FACILITATING INTERPROFESSIONAL LEARNING

Dr Lesley Dawson / Physiotherapist

Dr Gill Horne / Nurse

Dr Martin Leiper / Physician

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© PRIME Partnerships in International Medical Education

INTERPROFESSIONAL LEARNING

Interprofessional education occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes. WHO (2010) p24

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Outline

• Scriptural basis

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• Evidence base and literature search

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• Cultural challenges – panel

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• Simulation exercise and Empathy mapping

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• Facilitating an interprofessional learning �PRIME event

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How do these passages relate to you experience of interprofessional learning?

1 Corinthians 12:12-20

¹² Just as a body, though one, has many parts, but all its many parts form one body, so it is with Christ.

 ¹³ For we were all baptized by^[a] one Spirit so as to form one body—whether Jews or Gentiles, slave or free—and we were all given the one Spirit to drink. ¹⁴ Even so the body is not made up of one part but of many.

¹⁵ Now if the foot should say, “Because I am not a hand, I do not belong to the body,” it would not for that reason stop being part of the body. 

¹⁶ And if the ear should say, “Because I am not an eye, I do not belong to the body,” it would not for that reason stop being part of the body. 

¹⁷ If the whole body were an eye, where would the sense of hearing be? If the whole body were an ear, where would the sense of smell be? ¹⁸ But in fact God has placed the parts in the body, every one of them, just as he wanted them to be. 

¹⁹ If they were all one part, where would the body be? ²⁰ As it is, there are many parts, but one body.

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Ecclesiastes 4:9-12�

⁹ Two are better than one,�    because they have a good return for their labor:�¹⁰ If either of them falls down,�    one can help the other up.�But pity anyone who falls�    and has no one to help them up.�¹¹ Also, if two lie down together, they will keep warm.�    But how can one keep warm alone?�¹² Though one may be overpowered,�    two can defend themselves.�A cord of three strands is not quickly broken.

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Philippians 2:3-4�

³ Do nothing out of selfish ambition or vain conceit. Rather, in humility value others above yourselves, ⁴ not looking to your own interests but each of you to the interests of the others.

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Exodus 17:8-13�

⁸ The Amalekites came and attacked the Israelites at Rephidim. ⁹ Moses said to Joshua, “Choose some of our men and go out to fight the Amalekites. Tomorrow I will stand on top of the hill with the staff of God in my hands.”

¹⁰ So Joshua fought the Amalekites as Moses had ordered, and Moses, Aaron and Hur went to the top of the hill. ¹¹ As long as Moses held up his hands, the Israelites were winning, but whenever he lowered his hands, the Amalekites were winning. 

¹² When Moses’ hands grew tired, they took a stone and put it under him and he sat on it. Aaron and Hur held his hands up—one on one side, one on the other—so that his hands remained steady till sunset. ¹³ So Joshua overcame the Amalekite army with the sword.

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What is Interprofessional education?

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“…occurs when two or more professions learn about, from, and with, each other to enable effective collaboration and improve health outcomes.

(WHO, 2010)

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Interprofessional learning and interprofessional practice are closely aligned!

Literature review

What’s the evidence base

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Research questions:

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• What are the benefits and challenges of health workers from differing professions learning together?

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• What are the best ways or methods of facilitating interprofessional learning?

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Databases: : Knowledge & Library Hub, TripPro, Medline, Emcare, AMED, British Nursing Index, Proquest Health Research Premium, Cochrane Library, NICE, general internet search (last 10 yrs.)

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Search terms: (Interprofessional or interdisciplinary or multidisciplinary or multi-disciplinary or team-based or MDT) N4 (learning or training or education or collabor*) ) OR AB ( (Interprofessional or interdisciplinary or multidisciplinary or multi-disciplinary or team-based or MDT) N4 (learning or training or education or collabor*) ) OR SU ( (Interprofessional or interdisciplinary or multidisciplinary or multi-disciplinary or team-based or MDT) N4 (learning or training or education or collabor*) )

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57 articles of which 10 reviewed

Key Findings

WHO – Framework for Action on Interprofessional education and collaborative practice (2010)

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Recognition that in providing health care services we face:

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• increasingly complex health issues,
• 4.3 million worldwide shortage of healthcare workers
• Complex issues require complex and collaborative response (e.g. pandemic)

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Therefore, we need an interprofessional team approach!

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Professional – includes people with knowledge and/or skills to contribute to physical, mental, social (spiritual) well-being of a community

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Things that shape IPL

When does IPL happen

• Pre and post qualifications
• Variety of settings
• Informally & formally
• In clinical practice
• Interprofessional team meetings
• Visiting other organisations and projects

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What to include in IPL curricula?

• Shared vision
• Teamwork
• Roles and responsibilities
• Effective communication skills
• Learning and critical reflection – real world experiences
• Relationship with, and recognising the needs of the patient
• Interaction between students
• Ethical practice
• Simulation exercises

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Benefits of IPL

• Patient reported higher level of satisfaction
• Improved access to health services
• Better health outcomes
• Appropriate use of specialist resources
• Reduced length of hospital stay
• Reduced staff turnover and improved staff wellbeing
• Reduced clinical errors/adverse outcomes (23%)
• Reduced mortality rates (by 28%)
• Improved personal relationships; reduction in tension between caregivers and conflict management
• Reduced cost of care

More benefits…

• Better coordination of care and decision making
• Terminally ill more satisfied with care, fewer clinic visits, fewer symptoms and overall improved health
• ‘go beyond job title and communicate with each other with more respect’
• Co-creation and synergy

Enablers

• Clear and shared goals
• Shared values
• Effective communications
• Collaboration and joint decision making
• Own role clarity, tasks and responsibilities
• Team identity
• Trust and collegiality
• Patient centred
• Shared language
• Open attitude - flexible
• Safe, respectful environment and co-location
• Culture of change and learning

Barriers to IPL

What this means for PRIME and PRIME Tutors?

