Multiprofessional Education Research Articles

Hierarchies of evidence and hierarchies of education: reflections on a multiprofessional education initiative

AbstractThe concept of a hierarchy of evidence is an established part of the discourse of evidence‐based health care. In the drive to incorporate research findings into all aspects of health and social care practice, value judgements about the quality of the evidence available are commonplace, with research findings obtained via particular research approaches often being given more scientific credence than those obtained by using alternative methods. This hierarchy of evidence mirrors the existence of a well‐documented professional hierarchy within the healthcare workplace, with medicine as the dominant occupational group. Academic arguments for a broader appreciation of research evidence have been made in the literature for a number of years and have achieved considerable success. Equally, medical dominance in the workplace has been addressed on various levels, one approach being the rise in multiprofessional education initiatives. This article draws on the experience of facilitating multiprofessional groups undertaking a research appraisal skills programme within National Health Service‐based ‘classroom’ settings. The continuing existence of both medical dominance in the healthcare arena and a belief in a hierarchy of evidence was apparent from the courses. In addition, what might be called a hierarchy of educational backgrounds, presented some complex dynamics within the teaching situation and raised a number of hitherto seemingly unaddressed questions for the group facilitator.

Can the Internet widen participation in reproductive medicine education for professionals?

Traditional campus-based models of education are unsuitable to many, particularly if in full-time employment supporting families, whereas the Internet now permits new models of education. Following an iterative process of development and evaluation in 2001, the University of Bristol launched a masters programme covering reproduction and development delivered principally over the Internet. Students attend short biannual residential workshops and the rest of the course is delivered online. In 2003, the 20 active students were invited to complete a structured online questionnaire. The 18 students completing the questionnaire identified distance learning as the key factor in their course selection. Most students felt that residential workshops aided subsequent electronic communication. Discussion of ideas is an essential component of postgraduate courses and web-based discussion forums appeared to provide an acceptable medium for this. The use of web-based audio lectures and computer-assisted assessments was well received. Also these systems may reduce disadvantages overseas students encounter when completing assessments in their non-native language. The overall positive response from students (and their tutors) to using the Internet for multiprofessional reproductive medicine education is encouraging and has wider potential in the future.

AN OVERVIEW OF INTEGRATED MEDICAL AND DENTAL UNDERGRADUATE PRE-CLINICAL CURRICULA AT B. P. KOIRALA INSTITUTE OF HEALTH SCIENCES, NEPAL: A MULTIPROFESSIONAL APPROACH

Curricular innovations such as multiprofessional education (MPE) sensitise healthprofessionals towards the role of other health professionals and inculcate team spirit.This is a preliminary report on MPE in practice in the preclinical phase of dental andmedical undergraduate courses at B.P. Koirala Institute of Health Sciences, Nepal.The preclinical curriculum of the undergraduate courseis integrated, organ systembased and partially problem based. There is an emphasis on early exposure of studentsto patients and to community. The undergraduate course in medicine started in 1994and in dental surgery in 1999 based on the core curriculum developed at variousworkshops. The course duration and structure is similar in bot

Learning curve

The government has pledged more money for the development of multiprofessional education. Alison Moore reports on existing programmes

Pros and cons of vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum: examples and experiences from Linköping, Sweden

Problem-based learning (PBL), combined with early patient contact, multiprofessional education and emphasis on development of communications skills, has become the basis for the medical curriculum at the Faculty of Health Sciences in Linköping (FHS), Sweden, which was started in 1986. Important elements in the curriculum are vertical integration, i.e. integration between the clinical and basic science parts of the curriculum and horizontal integration between different subject areas. This article discusses the importance of vertical integration in an undergraduate medical curriculum, according to experiences from the Faculty of Health Sciences in Linköping, and also give examples on how it has been implemented during the latest 15 years. Results and views put forward in published articles concerning vertical integration within undergraduate medical education are discussed in relation to the experiences in Linköping. Vertical integration between basic sciences and clinical medicine in a PBL setting has been found to stimulate profound rather than superficial learning, and thereby stimulates better understanding of important biomedical principles. Integration probably leads to better retention of knowledge and the ability to apply basic science principles in the appropriate clinical context. Integration throughout the whole curriculum entails a lot of time and work in respect of planning, organization and execution. The teachers have to be deeply involved and enthusiastic and have to cooperate over departmental borders, which may produce positive spin-off effects in teaching and research but also conflicts that have to be resolved. The authors believe vertical integration supports PBL and stimulates deep and lifelong learning.

