Developing and delivering undergraduate interprofessional learning: a collaboration

• Pamela Jackson• Lead for Interprofessional Learning

University of Southampton, UK

The New Generation Project

A collaboration between the Universities of Southampton,Portsmouth and the NHS Strategic Health Authority.One of the 4 ‘leading edge sites’ funded by the Department of Health (<£2M) to introduce interprofessional learning into undergraduate Health and Social Care programmes to enhance professional competence and so improve the quality of care for patients and clients.

Context – why?• Modernisation of the NHS

The NHS and Social Services need graduates who can work together in multi-professional health and social care teams

- A Health Service for All the Talents: Developing the NHS Workforce, 2000• Many professions have a poor track record of working together

– Working Together – Learning Together, 2001

• Reports from service failures– Bristol Royal Infirmary, Shipman, Climbie, baby Peter,

• Increasing team based approaches to care ‘Health professionals are required to negotiate within and across an intricate

web of professional relationships which have the potential to affect the health outcomes and safety of patients’ (Braithwaite et al 2006)

• Evidence that team working leads to better outcomes for patients, clients and staff

‘The quality of teamwork is directly and positively related to the quality of patient care and innovation in healthcare’ (Borrill et al, 2002)

Driver: NHS Plan‘We expect Workforce Development Confederations and Higher Education Institutions to put interprofessional education, at all levels, at the top of their agendas. As a minimum we intend to ensure that:

common learning runs from undergraduate and pre-registration programmes, through to continuing professional education

common learning takes place in practice placements as well as the classroom

common learning centres on the needs of patients and clients.

The regulators

• Regular meetings and dialogue

• Minutes agreed and published

•Validation agreed in advance – ‘Minor change big difference’

Department of Health Regulatory Unit

Development of curriculumCommon content was identified through triangulation of analyses of:

• Academic and practitioner standards• Curriculum documents• Relevant policy documents• Local and national expert focus groups• Consultation

This generated a list of interprofessional topics that could be divided into learning in common and common learning

How do we do it? Theoretical underpinning

• CONTACT THEORY: “…the contact hypothesis holds that contact between members of different groups, in the appropriate conditions, can lessen intergroup discrimination and hostility. One reason suggested for this is that contact allows the discovery of similarities of value and belief which can lead to attraction” (Brown et al., 1986)

• But Contact is not enough: simply putting students together will not bring about attitude change.

• Key features for Contact to result in positive attitude change include: institutional support for programme, opportunity to work as equals in small groups on shared tasks in a cooperative atmosphere, positive expectations, a concern for and understanding of similarities and differences (Barnes et al., 2000; Carpenter and Hewstone, 1996).

• SOCIAL IDENTITY THEORY: Identification of self in terms of a social group (the ‘in’ group) and as compared to another group (the ‘out’ group).

• The Common Learning Programme aims to change the way in which health and social care professionals of the future work together in teams.

• Attitudes and behaviours of members of one group towards another are governed by the nature, strength and salience of the members’ social identity.

• Stereotyping and social identity are closely linked • Stereotypes are judgements that may guide behaviour;• Stereotypes exist as students enter higher education• Evidence: Stereotypes may (Carpenter & Hewstone, 1996) or may

not change through interprofessional education (Barnes et al., 2000)

Curriculum Aims

Students are expected to demonstrate mutual respect for all members of the interprofessional team, a reluctance to stereotype, an absence of discriminatory behaviour, and an increase in their:

• Skills and confidence in functioning as an effective interprofessional team member

• Understanding and valuing of the contributions made by others• Ability to learn from others• Understanding of and respect for other health and social care roles, in

order to benefit service users.• Understanding and comfort with different ways of working and changing

future professional roles

Interprofessional Learning• 11 pre qualifying professions + 3 foundation degrees

(Social Work, Audiology, Nursing, Medicine, Midwifery, Occupational Therapy,

Physiotherapy, Podiatry, Pharmacy, Radiography (Diagnostic &Therapeutic) • Small group model of learning (10-11) • 1300 students in each unit• Health and Social Care employers across Hampshire & IOW

• Unit 1 - Collaborative Learning, based in HEI• Unit 2 - Interprofessional Team Working, based in practice• Unit 3 - Interprofessional Development in Practice, based in

practice

Inter Professional Learning UnitsYear 1 Year 2 Year 3 Year 4 Year 5

3 Year Programmes: Midwifery, Nursing, Occupational Therapy, Physiotherapy, Podiatry, Radiography and Social Work

Key Profession specific learning

Learning in Common

Common Learning

4 Year Programmes: Audiology, Medicine (BM4), Pharmacy

5 Year Programmes: Medicine

Model of Learning

Guided Discovery Learning

Collaborative Learning

Interprofessional Learning

Facilitated Collaborative Learning

O’Halloran, Hean, Humphris & Macleod Clark (2006)

