Interprofessional Learning Environment Research Articles

Assessing Interprofessional Collaboration at Clinical Learning Sites: Methodology on Developing the IP-CLEAR Tool.

Interprofessional Clinical Learning Environment Assessment and Reflection (IP-CLEAR) tool was developed by a team of faculty from the schools of nursing, pharmacy, and medicine at University of North Carolina at Chapel Hill (UNC-CH), with the support of the North Carolina Area Health Education Consortium (NC AHEC) and the UNC-CH Office of Interprofessional Education and Practice (IPEP). The IP-CLEAR tool is intended for use by clinical sites that have or want to have clinical learners engaged and integrated into an excellent interprofessional CLE. The development of the IP-CLEAR and projections for future work are described here.

Culture change and lessons learned from ten years in the VA centers of excellence in primary care education

BackgroundTeam-based care is critical to achieving health care value while maximizing patient outcomes. Few descriptions exist of graduate-level team training interventions and practice models. Experience from the multisite, decade-long Veterans Affairs (VA) Centers of Excellence in Primary Care Education provides lessons for developing internal medicine training experiences in interprofessional clinical learning environments.MethodsA review of multisite demonstration project transforming traditional silo-model training to interprofessional team-based primary care. Using iterative quality improvement approaches, sites evaluated curricula with learner, faculty and staff feedback. Learner- and patient-level outcomes and organizational culture change were examined using mixed methods, within and across sites. Participants included more than 1600 internal medicine, nurse practitioner, nursing, pharmacy, psychology, social work and physical therapy trainees. This took place in seven academic university-affiliated VA primary care clinics with patient centered medical home designResultsEach site developed innovative design and curricula using common competencies of shared decision making, sustained relationships, performance improvement and interprofessional collaboration. Educational strategies included integrated didactics, workplace collaboration and reflection. Sites shared implementation best practices and outcomes. Cross-site evaluations of the impacts of these educational strategies indicated improvements in trainee clinical knowledge, team-based approaches to care and interest in primary care careers. Improved patient outcomes were seen in the quality of chronic disease management, reduction in polypharmacy, and reduced emergency department and hospitalizations. Evaluations of the culture of training environments demonstrated incorporation and persistence of interprofessional learning and collaboration.ConclusionsAligning education and practice goals with cross-site collaboration created a robust interprofessional learning environment. Improved trainee/staff satisfaction and better patient care metrics supports use of this model to transform ambulatory care training.Trial registrationThis evaluation was categorized as an operation improvement activity by the Office of Academic Affairs based on Veterans Health Administration Handbook 1058.05, in which information generated is used for business operations and quality improvement (Title 38 Code of Federal Regulations Part 16 (38 CFR 16.102(l)). The overall project was subject to administrative oversight rather Human Subjects Institutional Review Board, as such informed consent was waived as part of the project implementation and evaluation.

Inclusive LGBTQIA+ healthcare: An interprofessional case-based experience for cultural competency awareness.

Lesbian, Gay, Bi-sexual, Transgender, Questioning, Intersex, and Asexual (LGBTQIA+) patients report experiences of discrimination within healthcare settings due to a lack of provider knowledge and biases of healthcare workers. There is an identified need among all health professions to provide more culturally competent healthcare for this community. Early interventions during healthcare profession training programs may be effective to address this need. The overall goal of this study was to assess the educational impact of an active learning session that was specifically designed to enhance LGBTQIA+ cultural competency awareness using an interprofessional setting. This 2-year study involved students from 16 healthcare professional programs joining virtually to form interprofessional teams. A small group case-based learning approach was used and included pre/post-activity surveys to measure the change in student attitude and confidence, as well as the change in perception of the importance of the activity. Results indicate an increase in perception of importance (p < 0.005) and in overall level of confidence (p < 0.001) with respect to LGBTQIA+ issues post-session. Key themes established through the session represent an overall recognition of the importance of interprofessional education and awareness of LGBTQIA+ healthcare needs. The results demonstrate the effectiveness of a case-based approach for enhancing cultural competency awareness across different healthcare professions programs. This session also provided an interprofessional learning environment to allow multiple healthcare professions program students to interact and share perspectives. The positive impact of this intervention in a highly collaborative virtual learning environment also highlights that this immersive active learning approach that can be adopted across different programs and institutions.

