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open access to scientific and medical research

Open Access Full Text Article

http://dx.doi.org/10.2147/AMEP.S159844

Designing and developing a continuing interprofessional education model

leila safabakhsh1

Alireza irajpour2

nikoo Yamani3

1Medical Education Department, isfahan University of Medical sciences, isfahan, iran; 2critical care nursing Department, Faculty of nursing and Midwifery, nursing and Midwifery care research center, social Determinants of health research center, isfahan University of Medical sciences, isfahan, iran; 3Medical Education research center, Medical Education Development center, isfahan University of Medical sciences, isfahan, iran

Background: Interprofessional education is considered as one of the approaches in educating

learners in the health system that increases interprofessional collaboration and improves the

quality of patient care.

Purpose: This study sought to design an interprofessional continuing education model.

Methods: This study was conducted in three stages. In the first stage, a systematic review of liter-

ature and search of databases were conducted to identify the common models of interprofessional

continuing education and to extract the elements used in these models. In the second stage,

specialists in interprofessional continuing education were interviewed in relation to the fea-

tures of elements derived from the first stage. In the third stage, the model of interprofessional

continuing education was designed using the results of the first and second stages.

Results: Seven models were obtained. Five themes, including the subject of interprofessional

continuing education, objectives, content, learning strategy, and evaluation strategies, were

extracted from them. Specialists stated interprofessional collaboration, needs of community

and learners, focus on patient, using interactive teaching methods, and feedback as the main

features of these five themes.

Conclusion: The results of this study showed that providing a framework and model regulated

in interprofessional continuing education programs can help design these programs.

Keywords: continuing education, interprofessional education, interprofessional learning,

post-registration

Introduction According to the World Health Organization (WHO’s) definition, interprofessional

education is the method in which two or more groups of students or learners of differ-

ent professionals of health system are trained to provide health services, prevention,

treatment, rehabilitation, disease improvement, and promotion of health with the

important objective of creating an interaction and participation among them in a specific

period and place.1–4 An interprofessional team is composed of professionals in various

health sciences who have knowledge, attitudes, skills and special capabilities in the

form of a team with a common objective based on clients’ needs and their special-

ties are applied for patient’s objectives in an effective and constructive relationship.5

Specialization of health care and increasing advancement in its technology add to the

complexities of health services delivery more than ever and make provision of safe and

favorable treatment based on community depending on the participation of members

of various medical professions in interprofessional teams. The fact is that members

of these teams are rarely trained. In addition, they come from various disciplines and

correspondence: Alireza irajpour critical care nursing Department, Faculty of nursing and Midwifery, nursing and Midwifery care research center, social Determinants of health research center, isfahan University of Medical sciences, isfahan 8174673461, iran Email [email protected]

Journal name: Advances in Medical Education and Practice Article Designation: Original Research Year: 2018 Volume: 9 Running head verso: Safabakhsh et al Running head recto: Designing a continuing interprofessional education model DOI: http://dx.doi.org/10.2147/AMEP.S159844

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safabakhsh et al

have different educational programs and, in principle, are

less able to work in teams.6–8 Teamwork is very important

for patient safety. Particularly when the members of a team

know their responsibilities well, they make fewer mistakes

than others. In so doing, they need to be trained together to

understand their role in the team. It seems that the solution

to this problem is interprofessional education.9

Currently, continuing education programs are planned

based on professional needs. Research has shown that con-

tinuing education programs that are tailored to a particular

profession cannot empower provider with the challenges

they face in the workplace.10,11 Therefore, there is a weak

evidence of effective strategies such as teamwork in solving

the challenges of treatment in the country.12 In the context

of interprofessional education programs in Iran, research on

interprofessional education has expanded; however, it has

not so far reached the level of application at the university

level and educational centers.13 In this regard, interprofes-

sional executive model in health sciences was designed at

the university level according to the available contexts in

the educational system of Iran in 2014 by Vafadar et al.

This model provides an appropriate framework for the

development of morality and the evolution of human and

professional identities among the health system’s students to

provide a basis for patients.14 Irajpour examined the status of

medical education in the country in terms of preparation for

interprofessional education, cooperative learning, and the

required capacities.12 The results of the study highlighted the

favorable conditions and readiness for the development of

interprofessional education programs in medical education of

the country.12 However, in recent years, the attitude and readi-

ness of students in the country’s medical education have been

investigated in the field of development of interprofessional

education using Readiness for Interprofessional Learning

Scale (RIPLS).15,16 The results indicated the positive attitude

of the majority of medical students toward the necessity to

use this educational approach and its outcomes for improving

the provision of health services to clients and promoting the

quality of interactions among staff in the health system.17–19

Despite few decades of the emergence and growth

of interprofessional education in the field of health, this

approach is still unknown for many professors and edu-

cational planners due to inadequate knowledge and poor

evidence. Currently, interprofessional education research is

increasing in Iran’s educational system.20 In 2011, Yamani

et al developed a diabetic patient care program based on

interprofessional education. Thirty-four doctors and nurses

received the necessary training through a 3-day workshop.

