Inter-Professional Education in the Healthcare Sector

Inter-Professional education in the Healthc ar SectorChapter 1IntroductionHealth feel forrs chokeing in Malta ar judge to bring towards a patient-centred care and to communicate and collaborate in multidisciplinary teams even if they lack sufficient staple knowledge on the role of every team member. Sacco (2008) stated that thither has to be pitchive team-working, communicating and collaborationism surrounded by professions for patients and their completelyied care to improve. He in worry manner stated that I.P.E. surrounded by the different professions is a way of attaining this team-work.Much has been written over the past few years on inter- captain education (I.P.E.) and its effect on the health care corpse. A lot of look and promotion welcome been conducted. However, Lumague et al. (2006) still believes that headmaster programs are still non giving the beguile importance of I.P.E. in their curricula. According to Sacco (2008), I.P.E. was never utilize by an y of the professions related to medicine in Malta, as a way of instruction.Buttigieg stated (as cited in The Times of Malta, 2008) that we still live with a long way to go to be able to exact with confidence that interdisciplinary collaboration in teaching and research at our University is bearing the fruit that is get increasingly inherent in the world of today.Although the exercise was anchor to be very exhausting by the researcher, it was besides an enriching screw and an introduction to the world of research. Provided that this was the authors first attempt to research, the contract has athletic supportered her develop a best(p) arrest of the research process.Chapter 2Literature Review2.1 The Current Healthcare System and the Present perspective at the FHSSacco (2008) stated that in the present health care system, patients are looked after by Multidisciplinary Teams comprising an extensive track down of healthcare and former(a) overlords. Apparently, the FHS boa rd is not spaciousy aware of the benefits of I.P.E. and although a lot of lip overhaul is presented to working as a Multidisciplinary Team (MDT), not much is truly d peerless to promote it end-to-end the actual education (Sacco, 2008). Sacco (2008) argues that in Malta, although the medical profession is part of the MDT, little or no desegregation is happening through come out of the closet the undergraduate years.Furtherto a greater extent, on that point has to be a clear distinction between greens Core Learning and I.P.E. The terms should not be mapd interchangeably since they do not give the same meaning. Currently in Common Core study-units students are cosmos taught unitedly with other students from other divisions of the FHS, or other faculties within the University, which is the same as multi-professional education as this involves learning the same circumscribe together side by side, which in turn should not be mistaken with I.P.E. (Sacco, 2008). The latter does n ot only comprise the orbit matter, but it also involves the different roles of different professions and how professionals can work together towards a shared goal (Sacco, 2008).Health education was somewhat inward-looking, however, owe to the altering health services, has changed from being mono-professional to multi-professional, and then becoming inter-professional (Sacco, 2008).2.2 Background on I.P.E.The need for immediate improvement of human resources was recently stress by the World Health Report 2006 produced by the World Health Organisation, agree to which, the world is laconic of 4.3 million doctors, midwives, nurses and support workers. This crisis was also recognized by the 59th World Health Assembly (2006), who collected upgrading of the health strength production through various methods which included innovative approaches to teaching in industrialised and exploitation countries. Further more, gibibyte (2005) pointed out that shortage of healthcarers in Canada were already reported in the Curtis Report, back in 1969, and the latter authorise of considerations for replacing the training program with a more advanced one, empathetic patient care, and increased collaboration and management in delivering healthcare.In addition to this, the requirement of numerous necessities of particular groups of facility users, the diversity of necessary service responses to these and the necessity for telling instruction exchange and discussion with pretends to care planning and delivery, lead to the demand for cooperation between the health care professions and the social care professions, and health and welfare/ social care agencies (Towards whizz for Health, n.d.).Robson and Kitchen, (2007), also emphasised the importance of an effective interprofessional collaboration in request to provide the best healthcare possible. The necessity of health and social care professions working together more was already highlighted for a account of years ( i ncision of Health, 1989, 1998, 2000).The complexity of patient care is on the rise, thus effective cooperation between health and social care professionals is needed. However, evidence proposes that the latter two are not cooperating well with each other (Cochrane Review, 2002).collaboration still poses several problems e specificly with interprofessional coordination and communicating. In a study carried out by Robson and Kitchen, (2007), students thought that communication and interprofessional relationships are the key factors affecting collaboration. I.P.E. has long been supported to be a resolving power to the ch each(prenominal)enges which collaboration presents (WHO, 1988 Department of Health, 2000). However, although it is evident that I.P.E. initiatives within universities have many beneficits, in that stance were doubts to how successful the development of such initiatives could be (Oxley Glover, 2002). The side by side(p) are several problem issues that were identifi ed by Brian ONeill (as cited in Oxley Glover, 2002)Finding