• Ensure our training role models interprofessional learning through an interprofessional team of trainers with interprofessional learners.
• That our training fosters:
• team building activities and collaboration
• *patient/person-centredness
• effective communication skills
• provides a safe and supportive learning environment for whole team
• Is action and case-based
• combines learning methods
• uses simulation learning techniques
• invites enthusiasm, empathy and appreciates diversity

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• Consider professions – not just registered health care workers!
• Encourage collaborative practice and recognises everyone’s contribution
• Work across organisations
• Commit and champion IPL and collaborative practice internationally

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References

Carney, P et al (2019) The benefits of interprofessional learning and teamwork in primary care ambulatory training settings, Journal of Interprofessional Education & Practice (15), 119-126

Diggele, C et al (2020) Interprofessional education: tips for design and implementation. BMC Medical Education, 20(Suppl 2):455

Handgraff et al (2023) Identification of barriers and facilitators of successful interprofessional education (IPE) – a scoping umbrella review, International Journal of Health Professions (10), 1, 117–135, ISSN 2296-990X, DOI: 10.2478/ijhp-2023-0009

Links, M (2014) "Walking the Walk": Promoting Competencies for Interprofessional Learning through Team Meetings--A Case Study. Journal of Research in Interprofessional Practice & Education 4(2), pp. 1-16

Medina-Córdoba, M et al (2022) The effect of interprofessional education on the work environment of health professionals: a scoping review. Advances in Health Sciences Education https://doi.org/10.1007/s10459-023-10300-4

Nisbet, G et al (2015 ) Interprofessional team meetings: Opportunities for informal interprofessional learning. Journal of Interprofessional Care 29(5), pp. 426-432

Verbeek, F et al (2023) Facilitators for developing an interprofessional learning culture in nursing homes: a scoping review. BMC Health Services Research, 23:178

Webster, C et al (2024) Interprofessional Learning in Multidisciplinary Healthcare Teams Is Associated With Reduced Patient Mortality: A Quantitative Systematic Review and Meta-analysis. Journal of Patient Safety 20(1), pp. 57-65

Weil, A et al (2018) A new approach to multi-professional end of life care training using a sequential simulation (SqS Simulation™) design: A mixed methods study, Nurse Education Today, https://doi.org/10.1016/j.nedt.2018.08.022

WHO (2010) Framework for Action on Interprofessional Education & Collaborative Practice

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Research Title & Acknowledgment

• Evidence Search: Research title: What are the benefits and challenges of health workers from differing professionals learning together? What are the best ways or methods of facilitating interprofessional learning?

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• Librarian name: Liz Saward, January 2024, Torquay, UK: South Devon Health Library & Knowledge Service

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How do PRIME principles of Whole Person Health Care fit with interprofessional learning?

A definition of culture 

"The way of life, especially the general customs and beliefs of a particular group of people at a particular time" 

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The Cambridge Dictionary

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Characteristic values in cultures�

• Power distance
• Individualism versus Collectivism
• Masculinity versus Femininity
• Uncertainty avoidance

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Multi-professional Diploma in Palliative Care Gaza 2022

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How to prepare for and conduct a PRIME interprofessional learning event. �

• Humility. Assume nothing.
• Find out the culture between professions and between professions and carers.
• Have a multiprofessional PRIME team.
• Demonstrate obvious respect between each profession in the team.
• Switch roles and leadership.
• Tackle issues, case studies or questions with contributions from several professions.
• Explain the benefits to the patient, the family, and professionals of interprofessional working.
• Anonymizing feedback. Slips of paper, Mentimeter or use white board

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Lo tech ballot

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• Zoti P
• 77 vjec
• Kancer prostate
• I duhej te jetonte ne shtepine e vajzes qe para 7 vitesh
• I konfuzuar
• Mendon se eshte Krishti
• Pin 2 shishe raki ne jave

• Mr P – 77yrs
• Cancer of the prostate
• Had to move to daughter’s house 7yrs ago.
• Confused
• Thinks he is Jesus Christ
• Drinks 2 bottles of Raki/week

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Depression (depresion)� Dementia (demence ) � Delirium (deliri) � Acute Psychosis (psikoze akute)

How to hide names on ZOOM whiteboard or slide if you are host or co-host

Mentimeter

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What does the patient see in you?

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Empathy Map

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Case of patient with unplanned pregnancy.

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Instructions.

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Students type their reactions to each question in the relevant colour.

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What does the patient see in you?

Case study - Amerah

• Amerah is an 80-year-old widow who presents with a pharyngeal mass, reporting a year long history of profound dysphagia, severe breathlessness, pain and hoarseness of voice.
• You as her healthcare team are concerned that she may rapidly deteriorate due to obstruction of her trachea, which could result in a tracheostomy!
• She has a 50-year-old daughter with profound learning disabilities whom she carers for at her home within her village.

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Health care team member

What would a positive outcome look like for this team member?

the nurse

the nurse

What is this team member saying?

What is this team member’s body language and cues telling you?

How is this team member feeling?

What barriers is this professional experiencing?

What does the professional see in team leadership?

Session Feedback ��Please let us know your feedback

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