http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, 2015; 29(1): 82–84 ! 2015 Informa UK Ltd. DOI: 10.3109/13561820.2014.933949
SHORT REPORT
Attitudes of pharmacy and nutrition students towards team-based care after first exposure to interprofessional education in Qatar
J Interprof Care Downloaded from informahealthcare.com by Thomas Jefferson University on 03/11/15 For personal use only.
Kyle John Wilby1, Tamara Al-Abdi2, Abdelmonem Hassan2, Marian Amanda Brown2, Bridget Paravattil1 and Sherief Ibrahim Khalifa1 1
College of Pharmacy, and 2College of Arts and Sciences, Qatar University, Doha, Qatar
Abstract
Keywords
Little is known regarding attitudes of healthcare professional students towards team-based care in the Middle East. As modernization of health systems is rapidly occurring across the Gulf Cooperation Council countries, it is important for students to engage in interprofessional education (IPE) activities. The objective of this study was to assess pre-clinical students’ attitudes towards interprofessional healthcare teams after completion of their first IPE activity. A previously validated questionnaire was distributed to 25 pharmacy and 17 nutrition students at Qatar University after participation in an IPE event. Questions related to quality of teambased care and physician centricity. Results showed high agreement regarding high quality care provided by teams yet students were unsure of the value of team-based care when considering required time for implementation. Results provide baseline data for future studies to assess student attitudes throughout the professional programs and give valuable insight for future IPE program design in the Middle East.
Interprofessional education, nutrition, pharmacy, pre-clinical, Qatar
Introduction Interprofessional education (IPE) is becoming a global target for healthcare education. With the advent of team-based care, interprofessional learning opportunities enhance students’ understanding regarding scope of practice and the role of other professionals providing care (WHO, 2010). The importance of IPE has been recognized by accreditation bodies and has now become an accreditation standard across different professions (AIPHE, 2011). IPE in the Middle East is a new concept yet countries such as Qatar are moving towards modernized healthcare education (Bin Abdulrahman, 2008). As such, IPE activities are becoming prevalent in the region. IPE is an important milestone for the country and Qatar University is invested to become a leader in health education. Additionally, the College of Pharmacy is accredited by the Canadian Council for Accreditation of Pharmacy Programs and the Human Nutrition Program is seeking accreditation from the Accreditation Council for Education in Nutrition and Dietetics, both of which require IPE (ACEND, 2012; CCAPP, 2013). As team-based care is becoming standard of practice in Qatar, it is important to prepare students for collaborative practice and to identify their attitudes and perceptions towards IPE activities. The College of Pharmacy and the Human Nutrition Program in the College of Arts and Science at Qatar University recently
History Received 16 February 2014 Revised 16 May 2014 Accepted 9 June 2014 Published online 2 July 2014
organized and delivered an IPE activity for undergraduate students. Participants were formed into groups of four or five members, given a case describing a patient with Crohn’s Disease, and required to identify and solve drug and nutrition therapy problems. The final output was a collaborative care plan used for larger discussion. To our knowledge, this is the first course-based IPE session to occur between health sciences at Qatar University. The objective of this study was to assess students’ attitudes towards interprofessional healthcare teams after completion of an IPE activity. Background Twenty-five second-year pharmacy students and 17 final-year nutrition students participated in the IPE activity. Students were previously exposed to the concept and definition of IPE and the roles of other health professionals (including physicians) through didactic lectures and case studies but had no formal interaction with other health science students. Participants were formed into groups of four or five members; each group contained at least two students from both pharmacy and nutrition. Groups were given a case describing a patient with Crohn’s Disease, required to identify and solve drug and nutrition therapy problems, and produce a collaborative care plan. Upon completion of care plans, a large group discussion facilitated by pharmacy and nutrition faculty focused on integration of therapeutic decision-making by both professions.
Methods Correspondence: Dr. Kyle John Wilby, PharmD, Qatar University, College of Pharmacy, PO Box 2713, Doha, Qatar. E-mail: [email protected]
The study employed a post-intervention evaluation design. Data were gathered from student volunteers at the end of their IPE session in the form of an anonymous questionnaire.
Interprofessional health education Qatar
DOI: 10.3109/13561820.2014.933949
83
Table I. Pharmacy and nutrition student attitudes towards team-based care in Qatar (N ¼ 41). Agree N (%)
J Interprof Care Downloaded from informahealthcare.com by Thomas Jefferson University on 03/11/15 For personal use only.
