Self-Directed Learning, A Guide for Learners and Teachers

BACKGROUND: Poor interprofessional collaboration (IPC) can negatively affect the delivery of health services and patient care. Interventions that address IPC problems have the potential to improve professional practice and healthcare outcomes. OBJECTIVES: To assess the impact of practice-based interventions designed to change IPC, compared to no intervention or to an alternate intervention, on one or more of the following primary outcomes: patient satisfaction and/or the effectiveness and efficiency of the health care provided. Secondary outcomes include the degree of IPC achieved. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group Specialised Register (2000-2007), MEDLINE (1950-2007) and CINAHL (1982-2007). We also handsearched the Journal of Interprofessional Care (1999 to 2007) and reference lists of the five included studies. SELECTION CRITERIA: Randomised controlled trials of practice-based IPC interventions that reported changes in objectively-measured or self-reported (by use of a validated instrument) patient/client outcomes and/or health status outcomes and/or healthcare process outcomes and/or measures of IPC. DATA COLLECTION AND ANALYSIS: At least two of the three reviewers independently assessed the eligibility of each potentially relevant study. One author extracted data from and assessed risk of bias of included studies, consulting with the other authors when necessary. A meta-analysis of study outcomes was not possible given the small number of included studies and their heterogeneity in relation to clinical settings, interventions and outcome measures. Consequently, we summarised the study data and presented the results in a narrative format. MAIN RESULTS: Five studies met the inclusion criteria; two studies examined interprofessional rounds, two studies examined interprofessional meetings, and one study examined externally facilitated interprofessional audit. One study on daily interdisciplinary rounds in inpatient medical wards at an acute care hospital showed a positive impact on length of stay and total charges, but another study on daily interdisciplinary rounds in a community hospital telemetry ward found no impact on length of stay. Monthly multidisciplinary team meetings improved prescribing of psychotropic drugs in nursing homes. Videoconferencing compared to audioconferencing multidisciplinary case conferences showed mixed results; there was a decreased number of case conferences per patient and shorter length of treatment, but no differences in occasions of service or the length of the conference. There was also no difference between the groups in the number of communications between health professionals recorded in the notes. Multidisciplinary meetings with an external facilitator, who used strategies to encourage collaborative working, was associated with increased audit activity and reported improvements to care. AUTHORS' CONCLUSIONS: In this updated review, we found five studies (four new studies) that met the inclusion criteria. The review suggests that practice-based IPC interventions can improve healthcare processes and outcomes, but due to the limitations in terms of the small number of studies, sample sizes, problems with conceptualising and measuring collaboration, and heterogeneity of interventions and settings, it is difficult to draw generalisable inferences about the key elements of IPC and its effectiveness. More rigorous, cluster randomised studies with an explicit focus on IPC and its measurement, are needed to provide better evidence of the impact of practice-based IPC interventions on professional practice and healthcare outcomes. These studies should include qualitative methods to provide insight into how the interventions affect collaboration and how improved collaboration contributes to changes in outcomes.

Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes.

The overall goal of interprofessional education and collaborative practice is to provide health system users with improved health outcomes. Interprofessional collaboration (IPC) occurs when learners/practitioners, patients/clients/families and communities develop and maintain interprofessional working relationships that enable optimal health outcomes. Interprofessional education (IPE), which is the process of preparing people for collaborative practice, and IPC itself, are more and more frequently incorporated into health professional education and models of practice. For this reason, a clear understanding of the characteristics of the ideal collaborative practitioner is required to inform curriculum and professional development for interprofessional education, and enlighten professional practice for interprofessional collaboration.

A National Interprofessional Competency Framework

Nursing Research: A Qualitative Perspective

The Triple Aim unequivocally connects interprofessional healthcare teams to the provision of better healthcare services that would eventually lead to improved health outcomes. This review of the in...

https://www.tandfonline.com/doi/pdf/10.3109/13561820.2014.906391

A scoping review of interprofessional collaborative practice and education using the lens of the Triple Aim

The ability to work with professionals from other disciplines to deliver collaborative, patient-centred care is considered a critical element of professional practice requiring a specific set of co...

