Student outcomes, learning environment, quality of care and patient safety at an interprofessional training ward
Sammanfattning: The overall aim was to enhance knowledge on students’ collaborative learning and patient safety of interprofessional education (IPE) at an interprofessional training ward (IPTW). Medical, nurse, physiotherapy and occupational therapy students and patients at the IPTW were studied. STUDENTS. Study I: A prospective quantitative questionnaire study on 616 IPTW students evaluated whether students perceived they had achieved interprofessional competence. Anonymous pre and post course questionnaires were used. The response rate was 96 %. All four student groups perceived improved knowledge of the other three professions (p =0.000000). They assessed the course had contributed to the understanding of the importance of communication and teamwork to patient care (effect size 1.0; p =0.00002), where medical students had the greatest gain (p = 0.00093). All student groups perceived an increased clarity of their own professional role (p = 0.00003), where occupational therapy students had the greatest gain (p = 0.000014). Study II: A qualitative content analysis on free text answers of 333 questionnaires explored IPTW students’ perspectives on learning environment and on own development. Two themes emerged. An enriching learning environment – a safe place with space included authentic and relevant patients, well composed and functioning student teams, competent and supportive supervisors and adjusted ward structure to support learning. Awareness of own development with faith in the future – from chaos to clarity included personal, professional and interprofessional development towards a comprehensive view of practice. PATIENTS. Study III: A quantitative questionnaire study on 102 patients treated by student teams at the IPTW compared to 85 patients treated at a regular ward. Patients’ perceptions of collaborative and communicative aspects of care were assessed. The response rate was 82 % and 73 %. IPTW patients felt more involved in the decisions regarding their treatment as compared to controls (p = 0.006). They were also more satisfied that their home situation had been taken into account when preparing for discharge (p = 0.0002) as well as with given information regarding need of help at home (p = 0.003). Finally, IPTW patients felt better informed (p = 0.02). Study IV: A retrospective registry study on operated orthopaedic patients’ safety, by comparing readmission rates and mortality between patients treated by student teams at the IPTW compared to patients treated in usual care. Included cohort consisted of 5766 patients with 6274 admissions. No significant differences in either 30 or 90- day readmission rates or in one-year mortality were found. Patients with student team exposure every day of their hospital stay had an estimate of 0.89 for readmission within 90 days and of 0.68 for one-year mortality, i.e. a tendency to a lower risk. CONCLUSIONS. Active patient based learning by working together in a real ward context is effective to increase interprofessional competence. When the community of practice at an IPTW provides a safe, supportive and permissive learning environment it enables students to develop fully. With embodied understanding of practice, students obtain faith in one self as future healthcare professionals interacting with others. If the learning environment is impaired, however, students’ development could be halted. Patients treated at an IPTW perceive a greater quality of care in aspects of communication and collaboration as compared to usual care. A more structured interprofessional team-based care may be beneficial even in usual care. We found no increased risk for orthopaedic patients - as concerns readmissions and mortality – when exposed to student teams at an IPTW compared to usual care. The results should reassure further implementation of IPE in authentic patient based contexts.
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