Build Your Professional and Organizational Capabilities to Elevate the Interprofessional Learning Environment.

Build Your Professional and Organizational Capabilities to Elevate the Interprofessional Learning Environment.

2022: A Year in Review.

In 2022, program directors in ANCC accredited nursing continuing professional development (NCPD) organizations and transition to practice (TTP) programs embraced innovative and dynamic ways to envision the future of nursing and health care from a new vantage point. This column highlights key topics from the year: workforce development; the interprofessional learning environment; return on investment for NCPD and TTP programs; and outcomes-driven professional development. [J Contin Educ Nurs. 2022;53(12):525-527.].

Building Personal Capability: Fostering Inclusion in the Interprofessional Learning Environment to Improve Facilitation Skills.

Holtschneider, Mary Edel MEd, MPA, BSN, RN, NPDA-BC, NREMT-P, CPTD; Park, Chan W. MD, FAAEMEditor(s): Holtschneider, Mary Edel MEd, MPA, BSN, RN, NPDA-BC, NREMT-P, CPTD; Park, Chan W. MD, FAAEM Author Information

Thriving Interprofessional Learning Environments Begin With You: Building Emotional Intelligence as a Personal Capability.

Park, Chan W. MD, FAAEM; Holtschneider, Mary Edel MEd, MPA, BSN, RN, NPDA-BC, NREMT-P, CPTDEditor(s): Park, Chan W. MD, FAAEM; Holtschneider, Mary Edel MEd, MPA, BSN, RN, NPDA-BC, NREMT-P, CPTD Author Information

Creating an Optimal IP Learning Environment: NCICLE Pathways to Excellence.

Clinical learning environments are a shared space for various professions working together to provide the best care for patients. The National Collaborative for Improving the Clinical Learning Environment (NCICLE) published the NCICLE Pathways to Excellence: Expectations for an Optimal Interprofessional Clinical Learning Environment to Achieve Safe and High-Quality Patient Care as a tool that can be used to assess and develop ways to optimize learning and patient care. This framework provides guidance for health care professionals to collaborate with executives to transform the clinical learning environment and patient outcomes. [J Contin Educ Nurs. 2022;53(4):150-152.].

Student Perspective on a Predoctoral Interprofessional Education Initiative

Objective- The purpose of this study was to investigate students' perspectives on a newly implemented program of Interprofessional education (IPE) in terms of its effectiveness in increasing the awareness about other health care professionals and providing tools to emerging dental professionals for comprehensive health care needs. Methods- A new IPE course was incorporated in the second year of the predoctoral dental curriculum, and educators and students from various health professionals came together to provide a collaborative learning environment. The study evaluated the survey data from the graduating classes of 2019 and 2020 in the predoctoral program at Harvard School of Dental Medicine. The students were surveyed during and at the end of the course to obtain their perspectives on the effectiveness of the program. Result-The results of the surveys showed most student respondents agreed strongly that they liked getting information from other health professionals and 93-95% agreed that collaborating with other members of the health care team can help facilitate patients' overall health care. The IPE sessions helped bring about awareness of interprofessional relations and communications within the health care team and prepared the students for holistic patient care. Conclusion- The IPE methods facilitated an interactive and interprofessional learning environment to assist students in developing awareness of interprofessional relations and communications within the health care team. The connections between oral and systemic health were reinforced, thus giving predoctoral dental students a wider view of patient treatment and consideration for their patients’ comprehensive health care needs.