The missions of medical schools: the pursuit of health in the service of society.

Mission statements and role documents of medical schools in the United Kingdom, United States, Canada and Australia have been examined on their Internet Web sites and categorised in purpose, content and presentation. The format and content are highly variable, but there is a common vision of three integral roles, namely, education, advancement of knowledge and service to society. Other frequent themes include tradition and historical perspective, service for designated communities, and benchmarking to accreditation standards. Differences in content reflect variable interpretation of the notion of "mission", and local or national characteristics such as institutional affiliations, the types, levels and organisation of medical education, relationships with health systems, and extent of multi-professional education. Outcomes data and measures of medical school performance referenced to the institution's stated missions are rarely encountered.Mission documents placed on the Internet are in the public domain. These Web sites and documents and linked information constitute a valuable new resource for international exchange of approaches and ideas in medical education and generally in academic medicine. Routine inclusion of outcome or performance data could help to demonstrate the community roles and social accountability of medical schools This paper proposes that partial standardisation of these Web documents could enhance their value both internally and for external readers. A generic descriptive statement template is offered.

Plenary Session, May 25, 2000

1) Mucositis in cancer patients is multifactorial in nature. 2) A balance exists at the clinical level between the need to treat cancer and the relationship of that treatment to causing mucosal injury. 3) It is important to interface appropriate patient-oriented outcomes with objective outcomes relative to clinical trial design and Federal regulatory mandates. 4) There is need for innovative in vitro, in vivo, and clinical models for mucosal injury. These models could include identification of surrogate markers; examination of relationships of oral to other gastrointestinal mucositis; interrelationships of pain models with those for mucositis; patient-related risk factors, including the potential role of genomics in risk for and cause of mucositis; mucositis scoring systems; mucositis as a model for wound healing; and economic models relative to acute and chronic complications associated with mucositis, with attention paid to the variety of health care models that exist internationally. Ultimately, the best model is the human model. 5) Considerable opportunities exist for academic, clinical, industrial, and government collaborations. It is critically important that standardized approaches be utilized, including mucositis nomenclature as well as scoring system techniques. 6) Effective communication and multiprofessional education are essential to advance the research agenda. Examples by which this can occur include publication of the enclosed conference proceedings; development of a listserve linked to a website directed to research and clinical issues regarding mucosal injury in cancer; and participation in the activities of professional organizations, including the Multinational Association of Supportive Care in Cancer, currently operating in alliance with the International Society for Oral Oncology. In addition to these common themes, issues specific to a given workgroup were also addressed in the plenary session. A summary of these discussions follows.

MULTI‐PROFESSIONAL STAFF DEVELOPMENT PROGRAMME FOR PAMs

A unique, accredited, multi-professional education programme for junior staff in professions allied to medicine (PAMs) developed by Durham and Teesside Education and Training Consortium in collaboration with local trusts and social services is described. Designed to ensure competence to practice in line with clinical governance, it aims to strengthen multi-professional working practice through a greater understanding of roles and of the way the national health service (NHS) works. It enables staff to analyse their own learning needs and to employ self-directed learning skills for life-long learning. Using problem-based learning, it uses real clinical cases as triggers to promote critical evaluation and reasoning and the development of multi-professional care pathways.

An evaluation of a basic life support CD-ROM

The faculty has developed a basic life support (BLS) CD-ROM as part of a staff development project across the UK’s south west region’s universities. The introduction of the BLS CD-ROM to the faculty represents a paradigm shift, from the former method of delivering an acetate-based BLS lecture to groups of students across the professional disciplines. It is the intention that all students and staff requiring BLS instruction, should access the CD-ROM to gain and test essential theoretical knowledge, and have an opportunity to observe best practice through video demonstrations. The production of the BLS CD-ROM meets many of the current National Health Service and Higher Education agendas, with the potential for learning to take place in clinical environments and for developing key transferable skills. The tool can also be used to achieve the requirements for multi-professional education. This presentation introduces the evaluative testing by questionnaire of the beta version of the CD-ROM, using a convenient sample of 26 Diploma nursing students, adult branch. The results identify changes needed before implementation of the CD-ROM as a learning tool across all pre- and post-qualified professional groups. The students particularly valued the opportunity to learn at their own pace, and the use of critical thinking scenarios, which enhanced their learning. A small number of technical and presentational errors were identified for correction. Students also made suggestions for other improvements and further developments of multimedia learning materials. While this enthusiastic appraisal is acknowledged, the current paucity of research demands that the faculty continues to evaluate the use of the CD-ROM when fully implemented. This research will be used to inform further developments of multi-media learning materials.

