Interprofessional Education in Aberdeen: Improving Understanding of Elderly Care

1. Interprofessional Education in Aberdeen: The use of undergraduate team working to improve understanding of care of the elderly M Gibson and L Diack www.ipe.org.uk

2. Background • Nearly 50 years since the government called for the development of interprofessional education in the NHS† • Since then there have been a number of short-term initiatives developed • Well developed and well organised but had short life spans mainly due to: • changes in the lead staff • lack of funding and/or • timetabling difficulties †Zwarenstein et al. J. Interprofessional education: effects on professional practice and health care outcomes (Cochrane Review). In: The Cochrane Library, Issue 4 Hammick M. (2000) Interprofessional education: evidence from the past to guide the future. Medical Teacher; 22:461–7

3. In recent years in England many of these issues have been tackled with the help Department of Health funding • Leading to initiatives such as the New Generation project at Southampton and Portsmouth universities • Until recently in Scotland there has been little in the way of development or funding for interprofessional education in health and social care • It is now acknowledged that multidisciplinary working in the NHS is necessary to ensure the best quality of care for patients

4. There is well documented evidence of the benefits of different health professionals working together† • To ensure the best possible care for a patient close liaison is needed between all health and social care professionals involved in that patient’s care • Good communication between hospital-based staff and the primary care team is essential • †Davies C. Getting health professionals to work together [editorial]. BMJ 2000; 3220:1021-2.

5. Aims and objectives • The aim of this initiative was to generate an appreciation of interprofessional team working within the setting of the NHS • This was to be achieved using multidisciplinary workshops within an undergraduate student population • with a particular reference to interprofessional communication in the treatment of an elderly patient

6. The primary care team responsible for the welfare of a patient can include a wide range of different professionals including: • nurses • health visitors • midwives • pharmacists • social workers • general practitioners • physiotherapists • occupational therapists • dieticians • clinical psychologists

7. Workshops • In each workshop, groups of up to 10 first year students from all health and social care courses in Aberdeen: • Nursing • Medicine • Occupational Therapy • Pharmacy • Physiotherapy • Diagnostic Radiography • Dietetics • Social Work • took part in tutorials to explore the different roles of their future professions based on a case study of an elderly patient

8. Case study • Students given the following information: • An 80 year old woman living alone, fell on Saturday afternoon while leaving the local village post office. The postmistress dialled 999 and the patient was admitted to hospital. The patient was diagnosed to have sustained a hip fracture, had this fixed surgically and was fit to be discharged in 10 days time • Students “brainstormed” the health and social care needs of patient • What health and social work professionals would be most suited to providing each aspect of the care? • How might overlaps be resolved? • Principles of group working

9. Groups mixed on the basis of students’ disciplines • As many professions represented in any one group as was logistically achievable • Tutors also drawn from across the range of courses involved in this initiative • Session emphasised small group learning • Interactive • Tutor took on the role of facilitator • Students brainstormed ideas, made notes on suggestions and provided their views on the content and process of the session

10. By the end of the workshop it was expected that students should be able to: • Describe the likely range of health and social care needs of the patients in one or two case studies • Discuss the contribution of different health and social work professions to meeting the care needs of these patients • Identify overlaps in care provision and discuss how these might be resolved • Work productively and responsibly as part of a multi-disciplinary group • Recognize the importance of: mutual respect, recognition of the contribution and skills of other professionals, and good communication, in multi-disciplinary working

11. Feedback • Feedback from both students and facilitators was extremely positive • Data from a subsequent RIPLS-based† shared learning questionnaire demonstrated overwhelming support for the initiative and a strong desire to have more interprofessional content across the entire undergraduate healthcare curriculum † Parsell G, Bligh J (1999) The development of a questionnaire to assess the readiness of health care students for inter-professional learning (RIPLS) Medical Education 32 (2): 95-100

12. Students’ Comments

13. Helped to improve (our) communication skills and increase confidence Highlighted the need for communication and mutual respect COMMUNICATION Communication between diverse professionals; very important within hospital and community We now have a respect for the amount of communication needed Awareness of integration/overlap of professions and how communication is paramount

14. Interesting to meet other healthcare students and build up experience of teamwork and confidence within a group Good to work as part of a team rather than on our own Realised the importance of respect between people in a team Good to meet others from different university TEAM WORK It provided an opportunity to increase our views of otherprofessional roles We feel that things like this should happen more often We got an insight into other HPs’ roles and learned how they link together in a real life situation

15. May have been slightly more productive when everyone was further into their courses and knew more about their own identities. So hopefully there will be a programme in the future to build on what we have learned today It was hard to answer questions as we haven’t been on placement SUGGESTIONS Such session should perhaps be repeated with the same groups after placements to find out how experiences and views have changed We think we would benefit from it being a regular occurrence

16. Logistical Issues and Future Work • The major issues that arose from the organisation of these workshops were the huge logistical problems of moving large numbers of students to different locations and difficulties of timetabling these sessions into the curriculum • Sessions have been running for 3 years now so this is less of an issue but is still a consideration for any new interprofessional initiatives • To help overcome these logistical difficulties and to allow for further extension of the interprofessional initiative a decision was made to develop and pilot an online course in early 2004 • It is aimed to evaluate and embed this course from Spring 2006

17. Changing attitudes • Provisional data from a “RIPLS-based” questionnaire completed by medical and pharmacy students (with no previous exposure to interprofessional teaching) indicate a changing attitude between first and final years of courses: • Fewer final year students demonstrating willingness to learn with other healthcare professions (compared with first year students, P<0.05) • Fewer final year students agreeing that learning with other healthcare professions is beneficial for patient care (compared with first year, P<0.05) • These findings demonstrate the importance of a continuous interprofessional education programme throughout all phases of the courses to address the above concerns

18. Conclusions • The findings of this initiative demonstrate the benefits of working together in an undergraduate multidisciplinary healthcare team to improve communication and understanding of interprofessional working in a healthcare environment • It is hoped that this initiative for first year undergraduates will provide the foundation for a strong and growing interprofessional healthcare programme in Aberdeen

19. Acknowledgements Scottish Executive Health Department for providing the funding for the current ongoing project The staff at the School of Medicine (University of Aberdeen) and Faculty of Health and Social Care (The Robert Gordon University) for their assistance and cooperation, without which the initiative would not be possible