placements, particularly for team experiencesDifferences amongst students with take note to knowledge they bring to the be presumption, motivations for taking the course, and preferred learning stylesEvaluation of outcomesTransferability of knowledge and skills to practice, and daze of interprofessional learning to practice.2.3 Challenges to the execution of instrument of I.P.E.Research suggests that it is very important for the professionals to have knowledge on how to work, communicate and collaborate efficaciously and fussy boundaries between professions for a better health care system. According to the Council for the Professions Complementary to Medicine (2006), Physiotherapists should communicate effectively with registered medical practitioners, other health professionals and relevant outside agencies to provide effective and efficient service to the patient (p. 2).Salvatori, Berry, and Eva (2007), reported th at although barriers to implementing I.P.E. exist, the need to overcome them is critical if we are to bread and butter pace with the changing healthcare system and better prepare health professional students for collaborative practice.A preliminary survey of I.P.E. assemble that, there is a wide variability when the term interprofessional is interpreted and that there are many barriers to I.P.E. some of which are overloaded curricula in schools of health professions, faculty and administrations lack of support and also financial limitations (Rafter et al., 2006).Not all of the above had been successful where endeavored. Oxley and Glover (2002) stated that in their own research some participants felt that they had not benefited from inter-disciplinary work as the course were in any case theoretical. On the other hand, most of the respondents felt that this work was successful owing to the inclusion of for warning practical experience, work placements, and inter-professional proj ects.2.4 What is the Best Time to Introduce I.P.E.?The best measure to submit interprofessional learning in higher education still re importants debated (Horsburgh, Lamdin, Williamson, 2001). On the other hand, Yan, Gilbert, Hoffman (2007) stated that it is the time to take a step forward to an I.P.E. and collaborative practice.Students themselves were found to be in favour of I.P.E. as early as possible that is in their first year of their course prior to the development of professional prejudice (Parsell, Spalding, Bligh, 1998 Horsburgh, et al., 2001 Rudland Mires, 2005) and stereotyping of other healthcare groups which may in turn have a negative tinge on attitudes when it comes to collaborating interprofessionally (Hojat et al., 1997 Tunstall-Pedoe, Rink, Hilton, 2003 Rudland Mires, 2005). On the other hand, introducing I.P.E. early in the course may sometimes be null when labeling has already been formed in the oral sexs of those who are nigh to start the course. Ru dland and Mires, (2005), reported that medical students start the course already knowing the main(prenominal) differences between the nurses and the doctors characteristics and backgrounds. For example medical students perception of the nurses is that they are more caring, have less social status, less competent and academically weaker than doctors.According to Khalili Orchard (2008) currently the way healthcare students are learning and socialized is via a uni-disciplinary model, which in turn may lead to in-group and out-group behavior (The cordial Contact Theory). Learning about the roles and responsibilities of just ones profession leads to professional socialization which in turn king lead to professionals distrusting other professionals and forming myths of perceptions about them, thus professional socialization and lack of effective collaboration. Sacco (2008) stated that professional socialisation is more the training of medical students into developing as doctors and ph ysiotherapy students into developing as physiotherapists, sooner than preparing them to be able to become team members. Shared interprofessional learning may be a solution to this problem as professions come to appreciate roles and responsibilities of other professions. Thus, I.P.E. may be the key to more effective collaboration in the actual workplace. Furthermore, it would be ideal if knowledge, skills and attitudes would be passed on from the I.P.E. into the actual workplace, something that still has to be accomplished within Maltas health services (Sacco, 2008).Multiprofessional learning and education (now looked at as interprofessional) have been given great importance by the World Health Organisation (as being an important factor in primary health care) since 1978 in the Alma-Ata 1978 Primary Health Care Report and it was empha surfaced later in 1988, in their statement Learning Together to Work Together for Health. This initiative was also supported in many countries by other legislative and policy requirements such as Learning together to work together (Department of Health, 2000) in the UK and the Inter-professional Education for Collaborative Patient Centred Practice Initiative, supported by Health Canada (Herbert, 2005).2.5 demonstrate Available to Support I.P.E.Hammick, Freeth, Koppel, Reeves, Barr (2007) states that there is limited evidence to support the proposal that learning together depart aid practitioners and agencies to work better together. The effect of I.P.E. on the healthcarers work still involve to be re-examined since there is no published evidence that I.P.E. promotes interprofessional collaboration or improves client relevant outcomes (Zwarenstein et al., 2005). Campbell (2003) reported that most studies that he selected for his systematic review were deficient in their methodologic rigor. The review concluded that there was no convincing impact of I.P.E. in improving collaborative practice and/or health/well-being.On the othe r hand, evidence that suggests that interprofessional learning improves interprofessional collaboration is also available (Atwal Caldwell, 2002). Oxley and