Question 1. Working in teams unnecessarily complicates things most of the time 2. The team approach improves the quality of care to patients 3. Team meetings foster communication among team members from different disciplines 4. Physicians have the right to alter patient care plans developed by the team 5. Patients receiving team care are more likely than other patients to be treated as whole persons 6. A team’s primary purpose is to assist physicians in achieving treatment goals for patients 7. Working on a team keeps most health professionals enthusiastic and interested in their jobs 8. Patients are less satisfied with their care when it is provided by a team 9. Developing a patient care plan with other team members avoids errors in delivering care 10. When developing interdisciplinary patient care plans, much time is wasted translating jargon from other disciplines 11. Developing an interdisciplinary care plan is excessively time consuming 12. The physician should not always have the final word in decisions made by health care teams 13. In most instances, the time required for team meetings could be better spent in other ways 14. The physician has the ultimate legal responsibility for decisions made by the team 15. Physicians are natural team leaders 16. The team approach makes delivery of care more efficient
Data collection A pre-validated survey developed by Heinemann, Schmitt, Farrell, and Brallier (1999) was used to measure attitudes towards healthcare teams and was adapted. The tool consisted of a 6-point scale (1 ¼ Strongly Disagree; 6 ¼Strongly Agree) and participants were asked to check the number that matched their attitude towards the statement. Sixteen statements were utilized with no personal identifiers collected. Participants were allowed to skip any statement they desired and could withdraw consent at any time. Only those questionnaires handed to facilitators were included in the final analysis. Analysis All responses were pooled and descriptive statistics were used to determine overall agreement (a response of 4, 5, or 6) or disagreement (1, 2, or 3) with each statement. A third category was calculated for blank or answers listed as ‘‘Not Applicable’’. Ethical considerations Ethical approval was granted by the Institutional Review Board at Qatar University.
Results Forty-one questionnaires were collected, giving a response rate of 97.6%. Results are summarized in Table I. Greater than 80% of participants responded favorably on 7 of the 11 statements that assessed attitudes towards interprofessional healthcare teams and the quality of care these teams provide. The four statements that did not meet 480% favorability related to the time required for team-based activities, patient satisfaction, and challenges interpreting jargon from other professions. Five statements addressed the role of the physician and aimed to measure attitudes regarding hierarchical versus team-based decision making. Results were inconsistent between statements. While 73.2% of participants believed physicians should not always have the final word in decisions made by healthcare teams,
6 39 36 24 37
(14.6) (95.1) (87.8) (58.5) (90.2)
Disagree N (%) 34 2 4 16 4
(82.9) (4.9) (9.8) (39.0) (9.8)
Not applicable N (%) 1 0 1 1 0
(2.4) (0) (2.4) (2.4) (0)
35 (85.4)
6 (14.6)
0 (0)
38 (92.7)
2 (4.9)
1 (2.4)
15 (36.6) 38 (92.7)
25 (61.0) 3 (7.3)
1 (2.4) 0 (0)
17 (41.5)
23 (56.1)
1 (2.4)
15 (36.6) 30 (73.2)
18 (43.9) 11 (26.8)
8 (19.5) 0 (0)
15 (36.6)
25 (61.0)
1 (2.4)
18 (43.9) 18 (43.9) 37 (90.2)
21 (51.2) 23 (56.1) 4 (9.8)
2 (4.9) 0 (0) 0 (0)
85.4% believed the team’s primary purpose is to assist physicians in achieving treatment goals for patients. Further discrepancy occurred with only 58.5% of respondents believing that physicians have the right to alter patient care plans developed by the team.
Discussion To our knowledge, this is the first study to assess student attitudes regarding healthcare teams after participating in an IPE activity for health science students in Qatar. As healthcare delivery in the Middle Eastern region is transforming into team-based care and collaborative practice, it is important to ensure curricula throughout the health professions support this change and prepare students accordingly. In order to accomplish this, student attitudes regarding team-based care should be measured and addressed. Results indicated high agreement regarding the positive utility and quality of team-based care. This is an important finding, as these students will be expected to integrate interprofessional concepts into their clinical rotations and eventually lead the transition to a collaborative healthcare model. The lower level of agreement regarding statements focused on time considerations is somewhat expected. First, this was the first IPE session for these students and a considerable amount of time was spent discussing the case and attempting to determine each profession’s role. It can be hypothesized that with more exposure to IPE, agreement regarding time considerations may increase. Limitations of this study include that students and faculty from only two health professions, pharmacy and nutrition, were involved. The discussion regarding the physician’s role in the interprofessional team highlights the value of incorporating additional health professions in IPE. In addition, this study describes a one-day intervention in a small number of students.