Role understanding and effective communication as core competencies for collaborative practice

. Leung, A., McArthur, R., McMillan, D., Ko, D., Deacon, J., Parboosingh, J. and Lederis K. (the Divisions of Paediatrics, Pharmacology and Obstetrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada). Circulating antidiuretic hormone during labour and in the newborn. Acta Paediatr Scand, 69: 505, 1980.—Using a high specificity radioimmunoassay, antidiuretic hormone (ADH) concentrations were measured in the plasma of 33 expectant mothers during labour, in cord arterial and venous plasma of their infants at the time of delivery (19 delivered vaginally; 14 delivered by Cesarean section) and in the plasma of the same infants in the first few days of life. Extremely high concentrations of ADH (about 50 times higher than adult basal concentrations) were present in cord arterial blood indicating active fetal production of ADH. Plasma ADH decreased rapidly within an hour after birth and usually fell to adult basal levels during the first day of life. Stressed babies and babies subjected to difficult deliveries had higher plasma levels of ADH.

Circulating antidiuretic hormone during labour and in the newborn

The Royal College of Physicians and Surgeons of Canada, in 2001, implemented a mandatory maintenance of certification (MOC) program that is required for fellows to maintain membership and fellowship. Participation in the MOC program is one of the recognized pathways approved by provincial medical regulatory authorities in Canada by which specialists can demonstrate their commitment to continued competent performance in practice. This article traces the historical beginnings of the MOC program, highlighting the educational foundation and scientific evidence that influenced its philosophy, goals, and strategic priorities. The MOC program has evolved into a complex system of continuing professional development to facilitate and enable a "cultural shift'' in how we conceptualize and support the continuing professional development (CPD) of specialists. The MOC program is an educational strategy that supports a learning culture where specialists are able to design, implement and document their accomplishments from multiple learning activities to build evidence-informed practices. In the future, the MOC Program must evolve from assisting fellows to use effective educational resources "for credit" to enable fellows, leveraging a competency-based CPD model, to demonstrate their capacity to continuously improve practice. This will require innovative methods to capture learning and practice improvements in real time, integrate learning during the delivery of health care, expand automation of reporting strategies, and facilitate new sociocultural methods of emergent learning and practice change. Collectively, these directions will require a research agenda that will generate evidence for how transformative cultural change in continuing professional education of the profession can be realized.

The Royal College Experience and Plans for the Maintenance of Certification Program

National guidelines for the investigation of hyperbilirubinemia (jaundice in the newborn) and management by phototherapy were developed and widely disseminated in Canada. Adoption of the protocol at the study hospital was low; only 17.0 percent of babies received phototherapy in accordance with the guidelines. This study was designed to obtain information about physician awareness and acceptance of the protocol, to determine the influences that were at work in physician decision making related to the investigation and management of hyperbilirubinemia, and to identify how physicians preferred to learn about guidelines. Twenty-five physicians who prescribed phototherapy during a 3.5 month period were interviewed. With one exception, all 25 physicians reported that they were aware of the guidelines and accepted the rationale for the protocol. However, in addition to the guidelines, the physicians modified their investigation and treatment decisions based on the patient's clinical course, the physician's previous experience, and input from both colleagues and parents. Although the interview process was associated with a change (from 17.0 to 30.9 percent), reflecting closer adherence to the guidelines, only 32 percent of the physicians believed that the interviews had been of educational value. The physicians did not see a role for interviews as an educational method, preferring standard methods such as printed guidelines and educational sessions. Nonetheless, the results suggest that clinical recall interviews can be helpful in understanding physician noncompliance with guidelines. That information can be used as the basis for more effective implementation of guidelines.

Stimulated case recall interviews applied to a national protocol for hyperbilirubinemia

Purpose – Scholarship about communities of practice (COP) is uncovering evidence that interactivity between community members contributes to improvement in practice Leadership and facilitation are crucial elements of successful COP implementation The purpose of this paper is to describe an innovative COP facilitator ' s course and report on the experiences of participants in the first course Design/methodology/approach – In response to this need and emerging evidence, an on-line COP facilitator ' s course was developed and implemented in Alberta, Canada, in 2011 This course included a home-based COP practicum, introductory face-to-face session, an on-line discussion board moderated by faculty and on-line learning modules Evaluation of the course was formalized in a qualitative study incorporating content analysis of postings, semi-structured interviews of successful participants and narrative responses to questions in a post course survey Findings – A total of 15 of 22 participants perceived they ac

John T. Parboosingh

Papers

Role understanding and effective communication as core competencies for collaborative practice

Circulating antidiuretic hormone during labour and in the newborn

The Royal College Experience and Plans for the Maintenance of Certification Program

Stimulated case recall interviews applied to a national protocol for hyperbilirubinemia

Introducing a multimedia course to enhance health professionals' skills to facilitate communities of practice.