Glover (2002), maintain that there are benefits to I.P.E. for different stakeholders including employers, universities and students. For example the recruitment of a higher standard of graduate by employers get out in turn have a appointed(p) reflection on the institute and its operators.According to the Commission on the Future of Health Care in Canada (2002), If health care providers are expected to work together and share expertise in a team environment, it makes sense that their education and training should prepare them for this type of working arrangement.Barr, et al. (2000) succinctly summarises the four main benefits I.P.E. can provideEnhances motivation to collaborateChanges attitudes and perceptionsCultivates interpersonal, group and organisational relationsEstablishes common value and knowledge basesHammick et al. (2007) found that I.P.E. is generally liked, allowing knowledge and skills needed for to work in collaboration to be learnt. Furthermore, staff development is the main impact on the effectiveness of I.P.E. and can help learners bring out the unique values about themselves and others (Hammick et al., 2007). When it comes to initiatives with interpret to quality improvement, I.P.E. is effective in improving practice and services (Hammick et al., 2007).On the other hand, according to Zwarenstein et al. (2005), there is no published evidence that I.P.E. promotes interprofessional collaboration or improves client relevant outcomes. Thus, the need for more research on I.P.E. is needed.2.6 Attitudes towards the Inter-Professional Teamwork and EducationThere was an amount of studies carried out to gain more information regarding attitudes of healthcare students towards interprofessional teamwork and education. Such students tend to show autocratic attitudes towards I.P.E. (Tunstall-Pedoe, et al., 2003 Pollard, Miers, Gilchrist, 2004 Curran, Sharpe, Forristall Flynn, 2008). In a research study conducted by Lumagae et al. (2006), when it comes to patient care, interprofessional teamwork was approved by all the participants who all agreed that opportunities comprising their development of skills, attitudes and behaviours required for interprofessional collaboration should be mixed in their healthcare education. Salvatori et al. (2007) also stated that It is clear that students enjoyed their experience and perceived new respect and understanding of other professional roles and the potential for interprofessional collaboration in caring for patients (p. 80).Most of such studies stated that there is a tendency that medical students and also postgraduate medical residents have significantly less confirming attitudes towards interprofessional teamwork when compared to students from other healthcare professions (Hojat et al. 1997 Leipzig et al., 2002 Pollard et al. 2004 Tanaka Yokode, 2005).Attitudes of medical and nursing students towards interprofessional teamwork were analyze and no significant difference was found between them two (Curran, et al., 2008). However, Curran et al. (2008) also found out that these two groups of students report significantly less positive attitudes towards interprofessional teams when compared to drugstore and social work students.Curran et al. (2008) also reported that medical students significantly showed less positive attitudes towards I.P.E. when compared to nursing, pharmaceutics and social work students. Being a female and/or a senior undergraduate also showed more positive attitudes towards interprofessional teamwork and education (the latter being more significant especially with prior experience with I.P.E.). In this study, profession, gender and year also seemed to play a role in determining positive attitudes towards twain interprofessional teamwork and education.On the other hand, Pollard et al. (2004 ) found that there were students who had viewed interprofessional collaboration negatively and they included right students and those that had experience at university or of working in a health or social care settings. Curran et al. (2008), argues that although having previous experience in I.P.E. activities may not improve attitudes to it, participating in it may have more positive attitudes towards interprofessional teamwork.2.7 Attitudes towards the Roles of their Own other Professional GroupsResearch has also tried to give answers with regard to students attitudes towards the roles of their own other professions. Tunstall-Pedoe, Rink, and Hilton (2003), argue that the overall attitude of students studying medicine towards students from other professions was less positive. In a study carried out by Hojat et al. (1997), medical students were found to have different attitudes from nursing students with regard to areas of authorities and power, including professional dominance an d medical responsibilities in serving patients needs. Furthermore, Spence and Weston, (1995) maintains that nurses were more clear in their perceptions of competencies essential for medicine, than medical students were about competencies important for nursing.It should be observe that literature review with regard to I.P.E. at the FHS was scarcely and difficult to find.Chapter 3Materials Methodology1 IntroductionThis chapter describes the planning and development of the research study. It also explains the inherent rationale for deciding on the studys structure.3.2 Objectives of the StudyIt is not really known whether students of the qualification of Health Sciences (FHS) and the Faculty of Medicine and Surgery (FMS) agree to the implementation of a new I.P.E. system at the FHS.The overall fair game of the study was to understand whether students at the FHS and at the FMS know what I.P.E. is and to explore their opinions regarding the implementation or not of I.P.E. in the comm on curriculum at the FHS.The goals of the study were toExplore the students understanding of the term I.P.E.Identify whether the students agree or disagree to the implementation of I.P.E. and I.P.E. study-units at the FHS, and if