Delivering: Learning in practice

Practice Context:Organisation & Care Team

e.g. Community Mental Health Team, Child

Protection Team, Drug and Substance Misuse Team

Students learning about

interprofessional practice through observation and

interaction with ‘real teams’

Students learning about an aspect of practice throughcompletion of the

group task

Students experiencing and learning about

team work by working together to achieve the

group task

Assessment

Common assessment • Assessment compulsory in all programmes• Mix of individual, group and peer assessment.• On-line submission of work by students and

marking by assessors (both practice & academic)• Presentation to practice managers & organisation

Leads

information and resources available at www.commonlearning.net

• Learning in Common prior to each Unit

• Briefing specific to each Unit from HEI Project specific information and background

from Facilitator prior to Unit

Information and e-based resources available at: www.commonlearning.net

E based resources and systems

IPLU2 Evaluation: Students. 2010-11

Developed my understanding of how to undertake an Audit / audit related project

97% agree / strongly agree

Developed my understanding of how to be a 'team player'

96% agree/ strongly agree

Developed my understanding of how to work Interprofessionally

85% agree / strongly agree

Developed my understanding of my professional responsibilities when working interprofessionally

85% agree/ strongly agree

Developed my understanding of how to constructively review others contributions

94% agree / strongly agree

Peer review process was constructive and helpful

78% agree/strongly agree

My facilitator effectively supported our working together 91% agree/ strongly agree

My IPLU2 experience was positive

93% agree/strongly agree

Staff Development: preparing facilitators• Unit 1: University based, facilitated by

academic staff• Unit 2/3: Practice based, facilitated by practice

staff• Prepared through a 1 day facilitator workshop

and supported by Learning Environment Leads /school contact briefings and debriefings– Overview of whole project– Facilitation and team working skills– Assessment skills– Learning journey– Developing practice placements (units 2/3)

Benefits for hosts and students• Real Practice-based Projects

– Both students and practitioners benefit from a valuable learning experience and a useable report

• Groups facilitated/supported by senior prctitioners & practice managers – Time commitment and benefit recognised

• Senior managers, Heads of relevant agencies and HEI representatives attend the presentations – IPL activity valued by organisation and interest appreciated by

students• Placements increased students’ awareness / understanding of

social and health care issues– Expose students to new practice areas– Positive Impact on recruitment– Learn transferable skills

Examples of placement activity: IPLU2 audit

• Operating Theatres– how much of the scheduled operating session is actually used for operating.

• Falls pathways – effectiveness of the falls pathway intervention in a number of organisations

• Maternal Health– meeting the standards in decision-to-delivery times in emergency caesarean

sections and reasons for delays

• Diagnostic Imaging– appropriateness of knee and ankle x-ray referrals from A/E nurse practitioners

• Centre for Children with Learning Disabilities– respite care, jointly facilitated by health and social care

IPLU2 audit• Are there ward based teaching programmes in place on

all wards? how well attended are they?  How are staff assessed?

• audit of hospital's compliance with data protection.

IPLU3: Service Improvement

• Changing Workforce Configurations– What knowledge/skills are required by bands 2-4 to support qualified staff in the

delivery of quality care?

• Improving uptake and delivery of statutory / mandatory requirements within theatres

• Review of how a Trust Falls Prevention Policy is being implemented to reduce the number of inpatient falls

• How can we involve Service Users within Children's Therapy Services to help inform future service design?

• Identifying areas that could increase awareness of infection control and lower rates of Health Care Associated Infections

IPLU3: Service Improvement

• In 2009, an NHS Trust Library Service took decision to purchase more electronic books instead of printed books.  The Library Services Manager asked an IPLU3 group to produce an action plan for library staff to enable them to manage this change within this busy acute trust, which must include a strategy to keep library customers well informed and adequately supported.  

Does it make a difference?

1. Follow up of selected groups in practice Evaluation of the Outcomes of Student Projects: Interprofessional Learning in

Practice Units 2 and 3

– Qualitative study - identified key factors contributing to the success or otherwise: context, facilitation, task and inter-relationships

IPLU2/3 Projects followed up (pilot) – of those who responded,– over 65% reported to have been implemented in practice in some form.– 73% rated the quality of the report to be at least 7/10Larger follow up planned: all projects now on database.

2. Follow up of students during 1st 3 years after graduation