The Division of Health Sciences is implementing a strategy (2016-19) to develop and consolidate IPE within Health Sciences professional programmes. The current focus is on pre-registration programmes.
The sections below provide a selected overview of IPE on offer in the Division, either on a University campus or at one of its regional clinical sites. These activities have been substantially fostered by the IPE Centre’s Support Innovation Fund.
The Tairāwhiti Interprofessional Education Programme (TIPE) is a complex immersion programme for final-year health professional students. It was developed in response to a request for proposals from Health Workforce New Zealand, with the long-term goal of increasing recruitment and retention of healthcare professionals in rural and remote locations in New Zealand.
TIPE is jointly administered by the University of Otago and the Eastern Institute of Technology (EIT), and includes dentistry, dietetics, medicine, nursing, occupational therapy, oral health, pharmacy, physiotherapy, and—since 2017—social work students.
Students from each health discipline are based for five weeks in the region (Gisborne or Wairoa). They study and work together in rotational groups. Educational objectives for the programme relate to hauora Māori, rural health, interprofessional education, and chronic conditions management.
The programme was initially funded for a three-year period from 2012 to 2014, with funding renewed and currently obtained up to the end of 2018.
Since 2011, members of an interdisciplinary teaching team called the Wellington Interprofessional Teaching Initiative (WITI), have worked together to provide interprofessional education to students on the University of Otago Wellington (UOW) campus. Disciplines represented in the team include, among others:
- Educational psychology
- Radiation therapy
Evaluation research has been embedded in the WITI programme, yielding peer-reviewed publications.
For WITI, a central aspect of interprofessional education is facilitating opportunities for students in small groups to discuss their disciplinary backgrounds and similar/different skill sets, and to consider how to contribute jointly to patient care (learning about, from, and with each other).
Stated WITI teaching outcomes align to the Canadian Interprofessional Health Collaborative competencies.
Classroom time typically involves students in a mix of social interaction, small group work, and teaching about content. In the initial class, support is given to assist students to prepare to undertake a joint project.
Since 2011, increasing numbers of dietetics, medicine, physiotherapy, and radiation therapy students have studied together about long-term conditions management (LTCM). In small interdisciplinary groups, students undertake a visit to a person in their home who has complex long-term conditions (LTCs) and then co-present to peers and visitors about the person’s experience of having LTCs and how they as a healthcare team can provide support.
In 2016, Massey University and University of Otago Wellington worked together on a piloted inter-university collaboration to enable Massey University nursing students to join UOW dietetics, medicine, physiotherapy, and radiation therapy students in an interdisciplinary module.
During 2017, WITI welcomed additional partner institutions, as pharmacy interns from the Pharmaceutical Society of NZ and clinical psychology students from Victoria University of Wellington, joined the LTCM programme. For 2018, there are plans to involve new disciplines and partner institutions in LTCM, e.g. occupational therapy and social work students on clinical placement in local DHBs.
Also in 2018, Day One orientation at UOW included an interprofessional class on Whakawhanaungatanga, for students to learn with, from and about each other to ensure patient/whanau-centred care. Mid-year 2018 will see a new IPE pilot activity on the theme of prescribing, including pharmacy interns and fifth-year medical students.
UOC Quality and Safety Initiative
By early 2016, feasibility/pilot studies with pre-registration medical and nursing students had been completed to explore key components of quality and safety in healthcare, including: attitudes, role understanding, communication and situational awareness. During 2016/2017 simulation-based immersion learning opportunities continued for Year 5 medical, and final-year nursing students (also involving Ara Institute of Technology). In 2017, Year 5 medical, Year 3 physiotherapy and final-year nursing and dietetics students (all students from the University of Otago) participated in interprofessional tutorials on human factors in patient safety (IPE exposure), and interprofessional workshops on roles and teamwork (IPE engagement). Ultimately the goal is for students from all health professional groupings to progress through IPE learning in a graded way from exposure through immersion. In addition, the ongoing work is laying potential foundations for the development of an IPE mini-curriculum in patient safety. Data analysis will be ongoing during 2018-19.