they agree, the study-units or areas of study they would like to see becoming inter-professional and at what stratum of their course to implement it.Find out the students attitudes towards I.P.E. with regard to its benefits and challenges if any.Discover the students attitudes towards I.P.E. teamsDiscover the students attitudes towards other healthcare professions3.3 practicable Definition of TermsTable 1Illustrating the operational definition of terms.3.4 The Research DesignFor the aims and objectives of the study to be addressed, the latter had to be descriptive, qualitative and thus, a non-experimental and explorative research design was considered to be the most worthy approach.One-to-one wonders were preferred to group audiences since in the former more personal information about the participant could be elicited (Carter, Lubinsky, Domholdt, 2011), the patient may feel more comfortable to speak in depend of a person rather than in front of a group and thus giving more honest information especially when it comes to expressing his/her attitudes towards others. The interviews were carried out in-person, with the advantage of providing the best opportunity for structure rapports and for observing the interviewees sign(a) cues (Carter, et al., 2011).3.5 The Research SettingThis study was conducted in Malta with the permission of the University of Malta. The University has a number of Faculties two of which being the FHS and the FMS, from which students were elect to participate. The courses which fall under these faculties and which were included in the study can be found in addendum F, wherein the numbers of students present in each division is also given. The participants had a say in the weft of the research setting, and preferred meeting at places most familiar and within reach to them including University of Malta areas, Mater Dei hospital and at certain pharmacies, which were also within reach by the researcher.Carter, Lubinsky, and Domholdt (2011), suggest that the setting in which the research is carried out contributes greatly to an interviews success. The interviewer made sure to choose a setting which is familiar and comfortable to the interviewee, with special attention given to the environmental setting such as quietness to avoid interruptions, adequate lighting, get on temperature, and comfortable and appropriate set-up of chairs to avoid building psychological barriers.Carter, Lubinsky, and Domholdt (2011), emphasized the importance of an appropriate introduction to an interview as this sets up the tone, affecting the rest of the interview. Furthermore, the researcher was aware of the body language at all times, keeping the appropriate distance, maintaining eye contact in line with cu ltural norms, showing interest and full awareness in what the interviewee was saying (by for example leaning forwards to him/her, nodding, smiling to funny comments that the subjects passed) and speaking distinctly and at an adequate volume level. Attention was also given to choosing the appropriate type of clothing as in an interview the attire plays an important role.At the end of each interview, the interviewer made sure to thank the participant for his/her contribution to the research study in order to show appreciation and to indirectly help promote and encourage participation in future research.3.6 Target PopulationIn this study, the target tribe which is described as the entire universe of discourse in which a researcher is interested and to which he or she would like to generalize the study result (Polit and Beck, 2008, p. 767), included students from all the different divisions of the FHS and from the divisions of Pharmacy and Medical students which both fall under the FMS. When the researcher interviewed these students, the latter had already started their next scholastic year. The researcher staggered the interviews so as to gain more knowledge whilst completing the literature review and to be able to give the participants appropriate cues during the interviews. This helped the researcher to achieve better results because the cues given targeted the research question. A literature search of electronic databases including Ebsco, Cinahl and Pubmed was conducted between January 2009 and May 2011.The inclusion criteria for this study wereAll the students whose course fell under the FHS or the FMS.Male or femaleWillingness to participate in the study.English speakingStudents over 18 years of age.The study will be using undergraduate students opinions rather than post-graduate healthcarers opinions, as there is a lack of similar studies on the issue.The exclusion criteria for this study were as followsStudents who never had any clinical experience.Stu dents who did not fell under University of MaltaThose who did not want to participate.3.7 Sampling Size and Methods Used to Choose the SampleOwing to time constraints, a method of convenience try out was employ to select a sample for the study, choosing easily accessible pile who are in proximity to the researcher or who are willing to take part in the study (Castillo, 2009). This method is also the cheapest, simplest take in form available and does not entail planning (Ellison, Barwick, Farrant, 2010). This type of sampling offers a fast attainment of preliminary information with regard to the research question being studied and is also inexpensive (Berg, 2004 Castillo, 2009). Students who snug the criteria were recognized and 31 people were chosen including 12 males and 19 females whose ages ranged from 19 to 46. The following is a proportion showing the total number of medical students, is to the total number of pharmacy students is to the total number of students from the FHS, respectively 426 196 823. One student per 90 students for each FHS division was interviewed in order to have a representable sample.The researcher was aware that the selected subjects could not represent the entire population as to test the whole population it entails to interview an enormous amount of