreditation in the context of interdisciplinary health professions education.