UOC IPE Discharge Planning Simulation Sessions
As a new IPE initiative on campus, four IPE discharge planning simulation sessions have been scheduled in 2018 (Feb / May / Jul / Oct). Medical Trainee Interns (approx. 24 per session), Pharmacy Interns (approx. 4 per session), final-year physiotherapy (approx. 10 per session) and final-year dietetics students (approx. 4 per session) will participate, alongside students drawn from other institutions and disciplines (e.g. nursing, occupational therapy, social work, speech language therapy).
UOC IPE Ward-Based Initiative
During 2018, a ward-based IPE initiative will be developed and piloted at Burwood Hospital. This will be based on the INTERact model already being implemented in Nelson and Timaru. Year 4 medicine, and final-year physiotherapy and dietetics students will participate while on their clinical placement at Burwood, a hospital specialising in older persons' health. Students will undertake the interprofessional learning on a general rehabilitation ward.
In the earlier years of health professional students’ learning on the Dunedin campus, IPE activities focus on:
- IPE exposure: Precursor activities to lay IPE foundations, e.g. intentional group work with group learning outcomes.
- IPE exposure/engagement: Activities with mixed/progressive aspects of exposure and engagement.
- IPE engagement: Activities with IPE learning objectives, action, assessment and outcomes, not in a clinical or workplace setting.
Foundation Years activities stimulated through the IPE Support Innovation Fund include:
- Economic Barriers to Healthcare IPE activity 2016 and 2017 (and ongoing): engagement activity for year 3 dentistry, oral health and pharmacy students, and MDiet year 1 dietetics students; aiming to raise IPE students’ awareness of the daily realities for people living in poverty and associated socio-economic constraints on healthcare access, delivery and outcomes.
- Working Together in Clinical Pathology IPE pilot 2018: engagement activity for year 4 dentistry, year 3 medical laboratory science, and year 2 oral health, students; focusing on healthcare team collaboration in the diagnosis and management of oral pathology.
The Division’s current flagship IPE activity in the foundation years, is the IPE Smoking Cessation module.
2017 saw the inaugural implementation of an IPE module for around 700 students in Year 3 Dentistry, Oral Health, Medicine, Pharmacy and Physiotherapy, and Year 1 Master of Dietetics, programmes.
The module engages students in ways of learning with, from and about each other, as they gain knowledge and understanding about managing smoking cessation in New Zealand, in a collaborative environment. It includes self-directed learning, facilitated tutorials, case-based group work, and group presentations.
Development and implementation of the module has been a collaborative exercise, with a lead-in-time of approximately one year before first implementation. Planning committee members and 40 tutors have been drawn from across the Health Sciences Division and participating programmes. Administrators across the Schools/Faculties/Departments have needed to coordinate timetabling and other systems to support the module delivery.
Formal evaluation has been undertaken to consolidate and improve the module for future implementation rounds and it is being delivered again in 2018.
In the later and/or final years of health professional students’ learning on the Dunedin campus, IPE activities focus on:
- IPE engagement: Activities with IPE learning objectives, action, assessment and outcomes, not in a clinical or workplace setting.
- IPE engagement/immersion: Activities with mixed/progressive aspects of engagement and immersion.
- IPE immersion: Collaborative IPE activities in a clinical or workplace setting.
Advanced Years activities stimulated through the IPE Support Innovation Fund include:
- Journey of a Prescription IPE pilot 2017: engagement activity for year 5 medical, and year 4 pharmacy, students; to provide a model for developing a shared understanding or roles within the prescriber-pharmacy system.
- Māra Rongoā / Māori Medicine Garden IPE pilot 2018: engagement-immersion activity involving medical, pharmacy and other students in the development of a traditional medicine garden at Te Kaika community hub in Caversham.
During 2018 opportunities will be developed for IPE simulation learning and – potentially – ward-based learning. The IPE Clinical Reasoning Pilot 2018 trialled interprofessional learning for students at the start of the first semester, as they transitioned from the foundation to the advanced years of their degree programmes.