people and that would have taken an space amount of time to complete the study. The sampling was unrepresentative and did not offer statistical advantages (Ellison, et al., 2010).The sampling size was mostly determined by the available time and resources. The researcher tried to find a parallelism between depth and breadth of the interviews. The in-depth information obtained from the research population provided rich and valuable data.The researcher contacted subjects who satisfied the inclusion criteria of the study via e-mails or face-to-face, in order to set appointments for the interviews, and had to find a compromise between both her and the subjects availabilities. The re searcher made sure that she would not disturb them.The researcher used stratified sampling to make sure that a particular sample, from the known population under study, is denoted in the sample (Berg, 2004). Furthermore, the use of stratified sampling also helped the researcher to access small subgroups within the population, allowing the researcher to examine the extremes of the population (Castillo, 2009). This known population was divided into strata, chosen according to literature support, from which samples were selected. The researcher had information on the population and was able to divide it into strata, for which a sampling fraction had to be applied, which represent proportions of the whole population (Berg, 2004).qualitative research makes sure that informants are not manipulated in a certain way as would probably be typical in studies which are quantitative experimental, but, instead tries to access the informants viewpoints (Carter, et al., 2011).3.8 The Research Inst rumentThe interview guide had two parts, one of which included demographic data and the other part included xv open-ended questions. The latter produced the qualitative data.The intention of establishing a rapport with the interviewees was to make them feel more comfortable. palsy-walsy light conversations, the use of sense of humour, and common conventions for example talking about weather conditions and about the surround environment helped to ease any tension built by the research situation and to start building a warm rapport. Furthermore, the researcher made sure that the interviewees had a say in the setting of the interview by asking them their preferred place, to augment comfort of the participant (Carter, et al., 2011). Moreover, the researcher made sure that the location chosen offered the least interruptions not to prevent limitations in conducting the interviews.A self-preparatory semi-structured interview was the tool of the study (Appendix I). The clearest usance of an interview is to collect information (Carter, et al., 2011). Questions were pre-designed prior to the interview and based on literature, yet, the format used in semi-structured interviews allows the researcher to elicit more information from the participant and to make questions more clear (Carter, et al., 2011).Berg (2004), characterized semi-structured interviews as being relatively structured, as being flexible both in wording and order of the questions, as being able to allow adjustments in the language level, as allowing the interviewer to give answers to questions and to make some clarifications if needs be, and as allowing the interviewer to add/remove probes (according to subjects).Carter, Lubinsky, and Domholdt (2011), pointed out that observation and interviewing skills were actually qualitative research methods seen regularly in clinical practice. As a physiotherapy student, the researcher was taught how to observe and assess patients thoroughly. This was an advantage to the researcher as she had already been gaining skills in observing and interviewing people prior to beginning the research study, thus, eliciting better and more honest data. For example, being able to give relevant cues at the appropriate time during the interviews kept the interviews flowing. Carter, Lubinsky, and Domholdt (2011), stated that developing skills in interviewing when one is a student or a healthcare professional will dispatch to a research study.The researcher made sure to try to elicit as much information as possible from the interviewees without putting them in an uncomfortable position. The latter was avoided by not asking too much of the participants, by selecting the right probing and cues, by showing an attitude of healthy curiosity and care, and by not judging them and keeping in mind that others have their values and opinions too. Any non-verbal communication noted was written as fieldnotes during the interviews and added to the transcripts.During the in terviews the researcher followed a copy of the interview schedule in order to keep the interviewee on track and used probes to make it easier to elicit complete data from the interviewees (Berg, 2004). Probes were also used when the subjects used monosyllabic answers such as yes or no. Uncomfortable silence was also used as a sign that the researcher expected to obtain more information.The interviewer also kept in mind to sound as natural as possible when asking questions and to remain neutral on the subject so as not to bias the participant by sharing personal judgments. Choosing facilitative techniques like providing utterances (for example uh-huh), using reflection by repeating some words of the interviewees utterance, confrontation to point out certain physical evidence as the interviewee spoke (for example I noticed you smiled when you told me that), interpretation (for example It sounds to me like youre not happy about that situation) were used to encourage the interviewees to continue (Carter, et al., 2011).Goffman (as cited in Berg, 2004) noted that people do not only learn to send or receive messages during their growth but also they learn how to avoid particular types of them. Goffman called this avoidance evasion tactics. Berg, (2004) made it clear that although this has to be surmounted when conducting interviews, one has to be caref