The benefits of a multiprofessional education programme can be sustained

Improved understanding by third-year medical students about the professional roles of doctors and midwives in the care of labouring women following a multiprofessional education programme have been previously reported. Following a clinical attachment in the fourth year, the previously observed changes in awareness of professional responsibility were maintained in the same group of medical students and in some areas enhanced. We believe that a short multiprofessional course early in the medical curriculum can change awareness of professional responsibility. Further, we have evidence that these attitude changes were maintained and enhanced following a clinical attachment later in the educational programme. This reinforcement of multiprofessional experiences may enhance working practice after graduation.

The impact of expanding the numbers of clinical nurse specialists in cancer care: a United Kingdom case study

In the last few years there has been an increase in the number of clinical nurse specialists (CNSs) working in cancer care throughout the UK. This paper examines the issues raised by the proliferation of site-specific cancer CNS posts, developed to give a ‘nursing lead’ for a particular tumour type. The issues common to all CNS posts are exacerbated when a number of specialists are involved in the cancer journey, causing potential fragmentation and confusion. Key issues need to be addressed if the role is to remain credible, and ensure clarity for patients and the multiprofessional team. These include role clarification, sensitive integration, interface with other cancer CNSs and the multiprofessional team, evaluation, cost, education and training, recruitment and succession planning and the ‘career cul-de-sac’. Cancer nursing's response to these challenges will set the professional agenda for education, training and future models of service delivery.

Radiography: nature of knowledge and academic tribe

Purpose: The debate about the nature of academic knowledge and the characteristics of those who inhabit various disciplines (academic tribes) has produced a number of different classifications by which scholarly activity is assessed. The aim of this survey is to attempt to classify both radiographic knowledge and the academic tribe to which radiography lecturers belong.Methods: Data were collected by means of questionnaires sent to a convenience sample of radiography students and diagnostic and therapeutic radiography lecturers in the U.K.Results: The nature of radiographic knowledge appears to span both the hard applied and soft pure areas of academic knowledge, equating with disciplines such as mechanical engineering and sociology. Diagnostic and therapeutic radiography lecturers are reported as possessing many positive characteristics such as likeable and friendly, hardworking, pragmatic and good communicators. To this extent, they equate with the academic tribes of mechanical engineers and biologists.Conclusions: Overall, radiographic knowledge appears to span both the natural sciences and the humanities, as one would expect of a discipline that combines the use of technology with patient contact. The student images and the self-portraits of diagnostic and therapeutic radiography lecturers are very positive. In terms of multi-professional education, it is important to identify the similarities and differences between particular groups of healthcare academics to facilitate the development and delivery of appropriate educational programmes.

Inter- and multi- professional

Inter-professional education and multi-professional education are both high on the NHS's agenda. For me it says we have much to learn alongside, with and from our health care colleagues. And they have much to learn from us. It is important that the recipients of this ‘inter’ and ‘multi’ learning are taught by the most expert and/or appropriate person. I would be happy to have an endoscopy performed on me by an expert endoscopy nurse, but I want that nurse trained in the necessary skills by a medical consultant. The nurse after all is providing the same level of care that I should expect from the doctor. His/her competence and accountability will be judged at the medical level.

Tribes or teams? The challenge of multiprofessional education.

Evolving service development initiatives and clinical governance systems will require greater use of multiprofessional teamwork, underpinned by multiprofessional education delivered in clinical teams. Current professionally based education and training systems do not help to deliver this agenda.

Involvement in multiprofessional continuing education: a local survey of 24 health care professions

Multipmfessional education is becoming recognised increasingly widely as the way forward for the health professions. A survey was conducted within one English health authority, namely North and East Devon, to determine how much of it was actually taking place at post-qualifying level. Unlike previous survyes, which have mostly been addressed to educational providers, this was sent to individual workers in all the established health professions and sought to measure the extent of actual involvement within each profession, along with attitudes towards learning in a multiprofessional context. Nearly threequarters of those who replied had been involved in some form of multiprofessional education during a specified 12-month period, although levels of involvement varied greatly between professions, with some professions having markedly better access to opportunities than others. A key finding was that a number of professions are effectively excluded from multiprofessional education. Considerable interest in learning in a multiprofessional setting was found at all levels and amongst all groups of health professionals, and there was a clear demand from all professions for more opportunities, especially in the field of counselling and communication skills.