The questionnaire was used to evaluate the Team Climate

Inventory Questionnaire and Diabetes Questionnaire, which

were administered pre- and posttest. The findings of the

study assessed the quality of care provided for diabetics and

improved knowledge and practice of learners positively.21

An interprofessional education post-registration model

was designed by Ontario in 2009. This model was pro-

grammed in three stages: getting started; gaining mastery and

continuous mastery at each stage; and teaching, learning, and

evaluation of methods to assess the learners.22 Designing and

evaluating a new model of interprofessional education were

done with an emphasis on the use of asthma drugs in 2014 by

Bosnic-Anticevich. In this study, three models of continuing

education including face-to-face education, e-learning, and a

new interprofessional education model were implemented.23

In order to develop interprofessional education and improve

continuing education of the health community, it is neces-

sary to provide a suitable model for the country’s cultural

and educational context and its implementation to achieve

the abovementioned objectives. Using an implementation

model will pave the way for achieving these goals. To this

end, this study sought to design an interprofessional continu-

ing education model.

Methods This study was conducted in three stages. In the first stage, the

systematic review of literature was done to identify models

common in interprofessional education and to identify the

constituent elements in each model.

First, the search for literature was started with the key-

word of interprofessional continuing education. Other words

were used to combine with the original word using “AND”

and “OR”. These terms included interprofessional educa-

tion models, interprofessional continuing education models,

interprofessional education postgraduation models, and

interprofessional education post-licensure models.

Advanced search was done based on title, summary, and

keywords in English in years from 1990 to 2015. The results

were simultaneously transferred to EndNote software. Given

the accessibility to different databases and the coverage of

the available studies in this field, the search was conducted in

several specialized databases of health science studies includ-

ing Science Direct, PubMed, Eric, Cochrane Library, Ovid,

and Google Scholar. Search strategy is shown in Table 1. The

titles and abstracts of the obtained articles were examined in

relation to the research question. Then, the irrelevant articles

were excluded based on the inclusion and exclusion criteria,

and the relevant articles were entered into the qualitative

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Designing a continuing interprofessional education model

assessment process. Based on the components derived from

these articles, the features of this component were explained

by experts.

The following criteria were used to identify papers of

interprofessional education models post-registration in order

to develop the detailed case studies:

1. All case studies should be considered examples of models

interprofessional education post-registration or continu-

ing interprofessional education

2. All participants are health professionals

3. The purpose of continuing interprofessional educations

is expressed

Articles that were editorial report, bulletin, commentary,

book review, and introductory report and articles whose

purpose was not specified and the attendees were not health

professionals were excluded from the study.

In the second stage, interviews with experts in continuing

education and interprofessional education were conducted.

Before the interview, e-mails were sent to the experts, and

written informed consent and the time of the interview were

obtained. Ethical approval was granted by Isfahan University

of Medical Sciences. Since the adaptation of the interprofes-

sional education model to health education is an important

part of modeling design, the study of the sociocultural and

social context of educational approaches to health science

and, in particular, recognition of the experiences of continuing

education officials are of particular importance in designing

the model. At this stage, based on the components derived

from these papers, the characteristics that these components

have to offer in interprofessional training are explained by

specialists through semi-structured interviews. Considering

that the patterns of continuing interprofessional education

patterns are the most basic part of the model. In order to

analyze the articles, first, the article’s description on execu-

tive search methodology was reviewed repeatedly to obtain

a general understanding of the subject. The text was read by

line. Then, by repeated and frequent comparisons between

them, the codes that were the most frequent in the texts

were explained and combined, and descriptive themes were

identified.

In the third stage, the interprofessional continuing edu-

cation model was designed. The draft of this model was

presented to a group of interprofessional education experts,

and the applied model was finalized based on the results of

their comments and corrective suggestions.