Analysis of the Interprofessional Clinical Learning Environment for Quality Improvement and Patient Safety From Perspectives of Interprofessional Teams.

In 2018 the Clinical Learning Environment Review (CLER) Program reported that quality improvement and patient safety (QIPS) programs in graduate medical education (GME) were largely unsuccessful in their efforts to transfer QI knowledge and substantive interprofessional QIPS experiences to residents, and CLER 2.0 called for improvement. However, little is known about how to improve the interprofessional clinical learning environment (IP-CLE) for QIPS in GME. To determine the current state of the IP-CLE for QIPS at our institution with a focus on factors affecting the IP-CLE and resident integration into interprofessional QIPS teams. We interviewed an interprofessional group of residents, faculty, and staff of key units engaged in IP QIPS activities. We performed thematic analysis through general inductive approach using template analysis methods on transcripts. Twenty individuals from 6 units participated. Participants defined learning on interprofessional QIPS teams as learning from and about each other's roles through collaboration for improvement, which occurs naturally when patients are the focus, or experiential teamwork within QIPS projects. Resident integration into these teams had various benefits (learning about other professions, effective project dissemination), barriers (difficult rotations or program structure, inappropriate assumptions), and facilitators (institutional support structures, promotion of QIPS culture, patient adverse events). There were various benefits (strengthened relationships, lowered bar for further collaboration), barriers (limited time, poor communication), and facilitators (structured meetings, educational culture) to a positive IP-CLE for QIPS. Cultural factors prominently affected the IP-CLE and patient unforeseen events were valuable triggers for IP QIPS learning opportunities.

The effect of ISBARR on knowledge of and attitudes about interprofessional communication skills among Chinese undergraduate nursing students

BackgroundInterprofessional communication is essential for the coordination and collaboration of healthcare team members during patient care, especially in critical situations. Therefore, nursing students must learn and practice interprofessional communication skills throughout their education and clinical training. Previous studies evaluating standardized communication frameworks in the United States (e.g., ISBARR [identify, situation, background, assessment, recommendation, and repeat]) suggest that nursing students feel more confident about interprofessional communication and collaboration through familiarity with these frameworks. ObjectiveTo evaluate the effect of an ISBARR workshop on knowledge of and attitude about effective communication among Chinese undergraduate students. DesignA pre- and posttest quasi-experimental study. ParticipantsA convenience sample of 90 undergraduate nursing students at a vocational health college in China. MethodThe two-part ISBARR workshop featured a lecture and a video-simulation exercise. Differences in students' knowledge of and attitudes about interprofessional communication skills using ISBARR were compared pre- and post-workshop. ResultsWe observed a statistically significant (p < 0.001) improvement in overall mean scores of students' knowledge of and attitudes about utilizing ISBARR post-workshop. We also observed a statistically significant (p < 0.001) improvement in the overall mean scores of students' knowledge of and attitudes about ISBARR after the video-simulation exercise. ConclusionThe ISBARR workshop improved Chinese nursing students' knowledge and attitudes about interprofessional communication. Incorporating ISBARR into the nursing healthcare team eventually can lead to improved patient safety. Subsequent studies should target nursing faculty and clinical instructors to evaluate their knowledge and attitudes about teaching ISBARR and interprofessional education. Improving these attitudes can help establish a positive interprofessional communication learning environment for nursing students in China and other cultural contexts worldwide.

Reflections on 2021 and Microaggressions in the Interprofessional Learning Environment: Words Do Matter!

Reflections on 2021 and Microaggressions in the Interprofessional Learning Environment: Words Do Matter!