Multiprofessional education in undergraduate curricula can work

A multiprofessional educational programme about labour was introduced into the undergraduate curriculum for medical students and the diploma course for midwifery students. The students gained knowledge about labour and a better understanding of each other's role in the care of the labouring women. The change in awareness of professional responsibility was greatest for medical students; it was evident in medical students taught in medical-student-only groups and also in those taught alongside midwives. Differences in professional attitudes between the medical and midwifery students at the start of the course were less marked following completion of the course. The programme was well received by both students and tutors; both groups advocated the use of mixed medical/midwifery teaching in other areas of the curricula.We conclude that multiprofessional learning has a role in medical and nursing education when the intended educational objectives are clearly defined and the educational strategy and learning opportunities selected are appropriate to the objectives.

Multi-professional education programmes in midwifery

Multi-professional educational programmes are relatively new in relation to pre-registration midwifery programmes. Increasingly, however, educationalists are being asked to consider the feasibility of creating pre-registration programmes that will be utilized by a variety of health-care professionals. This has engendered considerable debate among educationalists. It is likely that this educational approach will provide students with increased learning opportunities; however, the challenges may be insurmountable. Issues such as ensuring that the learning outcomes of all professional groups are achieved are the key to success in any multi-professional programme.

AMEE guide No. 12: Multiprofessional education: Part 1 - effective multiprofessional education: a three-dimensional perspective

The question with multiprofessional education is not whether it is effective or not. Rather it is in what circumstances can this important educational strategy be made effective? Multiprofessional education can be viewed as a threedimensional model. The extent to which the approach to multiprofessional education adopted matches the context for the learning and the curriculum goals provides an indication of the success of developments in this area. Approaches to multiprofessional education can be described as 11 steps in a continuum with uniprofessional education at one end of the spectrum and transprofessional education at the other. The three-dimensional model offers a tool which can facilitate the planning and implementation of multiprofessional education. It is useful also for analysing and evaluating case studies in the field of multiprofessional education.

Tribalism, Loss and Grief: Issues for Multiprofessional Education

This paper examines tensions between a sense of loss of professional identity and drivers for change in achieving multiprofessional education and practice. Key ideas of Marris (1986), including feelings of ambivalence and ‘the conservative impulse’, are used as a framework for the paper and are linked to the vivid anthropological metaphor of ‘tribalism' (Beattie, 1994; 1995). The issues are considered to be important for innovations in multiprofessional education since they point to a dilemma which cannot be safely ignored. Legitimate expressions of resistance, arising from confusing expressions of ambivalence, conflict and grief, occur when boundaries of distinct groups appear to come under threat from integration of various professional groups and tribalism is often viewed as a negative expression of retreat and rejection of change. However, both can be seen as legitimate laments for betrayed traditions with elements of bereavement processes. As such they present a challenge for educationalists to adopt teaching methods conducive to open discussion and expression of feelings in a safe and non-judgemental atmosphere. Teaching in the affective domain recognises the legitimacy of cultural continuity and the need for professionals to wake transitions towards collaborative, professional, health care practices. The author concludes that the need to maintain the self-confidence of different professional groups is very real, as are the possibilities of failure if the issues of professional traditions are ignored.

AMEE Guide No. 12: Multiprofessional education: Part 2 - promoting cohesive practice in health care

The recommendations contained in this guide are derived from a two-year qualitative study of perceptions of multidisciplinary education in health care, funded by the Department of Health. The study was conducted by a multidisciplinary team at the Scottish Council for Research in Education (SCRE), the School of Health at the University of East Anglia, and the Centre for Medical Education at the University of Dundee. Interviews were conducted with course organizers and students, and with health professionals in two contrasting clinical settings: general medical practice and accident and emergency medicine. The evidence suggests that multidisciplinary education is neither an easy, nor a cheap option. It needs to be adequately resourced; the rationale for its development needs to be made explicit to both staff and students; and clear and achievable objectives need to be set for each stage. It requires careful planning throughout, and there should be adequate reflection upon the relative advantages and disadvantates of its inclusion at pre- and post-registration levels respectively. Finally, its success will ultimately depend upon the support and commitment of all staff involved.