Results Seven models were obtained from the findings of the

f irst stage in interprofessional continuing education

(Table 2).22-24,25-28 These models were studied repeatedly, and

five constructs were extracted out of them.

subject The first structure that came from interprofessional educa-

tion models was the subject of interprofessional education,

which included articles on health, hygiene, care, treatment,

and education. From the point of view of specialists, the title

or subject of interprofessional education should have the

features of interprofessional collaboration, teamwork, and

Table 1 search strategy

inter profession Or inter-profession Or inter discipline Or inter-discipline Or Multi profession Or Multi-profession Or Multidiscipline Or Multi-discipline Or Team Or collaborate

AnD learn Or Teach Or Education Or retaining Or Training

AnD continuing Or post registration Or post-registration Or post-licensure Or post licensure Or post-qualification

AnD

Model Or Framework Or flowchart

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patient centeredness. According to the theory of adult educa-

tion, the subject of continuing education and interprofessional

education programs should be the needs of the learners and

should be achieved through the needs assessment of learners

to be effective on the attitude and knowledge of learners.

Objectives The second construct obtained from the models is the

goals of interprofessional education. The studies identified

the objectives of interprofessional education programs,

interprofessional communication, recognition of the role

and responsibilities of other professionals in the team,

and mutual respect in the team. Professionals outlined the

characteristics of interprofessional education goals such as

relevance to continuing education, practice, participating

professions, and audiences. The objectives should also be

based on the need of the learner, patient, professions, and

community.

content Professional commonalities should be considered in the

formulation of the content. Professors of the professions

involved in the program should participate in content devel-

opment. It should be learner-based, profession-based, and

Table 2 continuing interprofessional education models

Author/year Article Model Teaching strategy Evaluation strategy

Competency

Medves et al (2009)22

interprofessional education curricula models for health care providers in Ontario

Ontario post- registration iPE model

role-playing, patient- centered care, workshop

Performance evaluation, rating scale, behavioral checklist

Role clarification, conflict management, inter-professional communication, team leadership patient/client/ family/community centered

Villarreal et al (2011)28

A model for increasing palliative care in the intensive care unit: enhancing interprofessional consultation rates and communication

consultative model AnD ‘‘integrative model”

clinical round discussion

Patient/family feedback and participant feedback

Patient-centered care, interprofessional communication, teamwork, consultation, interprofessional collaboration

Bosnic- Anticevich et al (2014)23

Development and evaluation of an innovative model of interprofessional education focused on asthma medication use

An innovative model of inter-professional education

Workshop, group interactions

semi-structured interviews and focus groups collaboration scale

interprofessional communication, interprofessional collaboration

Toner et al (2009)26

continuing interprofessional education in geriatrics and gerontology in medically underserved areas

Program for Outreach to interprofessional services and Education Model (POisE)

role-playing exercises and small group discussions

Questionnaires were developed by the consortium of new York Education centers

Team leadership skills, communication, systematic problem solving, decision making, team management, team maintenance

lundon et al (2009)25

The Advanced clinician Practitioner in Arthritis care program: an inter professional model for transfer of knowledge for advanced practice practitioners

– Didactic, practical, case-based, and self- directed learning, interactive learning

A traditional and retrospective self- evaluation, practice-focused survey, quantitative and qualitative analysis

Work collaborative system expanded scope of practice roles and responsibilities

Bonwell et al (2014)24

An interprofessional educational approach to oral health care in the geriatric population

case-based learning riPls and the iEPs questionnaire

improvement in patient care

gooding et al (2016)27

case-based teaching for interprofessional postgraduate trainees in adolescent health

case-based learning Kirkpatrick level 2 interprofessional collaboration

Abbreviations: iPE, interprofessional education; riPls, readiness for interprofessional learning scale; iEPs, interdisciplinary Education Perception scale.

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Designing a continuing interprofessional education model

patient-based care and cover all educational goals. Adult

education should be problem centered and function oriented,

rather than content centered.

learning strategies The interactive-based, learner-based, and problem-based

learning methods (seminars, workshops, group discussions)

are among the most widely used ones in studies. From the

experts’ point of view, teaching methods should be learner

based, create learning synergy, share experiences, and be

implemented in formative-summative method.

Evaluation strategies Evaluation is one of the most difficult and complex parts

of interprofessional education model. The patient is the

center of the professional system, and the health outcomes

will be affected by the performance of the interprofessional

team, whereas the learner is the center of the educational

system, whose consequences are affected by the educational

process.

In the articles reviewed, the most important instruments

used in evaluation were knowledge, attitude, and practice

questionnaires, RIPLS questionnaire, interviews with

experts, and feedback from families and patients. Experts

said that evaluation should be based on goals. It should also

be based on evidence-based and patient-center.