IPE Clinical Reasoning Pilot 2018
In February 2018, an orientation IPE activity was piloted, involving Year 4 Advanced Learning in Medicine (80) students and Year 4/final-year physiotherapy (31) students. Physio students joined the Clinical Reasoning workshop which forms part of the ALM4 Clinical Skills Week at the start of Semester 1. The workshop engaged students in collaboratively analysing clinical cases, using the Think Aloud approach to surfacing the clinical reasoning thought process. Depending on student feedback and evaluation, the pilot may be repeated or expanded to include other disciplines in 2019.
In 2017, an engagement-immersion IPE activity was piloted around the care and treatment of oncology patients; plans are under way to implement the activity again in 2018. Twenty students (drawn from MDiet year 2, medicine year 6, radiation therapy year 3, physiotherapy year 4, and pharmacy intern) collectively engaged with each other in learning about IPE and the interprofessional aspects of clinical oncology management; working in teams to interview a patient; and engaging with the larger group to present their findings. In teams, students immersed themselves in a clinical assessment of an oncology patient and developed an interprofessional treatment plan.
The INTERact programme was developed and implemented in Timaru from 2015, through a collaboration between South Canterbury District Health Board and University of Otago staff.
The primary objectives of the programme are to:
- Facilitate collaborative practice between health professional students on clinical placement
- Encourage information-sharing and joint-decision-making
- Help students gain insight into the roles of different health professions
- Help students gain insight into the benefits of collaborative practice in patient care.
INTERact activities are scheduled into the clinical timetable of fourth-year medical and physiotherapy students, running over the course of three days during one week of their 4–6 week placement in Timaru. Learning opportunities are based on following 1–2 patients that require medical and physiotherapy input, where students are immersed in the usual activities of the clinical team in the medical ward (e.g. ward round, multidisciplinary team meeting, physiotherapy interventions).
In addition, students are supported in their learning by provision of a booklet that guides focus and reflection on practice in the context of their clinical experiences. On the final day of the INTERact programme, clinical staff from physiotherapy and medical disciplines engage the students in a guided debrief and reflection session on management of the patient(s), and their respective roles in the context of the clinical team.
During 2017, the INTERact programme was piloted in Nelson with Trainee Interns and final-year physiotherapy students. The programme is being run again in 2018, also involving final-year nursing and occupational therapy students, on clinical placement from Nelson-Marlborough Institute of Technology and Otago Polytechnic, respectively.
To date, INTERact has demonstrated that students gain new insights and perspectives, and see value in engaging with health professional students from more disciplines in this activity. There is potential to replicate the programme at other clinical placement sites. During 2018-19, comprehensive evaluation of the INTERact programme will be undertaken, to ensure the resilience of the model at its current, and potential future, sites.
In Southland, one-day interdisciplinary training sessions, featuring simulated patient assessments, are delivered several times each year to improve communication and teamwork between students from medicine, nursing and other disciplines.
Sessions began in 2015 for Trainee Interns (TIs) on clinical rotation in Southland Hospital, and Southern Institute of Technology (SIT) third-year Bachelor of Nursing and enrolled nursing students. About eight conjoint sessions a year were held, involving approximately 30 TIs and 92 nursing students. The sessions were developed and are supported by a team drawn from SIT, Southland Hospital and the Dunedin School of Medicine.
Since 2016, final-year Masters of Dietetics students on clinical placement in Southland have been involved in the training, and Physiotherapy students since 2017. It is also intended to expand the programme through related research activities.
A detailed account of the programme is available here (PDF 274 KB).
The Longitudinal Interprofessional Study: Ben Darlow, Eileen McKinlay, Lesley Gray, Peter Gallagher, Christine Wilson, and Sue Pullon
The LIP Study is exploring health professionals' attitudes and skills related to collaborative team work and how these change over their final year of training and first three years of professional practice. It includes practitioners from the disciplines of Dentistry, Dietetics, Medicine, Nursing, Occupational Therapy, Pharmacy, and Physiotherapy. In 2017, the study was in its third year.