Concluding comments This study suggests that pre-clinical pharmacy and nutrition students in Qatar have positive attitudes towards the ability of interprofessional teams to provide high quality of care. Results are beneficial to academic and healthcare institutions seeking to create a culture of team-based care. Future studies should include
84
K. J. Wilby et al.
other health professions and centers in the Middle East to provide a comprehensive understanding of student attitudes. Other studies should assess the change in students’ attitudes as they engage in IPE activities during the course of their professional curriculum and the impact of IPE activities on collaborative practice in the workplace.
Declaration of interest The authors report no declarations of interest. The authors are responsible for the writing and content of this article.
References
J Interprof Care Downloaded from informahealthcare.com by Thomas Jefferson University on 03/11/15 For personal use only.
Accreditation Council for Education in Nutrition and Dietetics. (2012). ACEND accreditation standards for dietitian education programs. Retrieved from www.eatright.org/ACEND/.
J Interprof Care, 2015; 29(1): 82–84
Accreditation of Interprofessional Health Education (AIPHE). (2011, March 1). Knowledge exchange workshop report. Retrieved from www.cihc.ca/aiphe/consultation. Bin Abdulrahman, K.A. (2008). The current status of medical education in the Gulf Cooperation Council countries. Annals of Saudi Medicine, 28, 83–88. Canadian Council for the Accreditation of Pharmacy Programs (CCAPP). (2013). Accreditation standards for the first professional degree in pharmacy programs. Retrieved from www.ccappaccredit.ca. Heinemann, G.D., Schmitt, M.H., Farrell, M.P., & Brallier, S.A. (1999). Development of an attitudes toward health care teams scale. Evaluation for the Health Professions, 22, 123–142. World Health Organization (WHO). (2010). Framework for action on interprofessional education and collaborative practice. Retrieved from http://www.who.int/hrh/resources/framework_ action/en/.
SHORT REPORT
Attitudes of pharmacy and nutrition students towards team-based care after first exposure to interprofessional education in Qatar
J Interprof Care Downloaded from informahealthcare.com by Thomas Jefferson University on 03/11/15 For personal use only.
Kyle John Wilby1, Tamara Al-Abdi2, Abdelmonem Hassan2, Marian Amanda Brown2, Bridget Paravattil1 and Sherief Ibrahim Khalifa1 1
College of Pharmacy, and 2College of Arts and Sciences, Qatar University, Doha, Qatar
Abstract
Keywords
Little is known regarding attitudes of healthcare professional students towards team-based care in the Middle East. As modernization of health systems is rapidly occurring across the Gulf Cooperation Council countries, it is important for students to engage in interprofessional education (IPE) activities. The objective of this study was to assess pre-clinical students’ attitudes towards interprofessional healthcare teams after completion of their first IPE activity. A previously validated questionnaire was distributed to 25 pharmacy and 17 nutrition students at Qatar University after participation in an IPE event. Questions related to quality of teambased care and physician centricity. Results showed high agreement regarding high quality care provided by teams yet students were unsure of the value of team-based care when considering required time for implementation. Results provide baseline data for future studies to assess student attitudes throughout the professional programs and give valuable insight for future IPE program design in the Middle East.