Enhancing the Interprofessional Learning Environment: An Orientation of ICU Nurses to Effective Team Building and Their Impact on the Professional Development of the Young Physician

Purpose: Effective interprofessional teams are critical to resident physicians’ learning and patient safety. 1 How medical trainees function in the clinical learning environment is impacted by interaction with colleagues who may feel they have no “official” role in education, and as a result, often do not recognize their important role in the professional development of the medical trainee. Through a brief educational intervention for ICU nurses orienting to our institution targeted at effective teamwork and acknowledging the role of nurses as educators, we aim to improve the learning environment in this targeted setting. We chose to focus on the ICU as it has historically been a challenging, high-acuity working and learning environment and one that may not as readily espouse a learning culture for a trainee underperforming relative to peers. We elected to implement this intervention for new nurses with the hypothesis that they are still developing their style as regards interprofessional relationships and teamwork and may not recognize the importance of their role in the learning environment. Approach/Methods: In this pilot study, we enrolled 8 nurses participating in an established nurse residency program at Massachusetts General Hospital designed to prepare them for becoming independent ICU nurses. These nurses were surveyed using a Team Assessment tool, 2 followed by two 45- to 60-minute educational sessions roughly 4 months apart centered on elements of effective teamwork, the important role of nurses in physician trainee education, and the approach to a struggling trainee. One “booster” was sent by email summarizing the content of the first session. They were subsequently surveyed again using the same Team Assessment tool at the start of the second session. Results/Outcomes: These educational interventions were easy to incorporate into a previously established ICU nurse orientation program. The program was well received by both nursing leadership and participants. When surveyed, the nurse trainees reported that their teams were functioning moderately well (7–8/10). There was no significant difference in Team Assessment scores after this intervention, as anticipated. However, the nurses-in-training responded positively to the elements of the intervention that emphasized their role in medical trainee education, particularly with the struggling trainee. Discussion: Support for this educational intervention among nursing leadership and participants demonstrates interprofessional interest in improving teamwork and the learning environment in our ICUs. Many institutions have internship/orientation programs for new nurses; these forums are well suited to this type of educational intervention. We discovered that in this pilot program, orienting ICU nurses at our institution felt that teams function moderately well at baseline. However, nurses involved in our intervention did report benefit from clear discussion regarding their potential impact in their role as educators and techniques for managing a trainee who may be underperforming. Significance: Medical trainee learning environment is shaped by an interdependent system of interprofessional colleagues, who are frequently unaware of their important role in the professional development of such a colleague. Prioritizing effective programs during orientation to educate nurses on their role in trainee education has the potential to significantly improve physician-in-training learning, particularly for the underperforming trainee. This pilot program represents 1 feasible mechanism by which to achieve this goal. To significantly alter the culture surrounding medical education at our institution, long-term investment in these programs will likely be required. Further study is needed to understand best practices for implementation and impact on trainee professional development and well-being over time.

Tackling the Tough Questions: Microaggressions in the Interprofessional Learning Environment Part 2.

Tackling the Tough Questions: Microaggressions in the Interprofessional Learning Environment Part 2.

The Importance of Interprofessional Practice in Family Medicine Residency Education.

The practice of family medicine is undergoing rapid transformation, with increasing recognition that family physicians can most effectively meet the needs of individual patients and populations within the context of highly effective interprofessional teams. A substantive evidence base exists to support effective workplace learning by practicing health care teams and learners, much of which has been developed in primary care teaching practices. A strong national consensus now emphasizes the importance of the interprofessional clinical learning environment, including in graduate medical education. Evidence for the impact of improved team function on quadruple aim outcomes is increasingly robust. The World Health Organization, Interprofessional Education Consortium, National Collaborative for Improving the Clinical Learning Environment, and National Center for Interprofessional Practice and Education have developed evidence-based approaches and tools for improving interprofessional collaboration to improve important health outcomes in the clinical learning environment. Embracing the practice as the curriculum and preparing our residency graduates to work within high-functioning interprofessional collaborative practice teams, family medicine has the opportunity to lead the way in demonstrating the value of effective interprofessional practice across health care settings, including virtual teaming, to improve the health of the communities we serve, and across the nation.

Online interprofessional learning environment to prepare Doctor of Nursing Practice students for team-based primary care.