Development of continuing interprofessional education model From the findings of the first and second stages, the continu-

ing interprofessional education model was developed in three

stages: design, implementation, and evaluation (Figure 1).

At the design stage, first, the needs assessment is done

by the Continuing Education Center, and the subject of the

program is selected based on the needs assessment. Then

a panel of experts is formed on whether the selected topic

has the ability to run interprofessional education. If it can-

not be implemented using an interprofessional approach,

it will be implemented in a traditional method. If it can be

implemented using an interprofessional approach, it will

be selected in the same panel of participating professionals

and professors.

In the second session of the panel, the professors of each

profession are introduced and then the common learning

objectives among the professions, the common content,

teaching methods, interactive activities, and assessment of

the learners are identified.

The implementation phase is divided into three sections:

pre-teaching activities, while-teaching activities, and post-

teaching activities.

At the stage of pre-teaching activities, the characteris-

tics of learners and their readiness for implementation of

interprofessional education are determined using the RIPLS

questionnaire. Also, a pretest related to the curriculum is

implemented.

At the stage of teaching activities, learning methods

that suit the interprofessional training are used. During the

post-teaching activities, the materials are collected, and the

learning is fixed through questions and answers.

Evaluation stage At this stage, questionnaires and other evaluation tools are

kept ready. The determined evaluation methods appropriate

to the program and objectives are used. The results are col-

lected, judged, and analyzed. At the end of the report, the

results are presented, and the feedback is given to all groups.

Discussion The results of this study showed that providing a framework

and model for continuing interprofessional education pro-

grams can help design these programs.

The basis of this design was the implementation of con-

tinuing education programs based on the interprofessional

training. The characteristic of this model, which distinguishes

it from other patterns, is the step-by-step explanation of the

implementation of the interprofessional continuing educa-

tion program.

The designed model in Ontario has been developed in

three stages of the start-up phase, the stage of excellence

and continuous mastery, and emphasized the learning and

evaluation methods in three stages. In other articles, the

interprofessional training program has not been designed

and implemented on the basis of interactions between the

professions. The model we have designed is also applicable

to all educational systems in other countries, and its imple-

mentation stages are clear. There are resistances to imple-

menting interprofessional training programs. Planning and

coordinating the implementation of these programs is hard.

The differences in the culture of every individual and conflicts

of interest are the basis of these resistances.

The lack of formal and academic experience in interpro-

fessional continuing education and the lack of familiarity

with respect to interprofessional training among the con-

tinuing education officials were the limitations of this paper.

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Figure 1 (Continued)

Select a topic

Needs assessment by continuing education

Implementation in the traditional method

Yes

No

No

Yes

Does the topic based need assessment?

Register in continuing education system

Can the issue be implemented interprofessionaly?

Determine professions and sample number

Selection of professors for each profession

Membership introduction: the history of teaching subject in the relevant profession

Expressing educational goals as a single profession

Professional consensus on educational goals

Determine the content and division of the lesson

teaching methods Identify learner interactive

activities Expectations of learners at the

end of the course Evaluation method

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Designing a continuing interprofessional education model

Figure 1 (Continued)

Confirm learning by asking a few

questions

Provide instruction using appropriate teaching methods Types of teaching

methods simulation: role playing

Exchange-based: workshop, seminar, group discussion

View-based: home- visit inter-professional

Action-based: presence in the workplace

Action-based: problem- oriented

Electronic based: face to face

Ready yourself Ready to have training aid Determine the readiness

of learners Pre-test

Formation of a inter- professional team

Extraction of participants from the systemImplementation

Pre-teaching activities

Post teaching activities

Activities during teaching

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Figure 1 The model designed for continuing interprofessional education. Note: (A) designing interprofessional program; (B) implementing interprofessional program; and (C) evaluating interprofessional program.

Evaluation

Evaluation panel

Preparation for evaluation

update evaluation tool

duplicate questionnaires

variety of valuation tools

Distribution and implementation of evaluation (theoretical–practical)

Collect, judge and evaluate

Provide results

Analysis of results

Feedback to all groups

Conclusion The most important feature of this template is the transpar-

ency of the steps and step-by-step description in three stages

of design implementation and evaluation. It is suggested that

interprofessional training programs should be conducted not

solely for theoretical training but should also be implemented

in the clinical setting according to this model.

Acknowledgments This study is supported by the Department of Medical

Education, Medical Education Research Center at Isfahan

University of Medical Sciences, as part of a thesis.

Disclosure The authors report no conflicts of interest in this work.

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