Good Quality IPL within Health and Life Sciences

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Good Quality IPL within Health and Life Sciences

• A project funded by East Midlands Healthcare
  Workforce Deanery

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Team members

• Dr Peter Norrie
• Mr Lazar Karagic
• Ms Carol Greenway
• Dr Susan Dyson

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Project Aims Overview

• Context Productive relationship with Leicester
  University involving pre registration provision
• Main driver of this project is to explore
  existing provision of LBR IPL
• Phase 1
• Completed as of September 2009
• Phase 2
• To be run over Semesters 1 and 2 2009/10

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Phase 1

• Project has three aims
• 1 To identify the characteristics of high quality
  LBR Inter Professional Learning/ Education
• 2 To identify the ways in which LBR
  Inter-Professional Learning/ Education is
  delivered within the Faculty of Health and Life
  Science
• 3 To critically review delivery of LBR
  Inter-Professional Learning/ Education within the
  Faculty of Health and Life Science against best
  practice

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• Methods
• A literature review was undertaken to explore the
  terminology and research which underpins IPL
• Decided that IPL was synonymous with IPE
• Used CAIPE (2006) definition when two or more
  professions learn with, from and about each other
  to improve collaboration and quality of care
• Original contribution looking at IPL in Learning
  Beyond Registration education and/ or Post
  Registration provision for healthcare workers

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Review methodology

• Database searches on Medline, Web of Science,
  Scopus, ASSIA, CINAHL, BNI, Social Care Online,
  ERIC, Social Services Abstracts, Sociological
  Abstracts, BEI and Cochrane Database
• Initial high sensitivity search undertaken
• Search terms Interprofessional education,
  Interprofessional learning, IPE, IPL,
  inter-professional learning, learning beyond
  registration, post registration and
  post-registration
• Undertaken May 2009
• No restriction on date range.

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Search results

• 131 papers accessed
• 121 excluded as duplicates, or did not consider
  IPL in LBR, or did not meet definition.
• 10 papers included
• 5 from the UK
• 1 each from Australia, Canada, NZ, Netherlands
  and USA
• Of these 3 were research papers
• Other papers were recommendations/ descriptive
  papers with no formal research component

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Study 1Barnes et al (2000) UK

• Study Design Longitudinal Survey
• Quantitative questionnaires at the start of the
  course, and then at the end of the first and
  second years of study.
• Used existing questionnaire Attitudes To
  Community Care (Haddow and Milne 1995)
• Supported by participant observation in 9
  full-day teaching sessions.

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Who took part?

• Two cohorts of course participants (n25 in
  cohort one) (n46 in cohort two).
• The participants were community psychiatric
  nurses, occupational therapists, social workers,
  and others involved in community mental health.
• What was the intervention?
• A 3-year postgraduate IPL programme in community
  mental health.

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Key Findings

• Attitudes and values concerning community care
  for people with mental health problems were
  largely shared by different professions.
• The findings confirm the existence of
  Inter-Professional stereotypes and of perceived
  status differences, and there was no evidence
  that IPL broke these down
• The findings support the view that the programme
  was not providing sufficient opportunities for
  IPL, as opposed to shared learning (merely
  learning in the same environment) Qualitative
  element

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Quality of evidence

• Small sample size means findings need to be
  treated with caution.
• Much of the teaching was provided by an expert
  (e.g. lecturer) so the impact of IPL was not
  proven
• The mixed method element was unclear
• Although data were described as non parametric,
  ANOVA was used for some findings

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Study 2 Nauta (2006)

• Study design
• Mixed Method Longitudinal Survey
• Questionnaires pre and post, and at 3-month
  follow-up.
• Interviews at 18-month follow-up.
• Who took part?
• General practitioner (GP) trainees (n34) and
  Occupational Health Physician (OHP) trainees
  (n20) in Netherlands.

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What was the intervention?