Interprofessional education, nutrition, pharmacy, pre-clinical, Qatar
Introduction Interprofessional education (IPE) is becoming a global target for healthcare education. With the advent of team-based care, interprofessional learning opportunities enhance students’ understanding regarding scope of practice and the role of other professionals providing care (WHO, 2010). The importance of IPE has been recognized by accreditation bodies and has now become an accreditation standard across different professions (AIPHE, 2011). IPE in the Middle East is a new concept yet countries such as Qatar are moving towards modernized healthcare education (Bin Abdulrahman, 2008). As such, IPE activities are becoming prevalent in the region. IPE is an important milestone for the country and Qatar University is invested to become a leader in health education. Additionally, the College of Pharmacy is accredited by the Canadian Council for Accreditation of Pharmacy Programs and the Human Nutrition Program is seeking accreditation from the Accreditation Council for Education in Nutrition and Dietetics, both of which require IPE (ACEND, 2012; CCAPP, 2013). As team-based care is becoming standard of practice in Qatar, it is important to prepare students for collaborative practice and to identify their attitudes and perceptions towards IPE activities. The College of Pharmacy and the Human Nutrition Program in the College of Arts and Science at Qatar University recently
History Received 16 February 2014 Revised 16 May 2014 Accepted 9 June 2014 Published online 2 July 2014
organized and delivered an IPE activity for undergraduate students. Participants were formed into groups of four or five members, given a case describing a patient with Crohn’s Disease, and required to identify and solve drug and nutrition therapy problems. The final output was a collaborative care plan used for larger discussion. To our knowledge, this is the first course-based IPE session to occur between health sciences at Qatar University. The objective of this study was to assess students’ attitudes towards interprofessional healthcare teams after completion of an IPE activity. Background Twenty-five second-year pharmacy students and 17 final-year nutrition students participated in the IPE activity. Students were previously exposed to the concept and definition of IPE and the roles of other health professionals (including physicians) through didactic lectures and case studies but had no formal interaction with other health science students. Participants were formed into groups of four or five members; each group contained at least two students from both pharmacy and nutrition. Groups were given a case describing a patient with Crohn’s Disease, required to identify and solve drug and nutrition therapy problems, and produce a collaborative care plan. Upon completion of care plans, a large group discussion facilitated by pharmacy and nutrition faculty focused on integration of therapeutic decision-making by both professions.
Methods Correspondence: Dr. Kyle John Wilby, PharmD, Qatar University, College of Pharmacy, PO Box 2713, Doha, Qatar. E-mail: [email protected]
The study employed a post-intervention evaluation design. Data were gathered from student volunteers at the end of their IPE session in the form of an anonymous questionnaire.
Interprofessional health education Qatar
DOI: 10.3109/13561820.2014.933949
83
Table I. Pharmacy and nutrition student attitudes towards team-based care in Qatar (N ¼ 41). Agree N (%)
J Interprof Care Downloaded from informahealthcare.com by Thomas Jefferson University on 03/11/15 For personal use only.
Question 1. Working in teams unnecessarily complicates things most of the time 2. The team approach improves the quality of care to patients 3. Team meetings foster communication among team members from different disciplines 4. Physicians have the right to alter patient care plans developed by the team 5. Patients receiving team care are more likely than other patients to be treated as whole persons 6. A team’s primary purpose is to assist physicians in achieving treatment goals for patients 7. Working on a team keeps most health professionals enthusiastic and interested in their jobs 8. Patients are less satisfied with their care when it is provided by a team 9. Developing a patient care plan with other team members avoids errors in delivering care 10. When developing interdisciplinary patient care plans, much time is wasted translating jargon from other disciplines 11. Developing an interdisciplinary care plan is excessively time consuming 12. The physician should not always have the final word in decisions made by health care teams 13. In most instances, the time required for team meetings could be better spent in other ways 14. The physician has the ultimate legal responsibility for decisions made by the team 15. Physicians are natural team leaders 16. The team approach makes delivery of care more efficient
Data collection A pre-validated survey developed by Heinemann, Schmitt, Farrell, and Brallier (1999) was used to measure attitudes towards healthcare teams and was adapted. The tool consisted of a 6-point scale (1 ¼ Strongly Disagree; 6 ¼Strongly Agree) and participants were asked to check the number that matched their attitude towards the statement. Sixteen statements were utilized with no personal identifiers collected. Participants were allowed to skip any statement they desired and could withdraw consent at any time. Only those questionnaires handed to facilitators were included in the final analysis. Analysis All responses were pooled and descriptive statistics were used to determine overall agreement (a response of 4, 5, or 6) or disagreement (1, 2, or 3) with each statement. A third category was calculated for blank or answers listed as ‘‘Not Applicable’’. Ethical considerations Ethical approval was granted by the Institutional Review Board at Qatar University.