Integrating interprofessional education in an online Doctor of Nursing Practice program is challenging. This article describes the implementation of an online interprofessional education program for students in Doctor of Nursing Practice Family Nurse Practitioner, Bachelor of Science in Nursing, and dietetics programs to prepare them for team-based primary care.

Peer coaching in an interprofessional academic primary care clinic

Health professions trainees often provide one another with support and performance-related feedback, but seldom receive formal training on how to provide such support and feedback in an interprofessional setting. Peer coaching is a promising format of professional development and training that enhances non-competitive relationships among peers to provide support and improve task performance through goal-setting, direct observations, self-evaluation, and coach feedback. The Peer Coaching Curriculum was developed in an interprofessional academic primary care clinic and implemented among two cohorts of internal medicine residents and nurse practitioner trainees over the course of an academic year. Four learning objectives included: 1) practicing a collaborative communication style using motivational interviewing strategies, 2) performing direct observations of patient encounters by peer coaches, 3) applying collaborative communication elements to the delivery of feedback based on clinic observations, and 4) determining if participants’ self-reflection and insight were enhanced by engaging in this curriculum. The curriculum was delivered jointly by a health psychology postdoctoral fellow and a chief medical resident. Curricular interventions included brief didactic sessions and small group skills practice in a classroom setting followed by direct clinical observations and feedback in the primary care clinic. Participants were assessed using two questionnaires, the Self Reflection and Insight Scale and the Peer Coaching Inventory, and by behavioral counts of motivational interviewing strategies employed during a simulated skills demonstration. The majority of designated peer coaches successfully demonstrated the use of motivational interviewing strategies. Over the course of the sessions, participants demonstrated an increased understanding of peer coaching and an enhanced level of insight into the thought processes of themselves and others, suggesting that this curriculum inculcated important skills in an interprofessional learning environment. Descriptions of key curricular activities, a facilitator guide, and evaluation questionnaires are provided that may be adapted for other practice settings.

Addressing Blame, Shame, Bullying, Incivility, and Microaggression in the Interprofessional Learning Environment: Implications for Nursing Professional Development Practitioners.

Holtschneider, Mary Edel MEd, MPA, BSN, RN, NPD-BC, NREMT-P, CPTD; Park, Chan W. MD, FAAEMEditor(s): Holtschneider, Mary Edel MEd, MPA, BSN, RN, NPD-BC, NREMT-P, CPTD; Park, Chan W. MD, FAAEM Author Information

Ethics and Interprofessional Learning Environments During a Pandemic: Implications for Nursing Professional Development Practitioners.

Ethics and Interprofessional Learning Environments During a Pandemic: Implications for Nursing Professional Development Practitioners.

Getting outside the box: exploring role fluidity in interprofessional student groups through the lens of activity theory.

Health professionals' roles and scopes often overlap, creating a need for role clarity in interprofessional teamwork. Yet, such clarity does not mean roles are fixed within teams and some literature suggests role flexibility can enhance team functioning. Interprofessional practice competencies and learning activities often emphasize knowledge and definition of roles, but rarely attend to the dynamic nature of roles and influential contextual factors. This study explores role fluidity in interprofessional student groups using an activity theory framework. Using a collective instrumental case study approach, the authors examine the fluidity of one physical therapy (PT) student's role within 3 different interprofessional (medical, pharmacy, PT) student groups completing nursing home patient care plans. Field notes, group debriefing interviews, and care plans were collected and coded from all care planning sessions. Codes mapped to group-specific activity systems that compared role-influencing interactions and tensions. The PT student's role fluidity varied in each group's activity system, influenced primarily by system tensions from implicit rules (e.g., encouraging questions), division of labor (e.g., rigid profession-based task assignment), and tool use (e.g., computers). Attention to modifiable system elements, such as tool use and explicit rules of inclusivity, could foster role fluidity and improve interprofessional teamwork and learning environments.