• Four-day joint postgraduate IPL training
  programme to improve knowledge of the guidelines
  for exchange of information, and to enhance
  collaboration.
• Article includes outline of the education

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Key Findings
Trust variables
Knowledge of guidelines
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Quality of evidence

• Tautologous nature of the study (?)
• Small sample size means findings need to be
  treated with caution
• Subjective nature of findings

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Study 3 Pullon and Fry (2005) New Zealand

• Study design
• Cross sectional postal survey
• Who took part?
• Primary health care professionals (n114)
• Doctors (n79)
• Nurses (n28)
• Others (n7)
• who had undertaken postgraduate study between the
  years 1999-2003 at the University of Otago, New
  Zealand.

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What was the intervention?

• Reflection on a common IPL component, described
  in limited depth in the paper
• Key Findings
• The inter-professional nature of the education
  was seen as positive, and it contributed to a
  modest increase in collaboration between health
  professional groups.
• Respondents felt they were able to influence
  their workplace by introducing their own new
  knowledge and skills to others

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Quality of evidence

• The study was limited to retrospective responses,
  therefore important details may have been
  forgotten by respondents over the timeframe.
• All findings are (very) subjective

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Summary of phase 1

• There is weak evidence that IPL in LBR can
• Challenge stereotypes in the health care setting
• Increase trust between groups
• Increase knowledge between groups
• Increase collaboration

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Phase 2 Qualitative interviews with module leaders

• Aim 2 To identify the ways in which Inter
  Professional Learning/ Education is delivered
  within the Faculty of Health and Life Science
• Reviewed range of LBR modules delivered at DMU
  (Spring 2009)
• Identified those with two or more professional
  groups, least 10 of cohort represented differing
  professions.
• 10 modules identified, 8 module leaders
  interviewed, using semi structured interviews
• Interview transcripts analysed for open coding
• Open codes reviewed and axial codes identified
• NB these are early results, require validating

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Theme 1 Pre-Requisites

• Module leaders stressed the need to understand
  the professional groups and their requirements
• you have to know your groups! (6 reports)
• IPL worked well with student highs in their
  clinical professions- focussed on assessment,
  well motivated
• Being able to prescribe is a big carrot!
• Support from within division important, allowing
  well represented steering groups

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Theme 2 Techniques

• Examplification common feature was the use of
  examples/ case studies to satisfy professional
  groups (8).
• Could be stressful, difficult to find relevant
  sessions
• Using different visiting lecturers could be very
  helpful
• Could be very difficult to do example
  audiologists ( time with clients) Vs medical
  laboratory scientists (almost none)
• Mixing up of groups- using counters, or coloured
  stickers to break up and make new
  Inter-Professional groups
• Use films or other AVs to give examples of
  Inter-Professional working

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Theme 3 Adjustments

• Cultural changes- movements within profession
  cultural boundaries
• Equalising effect noted- professions see
  themselves as low in the hierarchy, e.g.
• Nurses- inhibited by specialist expertise of
  physiotherapists
• Physiotherapists- inhibited by breadth of
  nursing skills
• Noted that this changed during the modules
• Students became less parochial, moved to where
  the expertise was

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Theme 4 Sticking points

• Is IPL in LBR a Cinderella topic?
• Module specific content- can be the dominating
  force in module structure, limiting IPL
  opportunities
• My module is about XXXX, not about IPL
• Institutional directives/ pressures (3), module
  pass rates, evaluations (PMN)
• Friction between groups trained to different
  levels noted (diploma/ graduate), difficult to
  bring students together
• Nursing dominant in terms of numbers
• Next Step in Phase 2

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Like Ricky Ponting we are a little
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Stumped!
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Phase 3 The students perspective

• Intend to Survey Students using
• Inductive
• Quantitative methods
• Find out where IPL takes place
• How students learn
• Who they learn from
• By understanding this we can provide a strategy
  for supporting this process

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How Do We Do This?
Thank you, Peter and Lazar