Results Forty-one questionnaires were collected, giving a response rate of 97.6%. Results are summarized in Table I. Greater than 80% of participants responded favorably on 7 of the 11 statements that assessed attitudes towards interprofessional healthcare teams and the quality of care these teams provide. The four statements that did not meet 480% favorability related to the time required for team-based activities, patient satisfaction, and challenges interpreting jargon from other professions. Five statements addressed the role of the physician and aimed to measure attitudes regarding hierarchical versus team-based decision making. Results were inconsistent between statements. While 73.2% of participants believed physicians should not always have the final word in decisions made by healthcare teams,
6 39 36 24 37
(14.6) (95.1) (87.8) (58.5) (90.2)
Disagree N (%) 34 2 4 16 4
(82.9) (4.9) (9.8) (39.0) (9.8)
Not applicable N (%) 1 0 1 1 0
(2.4) (0) (2.4) (2.4) (0)
35 (85.4)
6 (14.6)
0 (0)
38 (92.7)
2 (4.9)
1 (2.4)
15 (36.6) 38 (92.7)
25 (61.0) 3 (7.3)
1 (2.4) 0 (0)
17 (41.5)
23 (56.1)
1 (2.4)
15 (36.6) 30 (73.2)
18 (43.9) 11 (26.8)
8 (19.5) 0 (0)
15 (36.6)
25 (61.0)
1 (2.4)
18 (43.9) 18 (43.9) 37 (90.2)
21 (51.2) 23 (56.1) 4 (9.8)
2 (4.9) 0 (0) 0 (0)
85.4% believed the team’s primary purpose is to assist physicians in achieving treatment goals for patients. Further discrepancy occurred with only 58.5% of respondents believing that physicians have the right to alter patient care plans developed by the team.
Discussion To our knowledge, this is the first study to assess student attitudes regarding healthcare teams after participating in an IPE activity for health science students in Qatar. As healthcare delivery in the Middle Eastern region is transforming into team-based care and collaborative practice, it is important to ensure curricula throughout the health professions support this change and prepare students accordingly. In order to accomplish this, student attitudes regarding team-based care should be measured and addressed. Results indicated high agreement regarding the positive utility and quality of team-based care. This is an important finding, as these students will be expected to integrate interprofessional concepts into their clinical rotations and eventually lead the transition to a collaborative healthcare model. The lower level of agreement regarding statements focused on time considerations is somewhat expected. First, this was the first IPE session for these students and a considerable amount of time was spent discussing the case and attempting to determine each profession’s role. It can be hypothesized that with more exposure to IPE, agreement regarding time considerations may increase. Limitations of this study include that students and faculty from only two health professions, pharmacy and nutrition, were involved. The discussion regarding the physician’s role in the interprofessional team highlights the value of incorporating additional health professions in IPE. In addition, this study describes a one-day intervention in a small number of students.
Concluding comments This study suggests that pre-clinical pharmacy and nutrition students in Qatar have positive attitudes towards the ability of interprofessional teams to provide high quality of care. Results are beneficial to academic and healthcare institutions seeking to create a culture of team-based care. Future studies should include
84
K. J. Wilby et al.
other health professions and centers in the Middle East to provide a comprehensive understanding of student attitudes. Other studies should assess the change in students’ attitudes as they engage in IPE activities during the course of their professional curriculum and the impact of IPE activities on collaborative practice in the workplace.
Declaration of interest The authors report no declarations of interest. The authors are responsible for the writing and content of this article.
References
J Interprof Care Downloaded from informahealthcare.com by Thomas Jefferson University on 03/11/15 For personal use only.
Accreditation Council for Education in Nutrition and Dietetics. (2012). ACEND accreditation standards for dietitian education programs. Retrieved from www.eatright.org/ACEND/.
J Interprof Care, 2015; 29(1): 82–84
Accreditation of Interprofessional Health Education (AIPHE). (2011, March 1). Knowledge exchange workshop report. Retrieved from www.cihc.ca/aiphe/consultation. Bin Abdulrahman, K.A. (2008). The current status of medical education in the Gulf Cooperation Council countries. Annals of Saudi Medicine, 28, 83–88. Canadian Council for the Accreditation of Pharmacy Programs (CCAPP). (2013). Accreditation standards for the first professional degree in pharmacy programs. Retrieved from www.ccappaccredit.ca. Heinemann, G.D., Schmitt, M.H., Farrell, M.P., & Brallier, S.A. (1999). Development of an attitudes toward health care teams scale. Evaluation for the Health Professions, 22, 123–142. World Health Organization (WHO). (2010). Framework for action on interprofessional education and collaborative practice. Retrieved from http://www.who.int/hrh/resources/framework_ action/en/.
